Night float systems

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kiwi149

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CA0 soon to be CA1 here. Our PD just told us that we are likely going to a night float system sometime within the next few months, and he wants our input. We have 6 residents per class, and we currently have a rotating junior/senior call system in place. The main push for this is to try and get more time in the OR for subspecialty months. Any residents out there have a night float system, and if so, what are some of the specifics? Likes dislikes? Thanks.
 
Loved it as an intern....except of course those weeks when I was on night float....Residency didn't have it.
If I were starting residency tomorrow, I would vote "NO". But that vote is based on having no shortage of depth and breadth of cases when I trained. It is simply a lifestyle preference.

If I was concerned about subspecialty experience, I would suck it up and vote yes. You only do one residency. Make the most of it. Some programs are a little thin on some subspecialties.
 
We have a night float system and I like it enough to volunteer for extra weeks of it.

A senior resident (CA-3 or CA-2 who has done 2 months of hearts) is assigned to come in 7 PM - 7 AM Mon-Fri, usually for 2 weeks in a row. 2 other call residents, usually juniors, are also present on conventional call shifts, with one covering the Main OR and one covering OB. Sometimes an additional resident is on call in the SICU. The NF resident often functions like an attending, supervising case starts, giving breaks, and accompanying the junior call resident (or ICU resident if present) to codes, traumas, etc. During high-volume nights, the night float resident also has his own cases. Should there be a liver transplant, the night float resident is specifically assigned to that as a priority.
 
The idea of a night float system in my program was put out when I was a resident, I don't know if it ever happened or not. Our call system (M-F) was a come in at 4 pm, go home post call. The night float system would put one more resident in the OR every day, instead of missing the pre call and the post call resident each day, you'd just be missing the night float each day. My program was a big (20+ residents per class), good case volume. We weren't missing numbers. We liked the old system, we would frequently bookend our vacations with post call (following a Thursday night call) and a pre call day (the Monday afterwards) and have almost 10 days off.

On the flip side, our weekend calls were 24 hours. At our trauma hospital it was not uncommon to be in a room the whole time, save meals and pee breaks. We were split on the idea of some sort of weekend night float to break up the long weekend calls.

So, it depends, what system you'd be giving up, after hours case load, weaknesses in case volume, opportunities for leadership on call, etc.
 
The idea of a night float system in my program was put out when I was a resident, I don't know if it ever happened or not. Our call system (M-F) was a come in at 4 pm, go home post call. The night float system would put one more resident in the OR every day, instead of missing the pre call and the post call resident each day, you'd just be missing the night float each day. My program was a big (20+ residents per class), good case volume. We weren't missing numbers. We liked the old system, we would frequently bookend our vacations with post call (following a Thursday night call) and a pre call day (the Monday afterwards) and have almost 10 days off.

On the flip side, our weekend calls were 24 hours. At our trauma hospital it was not uncommon to be in a room the whole time, save meals and pee breaks. We were split on the idea of some sort of weekend night float to break up the long weekend calls.

So, it depends, what system you'd be giving up, after hours case load, weaknesses in case volume, opportunities for leadership on call, etc.

There is a night float system (at the county hospital and the university medical center) now at the large university based program from which you are alumni 😉. I think it is pretty much universally liked by the residents. It is really not that different than it used to be; same number of calls per month (roughly) and they are still 4p-7a or so. The only difference is they are clustered together in 3 or 4 night stretches, with 2-3 post call days usually sandwiched either with vacation (which is completely sweet) or a weekend (still awesome).

Example of a recent night float stretch I recently had:
Sa: 4p-7a
Su: 4p-7a
M: 4p-7a
T: 4p-7a
W: post
Thu: off
Fri: off
Sat: off
Sun: off
Mon-Sun: scheduled vacation

Pretty awesome.

At the trauma hospital, all of the calls (junior and senior resident) are 12h now. I can see pluses (not doing what could be a really, really busy 24h stretch) and minuses (more calls per month, often only 1 weekend entirely off the whole month).

Love our program.
 
There is a night float system (at the county hospital and the university medical center) now at the large university based program from which you are alumni 😉. I think it is pretty much universally liked by the residents. It is really not that different than it used to be; same number of calls per month (roughly) and they are still 4p-7a or so. The only difference is they are clustered together in 3 or 4 night stretches, with 2-3 post call days usually sandwiched either with vacation (which is completely sweet) or a weekend (still awesome).

Example of a recent night float stretch I recently had:
Sa: 4p-7a
Su: 4p-7a
M: 4p-7a
T: 4p-7a
W: post
Thu: off
Fri: off
Sat: off
Sun: off
Mon-Sun: scheduled vacation

Pretty awesome.

At the trauma hospital, all of the calls (junior and senior resident) are 12h now. I can see pluses (not doing what could be a really, really busy 24h stretch) and minuses (more calls per month, often only 1 weekend entirely off the whole month).

Love our program.

Not bad, better than what they were proposing a few years back. Like the blocked post call days. I figured the HMC call thing would come eventually. Did they work out a way to just do 2 12s over the same weekend?

Wish I had something like that now. Instead I have 14 days of home call this month and an overnight.
 
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Not bad, better than what they were proposing a few years back. Like the blocked post call days. I figured the HMC call thing would come eventually. Did they work out a way to just do 2 12s over the same weekend?

Yeah it usually ends up being something like one Sa/Sun 7a-7p or 7p-7a; two weekends that are a Fri night call and Sun 7a-7p; one weekend off. I can't imagine what a hectic OR1/OR2 24h shift at HMC must have been like. Pretty crazy.
 
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Yeah it usually ends up being something like one Sa/Sun 7a-7p or 7p-7a; two weekends that are a Fri night call and Sun 7a-7p; one weekend off. I can't imagine what a hectic OR1/OR2 24h shift at HMC must have been like. Pretty crazy.

Jake

The problem was that the cases at hour twenty or so were usually some exceedingly long and boring wash out or ORIF that made staying awake a challenge. At least on the 24+6 hour ICU calls things were happening. If not you could go lay down.


On the iPhone
 
There is a night float system (at the county hospital and the university medical center) now at the large university based program from which you are alumni 😉. I think it is pretty much universally liked by the residents. It is really not that different than it used to be; same number of calls per month (roughly) and they are still 4p-7a or so. The only difference is they are clustered together in 3 or 4 night stretches, with 2-3 post call days usually sandwiched either with vacation (which is completely sweet) or a weekend (still awesome).

Example of a recent night float stretch I recently had:
Sa: 4p-7a
Su: 4p-7a
M: 4p-7a
T: 4p-7a
W: post
Thu: off
Fri: off
Sat: off
Sun: off
Mon-Sun: scheduled vacation

Pretty awesome.

At the trauma hospital, all of the calls (junior and senior resident) are 12h now. I can see pluses (not doing what could be a really, really busy 24h stretch) and minuses (more calls per month, often only 1 weekend entirely off the whole month).

Love our program.

Looks pretty sweet.. isn't there some sort of rule that for time off between shifts? I thought it was ten hours or something...

drccw
 
Looks pretty sweet.. isn't there some sort of rule that for time off between shifts? I thought it was ten hours or something...

drccw

"should" have 10 hours between duty periods, "must" have 8 hours.

We are starting up a night float system at our main hospital in July. Three resident teams from Sat-Thu 5:30p-7a. The only 24-hour call shift will be on Fridays.
 
We went to nightfloat at our main hospital last summer. I cannot say that I like it. We used to have 24+hr (usually came in 0530-0600-ish, left 0700 after morning report) call every 5-7 nights (two residents), only ever had the two post-call residents out of the OR on any given day. With the new duty hours, we changed to a 1800-0700 nightfloat M-F (call attending arrives 1500), with 0600-0600 Sa/Su call. Some of the bad things about this are:

1) We don't have the overnight case volume to support it - Generally, the nightfloat team arrives, takes over some rooms, and finishes out the add-on cases, then the junior manages the Acute Pain Service as his primary responsibility (can be a massive headache, depending on which ward nurses are working), while the senior does preops and sleeps. Rarely do we have cases coming in the middle of the night, and the few that do are usually simple appys (80% of the time, nothing after 2200).

2) Being on nightfloat is a week out of the OR, and a week that you are not doing regular cases (some see this as a plus, though, as it can provide a break from the grind). Consequently, those on subspecialty months are not placed in the nightfloat pool (just weekend call, usually a Saturday).

3) Mondays are down four residents, rather than two (Sunday post-call pair, and the new nightfloat team)

4) People on PACU and Regional have to stay later. No more signing out to the call team at 1500-1600 and leaving, those residents now stay until the nightfloat comes on (sometimes the PACU resident will get released after 1700, if the call attending is actually willing to carry the pager for an hour).

5) NO POST CALL DAYS - With the old call schedule, we were generally guaranteed to have a couple of weekdays off each month to relax and take care of things at home (take the car to the shop, go to the post office, doctor's appointment, etc). With the nightfloat system, we get none, unless on nightfloat. But if you are on, and happen to get a case in the middle of the night (even a simple appy will ruin your night, as everyone is incredibly slow to get things rolling), it screws your week, as you never settle into a proper day/night rhythm, and have to come right back the following evening.

When I am at work, I want to work. If we were actually busy doing good cases throughout the night, I might feel different about nightfloat, but as it stands, I see it as an inefficient call system that interrupts my ability to do real/regular cases and sleep for a week.
 
The lack of flexability is what I see as a main issue. There would be no way to get a weekday off outside of taking vacation. If i have a dentist/doctor/vet visit for the dog, it would be alot more difficult to arrange. Overall work hours would end up increased as well, but this wouldn't be that big of a deal. Our nights consist of alot of OB and ORIFs, but maybe a STAT crani or something out of the ordinary every week or so.
 
The lack of flexability is what I see as a main issue. There would be no way to get a weekday off outside of taking vacation. If i have a dentist/doctor/vet visit for the dog, it would be alot more difficult to arrange. Overall work hours would end up increased as well, but this wouldn't be that big of a deal. Our nights consist of alot of OB and ORIFs, but maybe a STAT crani or something out of the ordinary every week or so.

In our nightfloat system (as detailed above), this is not an issue. You get the same number of postcall days as you would normally in a traditional call schedule, they are just all stacked consecutively after your nightlfoat stretch is over.
 
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