Night float--weigh in here!

[blanche]

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So I'm curious to hear others' opinions on programs that have gone to night float v. traditional call. I'm not sure which I do (or will) prefer, but I think both have attributes and drawbacks. This may have been addressed before, but I think it's a fluid topic and many programs are continuing to adjust things since the RRC requirements were put into place a few yrs ago. I know some programs have 'night float' that consists of a resident who stays late, but I'm specifically interested in true night float that takes the place of q4/q-whatever call.

What what I've seen/heard/been told:

NF Pros-you're well rested when you're there at night (in theory), more 'humane' periods of time to work (ie 12 v 30 hour shifts), hey! i can make it to the bank/laundry/dentist/etc when they are open for business hours.

NF Cons-continuity of care not so good, cross covering more pts, hard for those with families/children, vampire-like existance when you're on nights (you'll be asleep when SOs/kids/friends/families are awake), education may suffer (miss conferences, teaching, etc), you lose the 'post call day', which can be nice in some ways

I'm especially curious as to what current residents have to say about this. I've done night float and trad call as a med student, but of course that probably has little similarity to what life will be like as a resident.....
Thanks!!

 

[14022]

I love our night float system. This is how it works.

Two second year residents split a two week block of night float and split the 14 shifts among them. Night float comes in at 8 pm. At our program, heme-onc is pretty busy so they have a separate service from all of the other speialty services and general peds service. From 8pm-7am, the night float residebt covers heme-onc cross-cover and new heme-onc admissions. At 12 am, they additionally become the on call resident and take all admissions that come in from 12am-5am. From 5 am-7 am the ER holds all admissions down in the ER. The night float resident then hands off the overnight admissions to the next days on call intern. It is nice for that intern since the H&P and all of the orders are done and now they just have to coordinate their care.

So basically the on-call interns and senior stop admitting at 12 am when the night float resident starts admitting all patients from the ER. Therefore, after 12 am, the on call resident/interns can finish all their work from the day (H&P's, f/u labs, orders, etc.) without having to worry about new admits. They still stay in house to cross-cover all the patients on the floors but they have no new admits. This allows the on call team to get at least an hour or two of sleep a night. Most times, you get closer to 3 or 4 hours of sleep a night. The nurses on the floor are great about paging you around midnight to touch base about their worrisome patients and ask specifically what they need to call u about and what can they do temporarily before calling you. So I do not get calls in the middle of the night about a patient with a fever needing tylenol unless they are immunosuppressed or they do not look well or some other complicating circumstance.

I can't tell you how great night float is for me. Its great because even if you get rocked during the day and evening you know that there is a point in the night (ie, 12 am) when the admits will stop and you will have a few hours to get caught up. Plus, when you get called in the middle of the night, it is on a patient u already know so u dont have to work up a new patient in your middle of the night daze. Also, most of the residents I have talked to do not mind being the night float resident at all. They may not like the change in sleeping scheudle for the 2 weeks (working night and sleeping in the day) but they say the working part is fine. Well even if you dont like being the night float resident, it is only a few weeks over the entire three years versus the several months of a better experience on the wards over the three years.

So I would strongly recommend taking a serious look at the programs with a system like this because it makes for a much better on call experience, at least for me and my co-residents it does.

 

[Stitch]

I think more and more programs are moving towards a night float, in part because of work hour restrictions. My program has some night float shifts and some regular call. Those on the night float do say it's pretty tough keeping the night schedule and it can also be tough because you tend to be covering a lot of patients. But it's a much shorter shift and I think you're making better decisions than you would after 24 hours with no sleep on a rough night.

In all, I'd like to see more night floats out there. It's better for patient care in terms of errors, but you have to have a good sign out system and good communication between the on coming and leaving teams. Probably the reason people haven't done it completely has to do with staffing and a certain machismo that says 'this is how I trained, so you should too.'