Night Float?

[sandbtwmytoes]

Hi-
My program is looking into changing to night float.
For those of you with night float--
--how do you like it
--how long are the night shifts
--how many do you do a year
--is there anything you would change

Thanks for the input!

 

[Faebinder]

Hi-
My program is looking into changing to night float.
For those of you with night float--
--how do you like it
--how long are the night shifts
--how many do you do a year
--is there anything you would change

Thanks for the input!

Life is so much more human with a night float....

 

[DOtobe]

I absolutely love night float.

To answer your other questions:
1. night shifts are from 8:30 pm-7:00 am Sunday thru Thursday.
2. In our intern year we do 4 weeks of night float and in our second and third year we do 2 weeks.
3. I wouldn't change anything - it's a great system and as a result the only overnight calls are Friday and Saturday nights. It's kind of rough getting used to working nights when you have been working during the day, but you adjust pretty quickly.

 

[Trisomy13]

Hi-
My program is looking into changing to night float.
For those of you with night float--
--how do you like it
--how long are the night shifts
--how many do you do a year
--is there anything you would change

Thanks for the input!

the IM night float at my hospital is 1 month at a time, team of two interns and a senior resident, 8p-8a, Sun-Fri, with only Saturday off. I think people only do 1 month per year but i might be wrong.

it's hard work... admitting patients while cross-covering the entire medicine service in addition to bone marrow unit and heme-onc, etc is not a simple task. there is little or no down time.

the plus side is the rest of your time on wards is mostly overnight call-free (except the occasional saturday when you are up to relieve night float).

my old hospital was overnight q5. this is more humane, although nobody really enjoys that month of nights. i know some places have sat and sunday off, and while that sounds good, then you have to take more call on your months not on night float... personally i'd rather bite the bullet for a month of nights sun-fri and have more golden weekends the rest of the year...

 

[gutonc]

Of our 4 inpatient rotations, 2 have night float and one more will probably have it next year. For the VA Wards it's 8p-8a, Sun-Thurs, 1 resident, 1 intern w/ X-cover and up to 6 or 8 admits (I forget the number) and you do it for 2 weeks. On our Univ. MICU service, there are 4 MICU teams and each one spends one of the weeks on nights, M-F, 7:30p-7a w/ the CCM fellows having night float as well. So as it stands now, the most you'll do is 2 weeks of wards NF and maybe 2 weeks of MICU nights. It's not easy but it sure makes the rest of your wards/unit months go much more smoothly. By next year all of our wards months will probably have NF and the PD would like to make it so that there is NF 7 days a week for all services.

The program I trained in managed to make that work, at least at the County hospital. They had 2 NF teams for each 2 week block. One of them worked 3 nights one week and 4 the next and then the schedule switched. Made NF a much more tolerable thing and meant that there were NO 24 hour ward shifts which was quite pleasant.

 

[highball]

At Virginia Mason in Seattle, surgery night float is 6pm-6am Sun-Thursday, there is a friday 6pm-6am, saturday 6am-6am and sunday 6am-6pm shift that are split evenly amongst the rest of the surgery interns on surgical rotations. you do 1 month a year of night float as an intern and 2 as a PGY-2. Great system!

 

[typhoonegator]

As someone who has experienced both a nightfloat and a traditional call system, I would like to make just a few comments.

As a prelim medicine intern at a pretty large hospital, I always felt a bit rushed on call days, particularly as the evening wore on, as we struggled to admit all the patients the ED dropped on us before our admitting cycle ended. So you sprint around at the end of your shift trying to tuck everyone in for the nightfloats, because you need to get home and get some sleep since you're going to be working a full day on your "post-call" day.

Now that I've gone on to my categorical neurology position, we have a traditional q4 overnight call schedule. It's at a big referral center in Boston, so you're super busy with admissions and cross-coverage for pretty much the whole night, but at the same time you never feel like you're rushing to get out of the hospital. You get to know your new admissions much better since you spent all night with them instead of passing them off to some nightfloat while you slept. Finally, there is something really pleasant about the post-call day, when you can cruise out of the hospital after lunch (hopefully).

I don't know if either system is inherently better, but I think it is worth noting that the traditional overnight call system does have at least a few benefits...

 

[Mumpu]

The problem with night float is that when you come back in the morning, you are handed a bunch of new patients to care for. No matter how good you are, you will never know a patient you took from someone as well as a patient you admitted yourself. To be handed 5 new patients at 7 am is like going to an underserved primary care clinic -- 500 problems, 10 minutes per patient, no time to think, look things up, figure out if night float actually made the right admitting diagnosis, etc.

 

[angel80]

I know of people who prefer night float, and those who prefer traditional call. Personally, I did both as a med student, and I ended up going with a program that does Q5 traditional call.

The pluses of night float are, as people mentioned, you only have to do overnight call on Fri and Sat. You get to go home and sleep in your bed every night. What I didn't like about night float is that when you are on call, you are in such a rush to finish up your work and get done at a decent time, so that you can get home and sleep, because you have to come in for a full day's work the next day. Many times, we wouldn't get done until after 10 pm, and by ACGME rules, you have to be gone for 10 hours before coming back to work, but there is no way you can show up for work at 8am the next morning. That's way too late. Also, I hated picking up admissions from night float in the morning and trying to learn about them all before rounds.

In my program, we take call as a team, and it builds a lot of commradery taking overnight call with your team. Some of my most memorable moments during residency so far have been messing/joking around with my colleagues in the middle of the night. Plus, if I'm able to get 3-4 hours of sleep (which is usually possible in my program), I can go home post-call, take an hour nap, and still have the rest of the day to enjoy. In my program, we have a day float team so that we can get out by noon post-call (they finish up any of our work that we were unable to get to).

 

[Mumpu]

That's true. I'm at a "malignant" program and I've only had two nights in the last 6 months where I did not get any sleep on call. 2-3 hours is the norm, and I've gotten up to 6.

 

[Hurricane]

Also, I hated picking up admissions from night float in the morning and trying to learn about them all before rounds.

It seems like there are about a zillion ways to do night float. Here the night float presents the new patients to the entire team at the beginning of rounds with the attending present, so there is no rush to try and learn the patients before rounds.

The problem with night float is that when you come back in the morning, you are handed a bunch of new patients to care for. No matter how good you are, you will never know a patient you took from someone as well as a patient you admitted yourself. To be handed 5 new patients at 7 am is like going to an underserved primary care clinic -- 500 problems, 10 minutes per patient, no time to think, look things up, figure out if night float actually made the right admitting diagnosis, etc.

Everybody says that, but the data doesn't support it. Shorter shifts = less medical errors, depsite the conventional wisdom that patient handoff is bad for the patients. It may be, but sleep deprivation is worse.

And what is with all you people getting sleep on call? I'm at a very non-malignant program, but it's super busy, and I rarely get an hour or two if that on call. Even with the night float, because we still have to do cross cover (they only do admissions) and it seems the admissions get bunched up right before the night float cut-off. (In constrast, where I went to med school, the night float did cross cover, and that was awesome.) Anyway, I can't wait until this, my last month of internal medicine, is over. Kudos to those of you who have chosen to do this for your career, because I sure as hell couldn't. 🙂

 

[Mumpu]

Just goes to show how accurate the "malignant" labels are.

 

[jennyboo]

I'm at a pgrm where as a PGY-1, I do 4 weeks of night float which involves cross-covering 50-80 floor patients which belong to the daytime ward teams. We split the four weeks into two 2-week blocks. Senior residents do the night admissions on night float and interns cover floors.

One frustration I have with the cross-coverage is that at our place, we don't get good continuity. Unfortunately, the primary teams are usually gone by the time you get the night float signouts at 7pm; they don't always tell you enough about the patients (and there's no way you can get really familiar with 80 patients anyway), you can get crappy signouts with no useful information at all. The signouts are passed from the primary team to the long-call team for 2 hours and then from long-call to night float. Which essentially means long-call can tell you absolutely nothing about the cross-cover signouts.

 

[gutonc]

This is a huge problem w/ cross-cover in general and not specific to NF systems. It never fails that the patients who the primary team spends 10 minutes signing out will be completely quiet overnight and the one that gets signed-out as "NTD, going home in the morning" will be the one you spend all night dealing with. I've been on both sides of the situation with that patient and it's taught me that as the one signing the patient out, I need to make one last swing through the ward and make sure that there really is "NTD" before finishing my sign-out. Checking in w/ the nurse taking care of that patient is useful as well. Many things that the day nurse (who has the good fortune of dealing w/ the primary team 90+% of the time) wouldn't bother to call about will undoubtedly result in a page shortly after RN shift change.

 

[Mumpu]

To quote a wise attending, "signout is sabotage."