Patient cap as a psych intern

[toothless rufus]

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Just wondering what the usual patient cap is for a psych intern on inpatient, consult and admitting from the ER. And what happens to this cap if you are on call as an intern covering all of those services simultaneously.

 

[nitemagi]

Just wondering what the usual patient cap is for a psych intern on inpatient, consult and admitting from the ER. And what happens to this cap if you are on call as an intern covering all of those services simultaneously.

There is no average. This will depend on the program. My old program had no cap.

 

[Doctor Bagel]

On inpatient units, we're limited by beds, so the cap is 8 at the VA and 7 at the university unit (10 if you're down a resident for whatever reason). No real cap on admissions during days on inpatient units aside from protection from the total patient caps -- when you can only have 7 patients, it's unlikely you'll do more than 3 admissions (which in itself would be rare) on a normal day.

On call, there's also no official cap for admits/consults. The oncall person is responsible for both consults and admission at whatever site they're covering (VA versus university). The limited beds in each unit gives some protection. There's no protection for consults, though, but that usually doesn't go overboard, especially since we're not the primary psych people in the EDs (SW + ED docs decide to consult us after evaluating pts).

We do have a backup system where we're technically supposed to call backup if we have 3 people waiting to see us at any one time. It's not heavily utilized, though, for lots of good and bad reasons.

So long answer -- no cap, but things normally don't get out of control.

 

[nitemagi]

The truth is that you should just expect a worse case scenario, which is that you're up all night. That's it. You can only do as much work as you can do, and whatever's left may have to be done by whoever comes on in the morning.

 

[Doctor Bagel]

The truth is that you should just expect a worse case scenario, which is that you're up all night. That's it. You can only do as much work as you can do, and whatever's left may have to be done by whoever comes on in the morning.

Interesting. We have a culture of not leaving anything left over for people in the morning. That's basically when you're for sure supposed to call back up. It generally works out, though, and being up all night working on call is more rare than not.

 

[nitemagi]

Interesting. We have a culture of not leaving anything left over for people in the morning. That's basically when you're for sure supposed to call back up. It generally works out, though, and being up all night working on call is more rare than not.

Sure. That's the culture in all of residencies, same as not wanting to use sick days so not to burden others. But if you have 12 ED consults and 4 admissions in a night shift, chances are you're only going to be able to do so much, that you could work all the way through the night and do as much as you can do, and that's it. What's leftover is leftover. Therefore there's a built-in cap in any call-night -- there's only so much work that can be done in X hours.

 

[Doctor Bagel]

Sure. That's the culture in all of residencies, same as not wanting to use sick days so not to burden others. But if you have 12 ED consults and 4 admissions in a night shift, chances are you're only going to be able to do so much, that you could work all the way through the night and do as much as you can do, and that's it. What's leftover is leftover. Therefore there's a built-in cap in any call-night -- there's only so much work that can be done in X hours.

You're totally right. Did people get mad at your for that or was it just understood? We've been told that it's absolutely 100% not OK to sign off work to the day shift people, and fortunately it usually doesn't come up.

 

[Sneezing]

Sure. That's the culture in all of residencies, same as not wanting to use sick days so not to burden others. But if you have 12 ED consults and 4 admissions in a night shift, chances are you're only going to be able to do so much, that you could work all the way through the night and do as much as you can do, and that's it. What's leftover is leftover. Therefore there's a built-in cap in any call-night -- there's only so much work that can be done in X hours.

Agree. Our place you always assume you will be awake all night. I've had to sign out floor consults to oncoming residents in the morning on weeknights or weekends. There's only so much work that can be done X hours. Furthermore, you could see more but then you risk having poorly quality interviews/notes, and at some point you have to draw the line at what's minimal vs just plain unacceptable.

 

[nitemagi]

You're totally right. Did people get mad at your for that or was it just understood? We've been told that it's absolutely 100% not OK to sign off work to the day shift people, and fortunately it usually doesn't come up.

People understood if you were swamped with heavy numbers. As you get more efficient, it become possible to do every evaluation cursorily, do the orders, even the consults, but things like H&P's may get deferred.