Post sample PL-1 ward schedules

[oldbearprofessor]

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I think it might be helpful and of interest for people to post what their program (adding a bit of anonymity if desired) are planning or considering for a typical month ward schedule for next year for PL-1s. I'm not the formatting cop, but try to indicate what a full month schedule would look like for both the day group and the night floats. Lets see what type of ideas we can generate or evaluate here. I'd stay away from ER, ICU and outpatient schedules and focus on general ward scheduling involving day and night teams. How will these be backed up by PL-2/PL-3s during the day and at night?

 

[Sweet Tea]

So here's the schedule for one of our interns this month who is on the general peds wards. Our ward team has already adopted the "nothing longer than 16 hours" rule for interns for the wards, and now we're working on expanding it to the nursery and NICU rotations so that we're ready on July 1 for new regulations.

Friday, 10/1: Day ward intern 6a-done (3 other interns on team, 1 senior for team)
Sat 10/2: Day Intern 6a-6p (only intern for the team, 1 senior in house for all admissions)
Sun 10/3: Day Intern 6a-6p (ditto coverage)
Mon 10/4-Fri 10/8: Day intern 6a-done (see Friday's coverage)
Sat 10/9: off
Sun 10/10-Fri 10/15: Night Float 6p-6a, w/1 other senior on the team
Sat 10/16-Sun 10/17: off
Mon 10/18-Friday 10/22: Day Ward Intern (see previous)
Sat 10/23-10/24: off
Mon 10/25-29: Day Ward Intern
Sat 10/30: Night float 6p-6a
Sun 10/31: rounds post-call

There are 4 days completely off, and 1 day of post-night float rounding on the wards. Rounds usually begin at 7 and the attendings are really good about rounding on the night float's patients first so it is highly possible to get your work done within 16 hours.

The day time ward schedule also incorporates continuity clinic 1 afternoon/week, and there's a distribution of "late stays"...the person who stays late to help with admissions. Usually 1-2x/week.

 

[generic]

I'm so confused.

And what is the upper level's schedule?

What time does "done" usually end up being?

Do interns ever forget to show up/show up at the wrong time because their schedule is so bizarre?

I'm afraid for next year.

 

[Sweet Tea]

No, interns never forget to show up on time, because they know when it's their week of night float and they show up at 6pm, and when it's not night float they're there at 6am. You know which one you're on. 😉

"Done" varies. 1 day a week you're in continuity clinic in the afternoon, and you'll be out sometime whenever that's done, usually between 4-5. 1-2 days you'll be late stay, and then you're there until the night float person comes in at 6pm. If you're not in clinic and you're not late stay, you leave when you're done. This varies by person. If you're slow, you sign out at 6. If you're not slow, you sign out at 2p.

There is a day senior who works 7a-6p, and a night senior who is on 6p-7a. During the week there are 2 seniors on days and 2 seniors on nights (1 for each general ward team), on the weekend there is 1 senior working these hours covering all of the ward teams.

All in all, it's working out really well. I've been impressed with the transition.

 

[runnergirl85]

i am a 4th year but when my classmates and i did sub-is there were quite a few plans that were being tried:

1) day team 7a-7p (3 interns, 2 srs/team). night team 7p-7a (1 intern, 1 sr split b/w two teams). everyone gets 4 days off a month but they come randomly. everyone was unhappy - no chance of ever leaving early even on slow days, never home for dinner (ever).

2) day team 7a-7p. night team 7p-7a. same distribution as option #1. However, of the 3 interns on days, 1 stayed til 7 and the others signed out early and went home when work was done. benefits: now everyone isn't staying all day. Drawbacks: signing out ALL THE TIME. early in the morning, twice in the afternoon, before leaving...ended up spending hours signing out and less time doing work. so many patient handoffs can lead to mistakes.

3) newest rendition: day team 6:30AM-5:30PM (3 interns, 2 seniors). Night team 5:30 PM-6:30 AM. Everyone was happy to add time to work a longer shift on nights when it meant they got out of all of their days earlier. fewer handoffs, people were happier.

For all three plans, the seniors had slightly different hours but i'm not sure what they were. one senior was long and one short every day. Night team was 1 week/month followed by staying through rounds on Friday and then a golden weekend. The other days off per month were randomly distributed. Worst parts of this: sometimes you go a REALLY long time without a day off. also, you are NEVER THERE to present the patients you admitted overnight. It was a huge bummer to work up a patient and do a great job and then never feel involved with the care. As a day team member, your patients were always being redistributed (someone is pre-nights, someone is post-nights, someone has clinic, frequently 1 person is covering the whole team). You might sign out after discharging a bunch of people one night and come in to find that you have a whole set of people from last night that you DON'T KNOW AT ALL. as an AI, i once came in on a thursday to find that i was covering 7 brand new patients. reading other people's notes on rounds is not a fun way to manage patients. i missed the old way that you worked hard overnight and knew your patients well since admission.

The best solution i have heard so far on an interview is as follows, but can only be accommodated by larger programs:
4) q4 - just like before. 4 interns per team, everyone is q4, which results in one golden weekend and one black weekend per month. However - the day you are "on call," you come in at 6pm. so you get the day off of your call, you stay 16 hours (til noon - through rounds). This way you admit patients overnight and you are able to stay and present to the team and do the work for them. Then you go home at noon, and you're not even as tired as you would have been after a 30-hr call. The interns are therefore q4 to provide continuity during the day. Seniors are night/day float, so they provide continuity during the night (at any given point of the day, SOMEONE knows all the patients). The biggest drawback of this system is of course, who will cover the patients when the pre-call person is gone all day? This particular program decided to add a 5th intern to each team as a "day float" person. THey have a new set of patients every day - the patients of the pre-call person. But for them, its a no-call rotation.

no perfect way to do it. but then again the old system wasn't perfect either. i will be an intern in july so i am hoping someone figures it out!