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Schedule Structure

Discussion in 'Emergency Medicine' started by USCDiver, Dec 6, 2005.

  1. USCDiver

    USCDiver Percocet-R-US
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    At my residency, we are working on changing our coverage from 12 hour shift to something shorter like 9's or 10's or some combination. I was wondering which shift structures you guys have seen or worked with that have worked well and don't use all 12 hour shifts (one per day max). Our department is about 53,000 visits/year and we have 12 EM residents and 2 EM/IM residents per class, so similar departments would be most helpful.

    Thanks

    Diver
     
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  3. kungfufishing

    kungfufishing Senior Member
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    Id vote for 9s with the last hour exclusively for tidying up if you could generate sufficient coverage. Having said that, Im on a 12 hr schedule and like it and the days off it affords.
     
  4. GeneralVeers

    GeneralVeers Globus Hystericus
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    I love the 12 hour shifts, as the days off are great. It's true that 12 hour shifts are exhausting (especially at county facilities) but you have a lot of time to spend with friends and family. I remember doing 16-20 9 hour shifts during my med school rotations, and I enjoyed that a lot less. When I interviewed at Beaumont in Michigan, all the residents were complaining because they had changed over from 12 hour to 9 hour shifts.
     
  5. USCDiver

    USCDiver Percocet-R-US
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    Let me clarify my question. We are changing to something less than 12 hour shifts. That much has already been decided by the Powers that Be. The simple overlapping 9s won't work for us, we'd end up not having enough coverage without working like 27 shifts a month or some such. So, unfortunately we're looking for something more complicated like overlapping 9s, plus some 9 hour swings or something. Anyway, if you guys can be real specific about what schedules worked, that would be greatly appreciated. Instead of

    "we worked ten 9-hour shifts a month at In-and-Out"

    say

    "We had shifts from 7-4, 3-12, and 11-8 and we had 4 residents come in for each shift and we were partying like animals every night with all the wellness we had discovered within ourselves"
     
  6. anonymousEM

    anonymousEM Senior Member
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    we have a much bigger program and about twice the volume, but I think that some of our info may be comparable...How do you currently staff your areas? How many residents work a day and how many from each class are in the ED each month? IF I recall correctly from my interview at ECU you have basically one major area with your resus bays on one side and some minor care areas in the back.
     
  7. NinerNiner999

    NinerNiner999 Senior Member
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    Diver - this may not be what you are looking for, but we have a mixed 8/12 hour schedule (8's Tuesday through Friday, 12's over the weekends and mondays). It works our pretty well...
     
  8. USCDiver

    USCDiver Percocet-R-US
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    Actually, Niner, that sounds like exactly what me may have to do... I'll probably propose some sort of variation on that theme, likely making Tuesday our other '12hour' day because it's our conference day (7a-12n) and it seems pointless to have someone working the 7a-4p shift that day. Anyway, I'd like to see what you all are doing up there.

    Anonymous, we have renovated in the last 2 years. We have a 22bed minor injury area and a 36bed acute patient area. Both are staffed with 2 residents (one senior and one intern) during both 7a-7p and 7p-7a (4 for each shift). In addition there are 2 residents (seniors) that work a 12n-12m swing shift. So a total of 10 residents per day minimum. Off-service rotators are thrown in at random as extras and there will occasionally be an extra intern or senior on one of the 7-7 shifts for extra coverage over weekends, holidays or whatever. We're working 15-19 shifts per month depending on year.
     
  9. NinerNiner999

    NinerNiner999 Senior Member
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    No problem. The bonus of our schedule is our "princess shift," where we work 11a-3pm on conference Friday. PM me your email...
     
  10. roja

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    As seniors we work 8's M-F and 12's on Sat/Sun and holidays. Works out awesome.

    8's are 7-3, 3-11, 10-7.

    Our chiefs keep track of hours/month and weekend/month.

    It is loved by all. I would be loathe to ever return to 12's and I was a big advocate of 12's. But life is SO much better on 8's.

    Most residents work 175hours/month and have 2 weekends a month.
     
  11. DrQuinn

    DrQuinn My name is Neo
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    USC-
    PM me your email address and I will send you one of our schedules so you can see. We unfortunately work a mix of 12s and 10s (not in your area) but we are a small program with high volume (80k, 18 residents).

    Q
     
  12. docB

    docB Chronically painful
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    Temple used to work 8s and they built the schedule to follow circadian. 2 days (7-3) then 2 swings (3-11) then 2 nights (11-7). With some days off between groups of 6. They were working ~20 month but you are much more human the whole time instead of being a zombie until the end of your stretch.
     
  13. USCDiver

    USCDiver Percocet-R-US
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    Roja, what are the other residents doing? All 12s?

    Quinn, done

    docB, how many residents were working each shift? we have to have extra coverage from 10am-2am most days
     
  14. roja

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    Yes, first and second years do 12's. (7-7's) with the 11-11's for interns at our very busy hosptial. Peds shifts are either 9-9,11-11 or 7p-7a (interns and second years)

    I would be happy to send you a scedule. We have 14 residents in each class. We functionat two hospitals (essentially one connected by a jitney) with a combined census of about 130K-140K/year.

    (our interns work 18 12's/28 days and our second years work 16/17 12's/28 days)

    There has been talk of moving to 8's for second years but I am not sure what is goign on with that.

    (We have a significant amount of elective time and peds so...)

    Every year people ask if we want to shift to a block system (as described above) but every year we veto it. We like being able to request off days for weddings, etc.
    And thankfully, our pd listens to us
     
  15. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD
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    We generally follow the overlapping 9s concept with some extra swings built in. Seniors 6a-3, 2-11, 10-7a...Juniors 7a-4, 3-12a, 11-8a...Interns 8a-5, 4-1a, 12-9a. We then have extra "swings" that are sometimes filled 10a-7, 1-11, 3-12a, 5-2a, 8-5a. So a skeleton crew is 9 shifts a day, a fully-staffed crew is 14 shifts/day. We all really like it, especially since with the overlapping shifts we are able to stop picking up new patients about 7 1/2 hours into our shifts.
     
  16. USCDiver

    USCDiver Percocet-R-US
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    Desperado, how many residents are in your program and how many shifts are each class working?

    roja, I'll PM you my email address, if you wouldn't mind forwarding me a copy of y'all's schedule.
     
  17. docB

    docB Chronically painful
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    I think it was 1 senior, and 2-3 PGY1 and 2s. They had ~7 residents per class and the PGY 1 and 2 slots were augmented by rotating off service residents.
     
  18. tonem

    tonem Senior Member
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    We switched to 10 hour shifts my intern year...everyone was surprised because the former party line was that it would never happen.

    We do 7a-5p, 4p-2a, and 10p-8a in that order (20 shifts month)....Four shifts on then two days off...the last day of the 7a-5p we fly overnight 2nd and 3rd years. The number of residents and patient volume is similar to yours.

    Off service residents and interns have a slightly different schedule but I'm not sure how it works but it overlaps nicely so that you can start cleaning up an hour before your shift ends...
     
  19. roja

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    Sent you an email with 3 4 week scedules.
     
  20. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD
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    11 per year, interns work 22, juniors 21, and seniors work 20 9-hour shifts per month (not 28 day period)
     
  21. GeneralVeers

    GeneralVeers Globus Hystericus
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    Ouch. The thought of actually WORKING the majority of days in a month is repugnant.
     
  22. ERMudPhud

    ERMudPhud Back for a visit
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    We did 2 7-3 shifts then 2 3-11's then 2 11-7's (overnight) followed by two days off. We had at least two and whenever possible 3 residents in the ED at all times. One year we had a surplus of residents and added a 10 hour afternoon/evening shift to the schedule as well. Although these were only 8 hour shifts we had an unwritten but pretty firmly honored rule that you would come 1/2 hour early and leave 1/2 hour-hour late from your shift so that signout wasn't so painful. There has been plenty of debate in the past about the cut and run vs stay and play philosophy of signout but that extended overlap worked for us. That made each shift really about 9-9.5 hours.

    I think the big difference between these shorter shifts and the 12(+signout) hour shifts which I've also done is that they still gave you time to do something else with your day. After a 7-3 (especially the 2nd one) you could go spend the afternoon outside and then go out in the evening because you knew you weren't coming in until noon. Before a 3-11 you could also have a full day of fun knowing that you would be at work at 3 and in bed by 1 am. Best, after your 2nd 3-11 you could get a good nights sleep, go skiing all day, take a nap in the evening and still go to work.

    With 12 hour shifts all I wanted to do was eat, sleep, and then suck it up to do it all over again.
     
  23. USCDiver

    USCDiver Percocet-R-US
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    I'm intrigued by your ideas, I'd like to subscribe to your newsletter [/homer]

    How many from each class were in the ED in a particular month? We have PGY3 x 7, PGY2 x 4 and PGY1 x 4 minimum so we have to cover with the minimum before we start adding extras. How do you decide which days to fill the 'swings'? Do you just fill them when you have extra people to work or are there particular days that need extra coverage?

    Diver
     
  24. Seaglass

    Seaglass Quantum Member
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    We have a department with about 73k visits a year, 17k of which are peds. The adult ED is staffed every day by an ED2, ED3, and a mix of off service and ED interns, about 7-8 a month.

    Our schedule is ED 2s and 3s do 8's during the week and 12's from 7A saturday until 7A monday. Otherwise it's 7-3, 3-11, 11-7.

    All interns do 8's all the time. They do 8-4, 4-12, 12-8A, and swing shifts of 10-6 and 6-2A. At any given time there are 2-3 interns in the ED.

    We have classes of 10 of which ~6-7 ED2s and ~8-9 ED3s are assigned to the ED any given month. We end up doing about 20-21 shifts a month as upper levels, and interns do 22-23. We like our schedules a lot.
     
  25. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD
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    I don't actually make the schedule, so I can't really say how you decide what days to put the swings on and what days not to...its really up to the scheduler. But we try to fill the 10a-7 swing first, then the next most important one is the 5-2a. The other two, honestly, are usually off-service interns. I think we have PGY1 X 5 +1-3 offservice interns, PGY2 7, and PGY3 8 or so. Our PGY1s and PGY2s also cover the fast track at times, but that just makes things more complicated. It is true what someone said earlier, when you're only working 9s (and you really leave at 9 hours) you still have an evening or a morning to go do something, so it isn't quite as painful to work 20/month.
     
  26. pinbor1

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    Hey USC diver this is how we do it. We have 12 residents a year (they are transitioning to 13/yr) and 2 IM/EM a year. We cover 3 hospitals with a census of ~50,000 ~43,000 and 40,000

    As seniors we work the following shifts, which I will include below for you

    UIH:
    shifts for seniors 18 for a full complement. -4shifts for vacations -2 for administrative duties (adm chief), -2 shifts for if you are educational chief for the month.

    shifts are 9a-7p, 12p-10p, and 7p-5a
    interns work 7a-7p or 7p-7a (this includes off services) typically 12-15shifts
    Students work 8hr shifts which coincide with attending shifts

    Mercy
    shifts are 8a-6p, 2p-12a, 8p-6a
    interns work 10a-8p and 6p-4a for a total of 18 shifts. Usually you only have one working
    off service and students work 7a-3p, 3p-11p, 11p-7a they work 14shifts

    Illinois Masonic
    shifts are 9a-7p, 2p-12a, and 7p-5a
    students, interns, and off service work 12hours shifts 7a-7p or 7p-7a

    Hope this helps, if you have questions feel free to ask

    pinbor1
     
  27. pinbor1

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    if you want a sample schedule send me your e-mail
     

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