The pros and cons of night float system

[USMELL]

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Okay I am coming from a school that does not have a night float system so I don't know how exactly it works. My question is:

1. Is it better to have a Night float system?

2. What does it mean when a program has a night float system but says "residents do not participate in the first year" Does that mean interns have no call or those that mean interns do Q4 night call, while senior residents get night float?

 

[IndyXRT]

Okay I am coming from a school that does not have a night float system so I don't know how exactly it works. My question is:

1. Is it better to have a Night float system?

2. What does it mean when a program has a night float system but says "residents do not participate in the first year" Does that mean interns have no call or those that mean interns do Q4 night call, while senior residents get night float?

The night float system has its plusses and minuses (the major minus being difficulty with hand-offs). I only did a preliminary medicine year, but my institution had night float for 2nd year residents and up. The interns did traditional Q4 or Q5 call. I never personally participated in the night float, but I can tell you that the Q4/Q5 call is not fun. It was nice to have well rested residents to consult, but it was tough to be so sleep deprived myself. I think I would have liked working in the night float system better.

 

[Law2Doc]

Okay I am coming from a school that does not have a night float system so I don't know how exactly it works. My question is:

1. Is it better to have a Night float system?

2. What does it mean when a program has a night float system but says "residents do not participate in the first year" Does that mean interns have no call or those that mean interns do Q4 night call, while senior residents get night float?

Pro -- you don't have to stay overnight at the hospital every third or fourth night.
Pro -- residencies don't run afoul of the 80 hour work week limitations.
Con -- you may have to take a turn as night float and sleep during the day and stay overnight at the hospital every night.

 

[USMELL]

so residents do not participate in first year, means it will be the traditional q4/q5 schedule?

 

[smq123]

1. Is it better to have a Night float system?

That depends on your point of view. Most people seem to really like night float.

But if you're a surgery resident, your months of night float will be, essentially, totally non-operative months. You will spend all your time in the ICU or on the floors, and none in the OR. That can be very frustrating for some people.

Some people also like getting the post-call day. It's nice to have some free time in the day to run errands (like going to the dentist, going to the bank, getting a haircut, etc.) - and you don't get post-call days in a nightfloat system.

so residents do not participate in first year, means it will be the traditional q4/q5 schedule?

Yep. When it says that interns don't participate in nightfloat, that doesn't mean that interns have an easy time of it. 😀

 

[Winged Scapula]

so residents do not participate in first year, means it will be the traditional q4/q5 schedule?

I suppose that depends on the "traditional" call schedule at your program. Q4/5 is certainly not "traditional" but rather a function of work hour restrictions and having night float.

But yes, if you do not participate in the night float call pool then you take call at whatever the usual schedule is for that program.

 

[SoCuteMD]

For what it's worth, I come from an institution with some night float and some traditional overnight call. I much much much preferred overnight call. With night float I just felt like I was ALWAYS at the hospital. The way it works at our institution is that the regular teams still take "call" which officially goes until 9 pm and they also work EVERY SINGLE SATURDAY - officially a "half" day, if half days end at 3 pm! I never once finished at 9 PM (more like midnight) and had to be back the next morning at the crack of dawn to finish up everything relating to my patients (we got SOOO slammed with other team's patients that I still had work to do before rounds) and work a regular day. After overnight call I at least got to go home the next day and sleep, recharge, and take care of myself a tiny bit.

 

[secretwave101]

Night float is becoming immensely popular. Many programs are switching over to it. True, hand-off problems arise, but this is not mitigated by q-call either. At some point, new teams come onto the service.

I'm a big fan of it now that I've lived it for 3 years. Much more reasonable hours and demands, in my opinion.

Both systems have their merits, but one thing I think most people can agree on is that programs switching from one system to the other are not fun places to be. The upheaval isn't pretty, usually. So, MS-4's, ye be warned!

 

[dragonfly99]

Perspective on night float in an IM program:
They had some night float at my med school. The 2nd year would come in at 7pm and take all the crosscover from the interns, so they only had to crosscover patients from around 4-7pm. They admitted until 10pm, went home around 11:30-12, came back the next a.m. around 7. The night float resident would do admissions 10pm-6 or 7a.m., then sign out to the short call teams on the next day, and leave. He usually didnt' get THAT many admissions...it was controlled by the ER and hospital had a hospitalist system to take the overflow/not good teaching case patients. The interns capped at 5 or 6 patients/intern, which wasn't bad. There were 2/team. They stayed until 11 or 12pm with their resident, who didn't do much but supervise them (she wasn't the same person as the night float resident). The minus of this system is when you are a 2nd year you have to do a month or two of night float, which isn't really that educational probably...

My residency did not have night float.
Pluses of night float include it tends to decrease the work hours worked by interns, and often, the number of patients they have to crosscover. If not decreased work hours overall, at least the interns have shorter workdays (no 30 hours in a row with no sleep and your pager going off Q5-10 minutes). I can tell you that being up doing admissions and procedures for 24 hours or more at a time, being in the hospital 30 hours in a row every 3-4 days, is not fun. I always felt like I didn't learn much the next a.m., having often been up all night with zero sleep...it was hard to learn a lot in morning report after being up x 28 hours already. I did enjoy the continuity of being there all night with my newly-admitted patients and felt I learned something from that. Programs without night float tend to be more "front-loaded" in terms of interns working more, and residents (particularly 2nd year ones) having to work a little more to make up for it.

Night float is a bit different every place. You have to just ask a lot of questions when you are on your interview, to figure out what the deal is.

 

[Samoa]

Last year my program switched from call and cross-cover to nightfloat, and I was lucky enough to have both a call and cross-cover month, and some night float on the same service. And here's my head-to-head comparison:

Call and cross-cover
Pro:
- you get to follow your own patients through a full 24h period, which is an incomparable learning experience with respect to perioperative surgical care
- I think you own your patients a bit more when you're there, and consequently worry about them a bit more when the other team is on call
- you get that half day off to take care of all those chores that aren't compatible with life as a surgical intern (basically anything that has to be dealt with between 8am and 5pm)

Con:
- the 24-48h period of sleep deprivation is the absolute worst, and the length of call is right smack in the middle
- when you take sign out from the other team, half your brain is still thinking about your own patients, so you may miss something crucial that was said
- you will also never know the other team's patients as well as your own, and it's hard to educate yourself at 3am when you've been up for ~24h already, about all the things the other team forgot to tell you that are now hitting the fan
- the night nurses are completely oblivious to the fact that you've been awake so many hours, because they're all well-rested

Nightfloat
Pro:
- you are much more well-rested, and much less likely to let someone give you a vague and dismissive sign out
- likewise, if the patient's status deteriorates, you are much more alert, and able to gather and sort through information quickly
- you are there every night, not just every 4th night, so there's better continuity from one night to the next
- all the patients are equally yours for the night
- if there are emergent operations, you might still get to operate (I did)

Con:
- you don't get good quality sleep during the day, so you get progressively more tired as the assignment goes on
- you don't have any real say in patient management decisions, which can be frustrating if one of the day interns is an idiot
- because you aren't there on rounds, lots of blame gets heaped onto you that really doesn't belong there
- the day interns will take credit for any changes you made overnight that turn out well
-you need to know what you're doing already, because there's not much learning that goes on, and you can screw things up royally

So that's my list. Overall, I think night float is better for patient care, but not as good for resident education.

 

[platon20]

Night float vs call is literally a day and night difference, and I cant understand anybody who likes the call system better.

Teh only con I see to night float is that sometimes your days run a little longer because you cant usually leave at 5 PM. But that is GREATLY OUTWEIGHED by the fact that YOU DONT HAVE TO DO CALL!!!!

I cant handle staying awake for 36 hours straight. its just ridiculous and i dont see how anybody can do it unless they are on drugs. Its no way to take care of patients.

 

[bluealiendoctor]

Well Platon,

Maybe a traditional night float system seems better than call. But if your nightfloat system has you working 14 days straight going in at 5pm and getting home at 9am..gets real old..real fast. Once you get home, eat and sleep...you're right back at it. Nevermind having to do anything like laundry, shopping, bills, etc. I think q4 sounds better than this.

 

[Top Gun]

What does it mean when a program has a night float system but says "residents do not participate in the first year" Does that mean interns have no call or those that mean interns do Q4 night call, while senior residents get night float?

This is what my program has. Interns do 24-hour call, but the second and third years have night float after 9 PM. Between 4:30 and 9 PM, second and third-years do short-call.

 

[elwademd]

as you can see, there are different schools of thought on whether its more pluses or more minuses, which seems to be colored by specialty (medicine/non surgery versus surgery residency).

also, there is a lot of variability in a night float system as well.