What coverage does your program require on call?

[st2205]

We're in the midst of attempting to change the way we provide coverage for call and I'm curious what exactly your responsibilities are elsewhere while on call. Which services do you cover (psych floor, ED, consults, etc.)? Also, if you're doing admits, is there a screener or are you the one doing the eval in the ED and then admitting? How many people, and in what capacity do you typically see at night?

We currently cover the whole hospital. 90% of time comes from the ED which is nearly an auto-consult if something psych comes in. At least half of these are people that don't need to be admitted and that could reasonably be handled by the ED.

How's it handled at your program?

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[deleted452516]

While on call PGYIIs cover the ~80 floor beds, plus admissions to those beds, with a complicated cap system that essentially limits to 4 admissions overnight and 6 on a weekend day. Those admissions are typically worked up already by a resident in the ED, but can come from OSH or the CL service.

In addition to the admits overnight we typically see at least 4 patients overnight for acute issues (CP, aggressive behavior, I want to leave...) and field about 20 pages for other things- but obviously those numbers are highly variable. I usually get 2 hours of sleep, again, highly variable.

The ED and consult coverage is provided by PGY IIIs, on a shift basis rather than call. Having residents assigned to the ED is great because it provides a wall/triage/sieve, but it also means that someone always has to be there, and the ED stops treating you like a regular consult team and like they own you.