What is your inpatient psych rotation like?

[Igor4sugry]

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Just curios what some of in-patient psych rotations are for other residents.

For example, in our residency we carry 10 patients (caped at 10 almost all the time).
We are 1st years and work directly with an attending. Have med students as well.
Shift is 7-6. Patients either come through the ED or direct transfers.
Completely electronic system, all orders and notes done in Epic.

 

[silas2642]

Just curios what some of in-patient psych rotations are for other residents.

For example, in our residency we carry 10 patients (caped at 10 almost all the time).
We are 1st years and work directly with an attending. Have med students as well.
Shift is 7-6. Patients either come through the ED or direct transfers.
Completely electronic system, all orders and notes done in Epic.

Wow. That's a heavy caseload, especially for a first year. During PGY-1 on psych we cap at 4 (all primaries). PGY-2s more or less cap at 6 patients, 7 max if a colleague is on a vacation. Medicine was a different story-- cap was at 10 but personally I almost never reached it.

 

[splik]

we have 7 on most units (there's not really a 'cap' you just have a certain number of patients which is basically number of beds/teams almost always all beds a full). on the higher acuity units we have 9 patients. pts either from the ED or transfer from psych ICU. extremely rarely there will be a direct admit from some rockstar but is unusual. there is either an intern or PGY2 (not both) working with the attending and med student. occasionally there is a pharmacy student or resident or a psychology intern.

 

[mass1]

in our intern year for inpatient psych, we carry four patients the first month, then carry 6 patients the latter 2 months. we are also capped at 6 patients in PGY2 during inpatient psych. our hours are 8-430, though we tend to stay later esp if we have late admissions. each month we work with a different attending, we have a senior teaching resident (PGY4) who supervises and gives lectures, we have medical students, and we get visiting attendings to give didactics twice a week. we also have full protected didactic day on wednesdays which provide a nice break in the week. i work at a VA inpatient psych so everything is done in CPRS.

 

[JourneyAgent]

Wow. That's highly variable. 10 patients for a new doc seems like pushing the envelope of safety. Like throw **** at the wall and see what sticks type of care. But that's just my impression.

Do you find this stuff out after you've already signed or before?

 

[shan564]

Wow. That's highly variable. 10 patients for a new doc seems like pushing the envelope of safety. Like throw **** at the wall and see what sticks type of care. But that's just my impression.

Do you find this stuff out after you've already signed or before?

Usually before. Unless they're dishonest with you. But you can generally get a pretty good idea of the caseload at your interview.

 

[markglt]

3 teams with: 1 intern, 1 attending, 1-2 med students, 12-13 patients per team.
the psych er is always waiting to send patients up, so you never fall below 12....

 

[digitlnoize]

3 Teams: 2 adult, 1 Geri.

Each adult team has 1 2nd year and 1 intern. Each of us is capped at 5, as the team is capped at 10. Geri is one second year and is variable, but I think capped at 7.

The only time this system falls apart is when our second year is post-call (call is 24h call q10 2nd year), at which time, the intern carries the whole team, 10 patients. Makes for a busy day, but doable.

Weekends are another story. Each weekend day is covered by 1 intern, 1 resident, and 1 attending who round in the morning on the whole 23 bed (max) ward, then do notes and required work. Usually the intern does one team and the 2nd year does the other team. We all then sign out to a 3rd year who covers 1 weekend day shift every 2 months or so.

A bit complicated, but the net effect is a pretty reasonable workload and call schedule.

 

[OldPsychDoc]

Hmmm--I'm wondering if our residents aren't working hard enough here!

 

[SmallBird]

We carry 5 patients. Work from 8:15 to 4:30 generally, with 1 to 2 hours didactics most days. Feels like a nice balance. I have enough time to do some good supportive therapy with most of my patients.

 

[Doctor Bagel]

Here we split our inpatient time between the university ward (busier) and the VA (less busy). At the university, interns carry 8 patients, and the PGY2 carries 4 with the idea that by carrying fewer patients they can do more mentorship/assistance/monitoring of the other interns. At the VA, both interns and PGY2s cap at 8 (or 9 with a bounceback). At the university, you're always capped, but that's not generally true at the VA. Hours at the university are 7:30 am until at least 4:30 pm (and usually later). You start at 8 at the VA. We only have on resident on call or nightfloat at time, so you cover the whole unit (both sides on nightfloat with reduced expectations for admission completion). Interns weekend shifts are maxed at 12 hours.

With these places that have two residents on at time on call, I wonder how big the program is and how many units you cover. I guess we'd have to have a lot more PGY3s and 4s on to make that happen. I think we're one of the few specialties that has interns alone on call, though.

 

[JourneyAgent]

Here we split our inpatient time between the university ward (busier) and the VA (less busy). At the university, interns carry 8 patients, and the PGY2 carries 4 with the idea that by carrying fewer patients they can do more mentorship/assistance/monitoring of the other interns. At the VA, both interns and PGY2s cap at 8 (or 9 with a bounceback). At the university, you're always capped, but that's not generally true at the VA. Hours at the university are 7:30 am until at least 4:30 pm (and usually later). You start at 8 at the VA. We only have on resident on call or nightfloat at time, so you cover the whole unit (both sides on nightfloat with reduced expectations for admission completion). Interns weekend shifts are maxed at 12 hours.

With these places that have two residents on at time on call, I wonder how big the program is and how many units you cover. I guess we'd have to have a lot more PGY3s and 4s on to make that happen. I think we're one of the few specialties that has interns alone on call, though.

Are psych patients more succinctly managed? My frame of reference currently is watching medicine interns try to handle 7 or 8 patients with lots of medical problems. And they understandably struggle to keep them moving through their course of hospital treatment. Is it system dependent? Because our interns are up against paper charting and horrible nursing care as well. Just trying to get a more accurate sense of psych work flow and what the variation means.

 

[Doctor Bagel]

Are psych patients more succinctly managed? My frame of reference currently is watching medicine interns try to handle 7 or 8 patients with lots of medical problems. And they understandably struggle to keep them moving through their course of hospital treatment. Is it system dependent? Because our interns are up against paper charting and horrible nursing care as well. Just trying to get a more accurate sense of psych work flow and what the variation means.

Well, they're generally less critically ill (meaning less likely to die), and lots are in need of less active treatment from their physicians. I don't know that the coverage requirements are that different, though. As in intern on the medicine service, I capped at 8 patients and 5 admissions in a call period. I had a senior, though, who didn't have any of his/her own patients, though. On call, I'd get signout for up to 32 patients on other teams and be responsible for their coverage overnight or until nightfloat arrived. Having one psych resident on call covering a 24 bed unit seems fairly equivocal. The one difference is that you can go through a weekend with lots of psych patients and not do very much, which is why one resident can cover and write progress notes on that many patients.

I will add, though, that our system is pretty efficient with good EMRs at both spots and pretty good nursing. Our new struggle is that our ED has become fairly consult happy (thanks in part to a new acute psychiatry rotation there on weekdays), which leads to an expectation (not a reasonable one and one that probably needs to be clarified) that the resident on call on the weekend is also essentially responsible for all the psych patients in the ED, regardless of dispo, acuity or need.

 

[vistaril]

Wow. That's highly variable. 10 patients for a new doc seems like pushing the envelope of safety.

not if you are working with an attending who is active in the service....

10 isn't a lot at all, especially when of those 10 3-4 may be just waiting on placement at that point.

 

[digitlnoize]

not if you are working with an attending who is active in the service....

10 isn't a lot at all, especially when of those 10 3-4 may be just waiting on placement at that point.

Agreed. I wouldn't want to do 10 every single day, but mostly just because of the paperwork involved.

 

[nobodo]

In our program, we are supposed to carry 6 patients. In first year we work with 2 attendings and 1 student. Timings are 8-8:30 to 5ish, whenever you finish work. 2nd year 1 resident works with 3 attendings and carried about 7 patients, about 2 medical students. Same timings.

 

[rgerwin]

2 units. One voluntary, one PICU. PICU capped at 5, working with an attending. 8:15-8:30 until 5pm. Voluntary is a bigger unit. Cap is 7. 8 am -5pm on, but notes usually extend past that. There are often med students. 3 attendings overall. Didactics of some kind anywhere from 1 hr to 5 hrs in the pm.