Why are 24 hr shifts a thing?

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Poit

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Studies have shown that 24 hrs with no sleep is equivalent to having a mental state of a BAC of 0.1. Would you want a drunk doctor managing your care? The military insists its soldiers get enough sleep when possible, so that they don't make stupid decisions. Why is the medical community the only group that is ******ed about this. Do the benefits of continuity of care really outweigh the costs?
 
Poit said:
Studies have shown that 24 hrs with no sleep is equivalent to having a mental state of a BAC of 0.1. Would you want a drunk doctor managing your care? The military insists its soldiers get enough sleep when possible, so that they don't make stupid decisions. Why is the medical community the only group that is ******ed about this. Do the benefits of continuity of care really outweigh the costs?
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Lost cost labor force with little negotiating power = exploitation.
 
Poit said:
Studies have shown that 24 hrs with no sleep is equivalent to having a mental state of a BAC of 0.1. Would you want a drunk doctor managing your care? The military insists its soldiers get enough sleep when possible, so that they don't make stupid decisions. Why is the medical community the only group that is ******ed about this. Do the benefits of continuity of care really outweigh the costs?
Click to expand...
Oh, please.
 
Poit said:
The military insists its soldiers get enough sleep when possible, so that they don't make stupid decisions.
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This made me lol for real. Obviously you've never been in the military and seen how flexible "when possible" can be.
 
As someone who would love having a short little 24 hour shift, here are my thoughts.

There is X amount of suckage in residency and this suckage will always be there . The only question is how it gets divided up. You can have more frequent but shorter shifts or longer but more sporadic ones. You can do a night float system plus something for weekend coverage. There are lots of options. The choice will depend on the program size, hospital size, coverage needs, etc.

The continuity of care consideration is real although probably only meaningful in the context of critical care type environments. If you've been making moves on someone every couple hours for the whole day shift, then being there at night having a full understanding of the arc of the current situation can be invaluable. If your census is mainly healthy post-ops, then continuity is probably less important. Personally, we carry a census that runs the gamut, so I will usually lay eyes on potentially active players and fresh big post ops early in the night before going home. The rest I typically never see and never hear about unless a new issue develops.

For surgical fields, occasional long shifts keep us operating more rather than taking long periods of night float. For those of us with home call, we don't even lose the post call day.

The fatigue issue is real but tends to be overblown by people who haven't done it. The reality is that the levels of supervision do a fine job of ensuring well rested competent people are there when things really start going down. It's not like a junior resident who is sleep deprived will be operating solo on someone. I think this is one of the main reasons the studies have found no difference in patient safety outcomes between call styles.

On a personal note, as someone in a surgical sub with a home call schedule, I do occasionally have a crazy long call shift with little sleep. We cross cover a large census spanning a few hospitals and take all the new consults overnight. It can get really busy and there typically isn't a post call day. The benefit is that we only rarely have to take call at all. I think about 85% of my weekends this year are golden ones. Overall I'm on about q14 averaged for the year. Life is good.
 
Mad Jack said:
To teach you how to function at long stretches of time while caring for patients without having your skills fall apart.

Also you get some sleep here and there, it's not like it's 24 straight hours of work.
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Sometimes you get to sleep. In my experience, crap is hitting the fan at all hours. But, such is the life of a black cloud.

That said, 24's really aren't that bad, even when I'm super busy.
 
Trickle-down care... oh wait, wrong thread
 
Osteoth said:
In my experience a fraction of the time residents are.
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Depends on your practice setting. Several of my friends have 8 24 hour shifts per month, which is far more than residents at our program have (1-2 per month, depending on the size of the team). Of course, they aren't working the rest of the time like the residents are, so overall they are working less. Our NICU docs have a handful of 24 hour shifts per month (3-4, probably, though they have so many schedules that it's difficult to keep track), and don't usually have a post call day (i.e. they work 36 hours at a time) unless they are working the weekend. Our PICU docs do more shift work--the person on service isn't usually the one taking call at night, but they have other responsibilities during the day. And our endo, nephro, pulm, and GI docs take call for a week (or more) at a time, so have to answer all the phone calls from the outpatient triage, ED, and inpatient residents. So their nights can be miserable, or easy, but they still have to come to work the next morning. And GI and Nephro are lucky enough to have emergent things that they actually need to come into the hospital for.

So, yes, residency sucks. But I'd much rather have some experience with 24 hour shifts as a resident when there is someone else watching over me, than have my first 24 hour shift be out in the real world where I don't have that sort of back-up.
 
mvenus929 said:
Depends on your practice setting. Several of my friends have 8 24 hour shifts per month, which is far more than residents at our program have (1-2 per month, depending on the size of the team). Of course, they aren't working the rest of the time like the residents are, so overall they are working less. Our NICU docs have a handful of 24 hour shifts per month (3-4, probably, though they have so many schedules that it's difficult to keep track), and don't usually have a post call day (i.e. they work 36 hours at a time) unless they are working the weekend. Our PICU docs do more shift work--the person on service isn't usually the one taking call at night, but they have other responsibilities during the day. And our endo, nephro, pulm, and GI docs take call for a week (or more) at a time, so have to answer all the phone calls from the outpatient triage, ED, and inpatient residents. So their nights can be miserable, or easy, but they still have to come to work the next morning. And GI and Nephro are lucky enough to have emergent things that they actually need to come into the hospital for.

So, yes, residency sucks. But I'd much rather have some experience with 24 hour shifts as a resident when there is someone else watching over me, than have my first 24 hour shift be out in the real world where I don't have that sort of back-up.
Click to expand...

Wow thats nuts, def hadn't experienced that before.
 
operaman said:
As someone who would love having a short little 24 hour shift, here are my thoughts.

There is X amount of suckage in residency and this suckage will always be there . The only question is how it gets divided up. You can have more frequent but shorter shifts or longer but more sporadic ones. You can do a night float system plus something for weekend coverage. There are lots of options. The choice will depend on the program size, hospital size, coverage needs, etc.

The continuity of care consideration is real although probably only meaningful in the context of critical care type environments. If you've been making moves on someone every couple hours for the whole day shift, then being there at night having a full understanding of the arc of the current situation can be invaluable. If your census is mainly healthy post-ops, then continuity is probably less important. Personally, we carry a census that runs the gamut, so I will usually lay eyes on potentially active players and fresh big post ops early in the night before going home. The rest I typically never see and never hear about unless a new issue develops.

For surgical fields, occasional long shifts keep us operating more rather than taking long periods of night float. For those of us with home call, we don't even lose the post call day.

The fatigue issue is real but tends to be overblown by people who haven't done it. The reality is that the levels of supervision do a fine job of ensuring well rested competent people are there when things really start going down. It's not like a junior resident who is sleep deprived will be operating solo on someone. I think this is one of the main reasons the studies have found no difference in patient safety outcomes between call styles.

On a personal note, as someone in a surgical sub with a home call schedule, I do occasionally have a crazy long call shift with little sleep. We cross cover a large census spanning a few hospitals and take all the new consults overnight. It can get really busy and there typically isn't a post call day. The benefit is that we only rarely have to take call at all. I think about 85% of my weekends this year are golden ones. Overall I'm on about q14 averaged for the year. Life is good.
Click to expand...

What field is this?
 
Only once in all my training was I awake for 24 hours straight: and it was on my 3rd year OB clerkship on L&D. Even now, when I'm attending, I get calls at night for a week straight. I get up, I take the call, I reassure my residents, and I go back to bed. You learn to balance. Remember, despite the fact that it feels like an eternity of training, you have a relatively short amount of time to learn enough medicine to stay out of trouble on your own.
 
I know people say you can get 10 minute naps, etc. How o people get away with that? Do you take turns spotting each other and pray you never get thrown under a bus? It seems wreckless to risk losing your job for a 10 minute nap.

I have had a lot of jobs and none of them allowed for any wasted time except for a an occasional 3 minute trip to the bathroom. I have heard "time to lean, time to clean" so much that I am really anxious about losing a job for not working the whole time. I know during my clerkships I have always felt very restless when instructed to sit down. Even when they tell me I worry about being seen as lazy. I don't check my phone at work unless given a meak break. (My kids know to get in touch with me a different way in case of a true emergency.)

So I was thinking 24 hr shifts are just something to deal with--the biggest challenge perhaps being driving home safely.
 
valid username said:
I know people say you can get 10 minute naps, etc. How o people get away with that? Do you take turns spotting each other and pray you never get thrown under a bus? It seems wreckless to risk losing your job for a 10 minute nap.

I have had a lot of jobs and none of them allowed for any wasted time except for a an occasional 3 minute trip to the bathroom. I have heard "time to lean, time to clean" so much that I am really anxious about losing a job for not working the whole time. I know during my clerkships I have always felt very restless when instructed to sit down. Even when they tell me I worry about being seen as lazy. I don't check my phone at work unless given a meak break. (My kids know to get in touch with me a different way in case of a true emergency.)

So I was thinking 24 hr shifts are just something to deal with--the biggest challenge perhaps being driving home safely.
Click to expand...

Lol you're not going to lose your job whether you sleep for 10 minutes or 3 hours, as long as you're able to be reached and you're not neglecting your patient care duties. You have a pager (and in my case, a phone) that the nurse can call you if there's an issue. You make sure your patients are tucked in (i.e. stable and not needing anything) and make sure you know when you need to check on labs or imaging or something, and you go take your nap. Patients do not require 24/7 direct physician care. That's part of the job of the nursing staff, especially in the ICU. They'll call me if there's an issue.

Being a resident is very different from being a med student. You get to stop worrying about what will happen to you if you *gasp* sit down (p.s. when we tell you to sit, it's okay to sit, you don't have to feel bad. Same with when we tell you to go home). I've had nights with no admissions and patients didn't make a peep, and I watched Netflix and slept.
 
valid username said:
I know people say you can get 10 minute naps, etc. How o people get away with that? Do you take turns spotting each other and pray you never get thrown under a bus? It seems wreckless to risk losing your job for a 10 minute nap.
Click to expand...

Huh?! What, but...how...why would you even think that?

I'm a PICU attending in a unit with 45+ beds, I did my training at an institution with a 40 bed PICU and a 30+ bed Cardiac ICU, as a resident, I covered a 100 bed NICU alone, and there were many nights in which all 7 pediatric floor services (100+ patients) were cross covered by only 2 interns and 1 upper level while also taking admissions. Outside of active code situations, there literally is only one case in my entire career where a patient decompensated over the course of less than 20 minutes (and that was an infant freshly post-op from a Glenn procedure...there probably is not any other surgery where patients come out more with more labile hemodynamics). It simply never happens that patients change that quickly, short of something you can't do anything about - throwing a massive PE is about the only thing that comes to mind on the inpatient side, major trauma/gun shot wounds in the ED.

You want patients to be stable, if they aren't so stable for you to sit down, return a phone call, grab a coffee, then you aren't done with them yet. But once they are stable, do those things you need to do.
 
BigRedBeta said:
Huh?! What, but...how...why would you even think that?

I'm a PICU attending in a unit with 45+ beds, I did my training at an institution with a 40 bed PICU and a 30+ bed Cardiac ICU, as a resident, I covered a 100 bed NICU alone, and there were many nights in which all 7 pediatric floor services (100+ patients) were cross covered by only 2 interns and 1 upper level while also taking admissions. Outside of active code situations, there literally is only one case in my entire career where a patient decompensated over the course of less than 20 minutes (and that was an infant freshly post-op from a Glenn procedure...there probably is not any other surgery where patients come out more with more labile hemodynamics). It simply never happens that patients change that quickly, short of something you can't do anything about - throwing a massive PE is about the only thing that comes to mind on the inpatient side, major trauma/gun shot wounds in the ED.

You want patients to be stable, if they aren't so stable for you to sit down, return a phone call, grab a coffee, then you aren't done with them yet. But once they are stable, do those things you need to do.
Click to expand...
 
Why would I not think that? I didn't realize it was different than other jobs I have had. I am almost done with clinicals but in every rotation I have assumed I should be actively working or following the whole time. No one ever suggested otherwise. I literally never sat down more than 5 minutes unless i was typing a note or an attending specifically said to sit down. If we haf down time I would triage patients, help in the lab--i just didn't know.
 
valid username said:
I know people say you can get 10 minute naps, etc. How o people get away with that? Do you take turns spotting each other and pray you never get thrown under a bus? It seems wreckless to risk losing your job for a 10 minute nap.

I have had a lot of jobs and none of them allowed for any wasted time except for a an occasional 3 minute trip to the bathroom. I have heard "time to lean, time to clean" so much that I am really anxious about losing a job for not working the whole time. I know during my clerkships I have always felt very restless when instructed to sit down. Even when they tell me I worry about being seen as lazy. I don't check my phone at work unless given a meak break. (My kids know to get in touch with me a different way in case of a true emergency.)

So I was thinking 24 hr shifts are just something to deal with--the biggest challenge perhaps being driving home safely.
Click to expand...

valid username said:
Why would I not think that? I didn't realize it was different than other jobs I have had. I am almost done with clinicals but in every rotation I have assumed I should be actively working or following the whole time. No one ever suggested otherwise. I literally never sat down more than 5 minutes unless i was typing a note or an attending specifically said to sit down. If we haf down time I would triage patients, help in the lab--i just didn't know.
Click to expand...

I don't know what situation you are involved in, but this is why ACGME mandates that residents be allowed 'strategic naps'. There have been very few shifts where I have been busy from start to finish, and most of them were at the start of a rotation when I was still trying to get a feel for how the process worked. Once you know the system, you can do things more efficiently, and thus can take 20-30 minutes for a nap. And most places will have something in place to get you home safely if you are concerned about driving--whether that is calling a cab to take you home, or letting you crash in the call room for an hour or two to get caught up on some sleep.
 
24 hr shifts are not that bad. You get used to it, you train your mind to work the way a soldier trains his body to carry absurd amounts of weight on long marches.
As an attending, you don't want to tell your third trauma patient, "oh sorry, your open femur can wait, I have to go take a nap."
It's preparation for the messy, demanding, and uncontrolled world of life after residency.
 
i have this theory that may partly explain the attitude in medicine towards long hours. It is a bit out there but deserves to be mentioned. Some people in medicine are often happier at work than at home. Nobody likes to say that because it makes you sound like a terrible SO, parent, etc... but on some level being always busy working hard/doing urgent stuff can free up your day from a lot of the mundane personal BS others have to deal with. An attending or even a senior resident at work is almost never ordered to take out trash, wash the dishes, or clean the garage. People generally respect you and your opinion counts. Besides, a lot of your buddies work at the hospital. They may actually be more fun to talk to and provide more intellectual stimulation than your family.
 
OrthoTraumaMD said:
24 hr shifts are not that bad. You get used to it, you train your mind to work the way a soldier trains his body to carry absurd amounts of weight on long marches.
As an attending, you don't want to tell your third trauma patient, "oh sorry, your open femur can wait, I have to go take a nap."
It's preparation for the messy, demanding, and uncontrolled world of life after residency.
Click to expand...

it can wait!
 
Actually, I just got scheduled for my first 30 hour shift in about 5 years (and I'll probably go to Home Depot afterwards, I don't know, I'll see if I have enough energy)...
200.gif
 
the fact that it keeps existing baffles me. Where I am, south america, you have 48 hour and more shifts. utter stupidity.
 
SurfingDoctor said:
Actually, I just got scheduled for my first 30 hour shift in about 5 years (and I'll probably go to Home Depot afterwards, I don't know, I'll see if I have enough energy)...
200.gif
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Go to Lowes. I went to my usual Lowes today, but their saw was broken. I went to Home Depot because it was closer than the other Lowes, and holy crap that place is a cluster****. Of course, their saw was busted too, so I had to go to the other Lowes after all. I walked in and felt like I was Virgil crossing from purgatory into paradiso.
 
Matthew9Thirtyfive said:
Go to Lowes. I went to my usual Lowes today, but their saw was broken. I went to Home Depot because it was closer than the other Lowes, and holy crap that place is a cluster****. Of course, their saw was busted too, so I had to go to the other Lowes after all. I walked in and felt like I was Virgil crossing from purgatory into paradiso.
Click to expand...
I do my best to stay away from Home Depot. Every time I walk in their store I feel like they play hide-and-seek with their stuff. "Oh, the tubing cutter is on aisle six? Why not put it near the plumbing products." Oh well...
 
Matthew9Thirtyfive said:
Go to Lowes. I went to my usual Lowes today, but their saw was broken. I went to Home Depot because it was closer than the other Lowes, and holy crap that place is a cluster****. Of course, their saw was busted too, so I had to go to the other Lowes after all. I walked in and felt like I was Virgil crossing from purgatory into paradiso.
Click to expand...
Agree Lowe’s is better, but it’s far and I’m feeling lazy after working 30 hours.
 
DPTinthemaking15 said:
I do my best to stay away from Home Depot. Every time I walk in their store I feel like they play hide-and-seek with their stuff. "Oh, the tubing cutter is on aisle six? Why not put it near the plumbing products." Oh well...
Click to expand...

Yeah. Tbf Lowes is kind of the same way. But it's so much nicer inside, and the people working there don't look like they're on work release.
 
VA Hopeful Dr said:
It's those stupid patients. If they were considerate of our needs and only got sick 9-5 this wouldn't be a problem.
Click to expand...
What if I told you you can care for patients without 24 hour shifts?
 
Ismet said:
Clearly a pre-med will have the solution that all us doctors fail to see. 😛
Click to expand...
It was pre-meds who kept saying incredibly long working hours in residency were a bad idea, and condescending pricks like you who kept insisting it was a good thing. And we all know how that worked out.
Being a pre-med doesn't automatically make me incorrect, just as being a doctor doesn't automatically make you correct.
Genetic fallacy - Wikipedia
Pity you clearly never studied logic in undergrad.
 
latinclubimperatus said:
Let's come at this from your perdepctive. We need 24 hour shifts because if we don't have them we won't make as much money, correct?
Click to expand...

No, that is not the reason for 24 hour shifts.

24 hour shifts are used to provide continuity of care, because the more handoffs there are, the higher the risk for error. Programs that have q3, q4, etc call can provide more continuous care to patients with fewer handoffs, therefore reducing errors. Plus you end up with more time off overall, as you get post-call days. It usually ends up being better for people with families, as they're not on night float for weeks at a time or working back-to-back-to-back 16 hour shifts. Other programs have a night float system and use 24 hour shifts to provide a day off for both a day shift person and a night shift person, thus only having to pull 1 person for that job instead of 1 person to cover the day and 1 person to cover the night.

BTW I never said that pre-meds are wrong and doctors are right. The fact remains that pre-meds have not yet lived it. I, too, did not understand the benefit or appeal of 24's before I did them, or before I realized I did nothing but work and sleep while on inpatient months without 24's. It makes more sense once you experience it.
 
Ismet said:
No, that is not the reason for 24 hour shifts.

24 hour shifts are used to provide continuity of care, because the more handoffs there are, the higher the risk for error. Programs that have q3, q4, etc call can provide more continuous care to patients with fewer handoffs, therefore reducing errors. Plus you end up with more time off overall, as you get post-call days. It usually ends up being better for people with families, as they're not on night float for weeks at a time or working back-to-back-to-back 16 hour shifts. Other programs have a night float system and use 24 hour shifts to provide a day off for both a day shift person and a night shift person, thus only having to pull 1 person for that job instead of 1 person to cover the day and 1 person to cover the night.

BTW I never said that pre-meds are wrong and doctors are right. The fact remains that pre-meds have not yet lived it. I, too, did not understand the benefit or appeal of 24's before I did them, or before I realized I did nothing but work and sleep while on inpatient months without 24's. It makes more sense once you experience it.
Click to expand...
Yeah, that's always been the excuse of these things. Here's the problem: that defense is garbage: Medical Residents, Misplaced Pride and Saner Hours
TLDR version:
 
latinclubimperatus said:
It was pre-meds who kept saying incredibly long working hours in residency were a bad idea, and condescending pricks like you who kept insisting it was a good thing. And we all know how that worked out.
Being a pre-med doesn't automatically make me incorrect, just as being a doctor doesn't automatically make you correct.
Genetic fallacy - Wikipedia
Pity you clearly never studied logic in undergrad.
Click to expand...
Chill brah
 
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