Workload for intern on call?

[Freggle]

How many patients does an intern see on a typical call night at your institution? On my calls, I combine the following:

- All IM admissions in the ER, about 8 per night.
- The 10-bed medical ICU
- Managing the problems presenting on 6 IM wards of 25 patients each.

The attending is also in the hopspital for help in emergencies, and for catching everything I cannot handle.

How does this compare to others?

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[AJM]

Hmmm, I thought the ABIM regulations for IM residency programs stated that interns are not allowed to admit more than 5 patients per call night... some programs are able to get around this somewhat, such as capping at 6 admits per intern call night with the argument that 1 of those pts is almost always going to be "noneducational", so shouldn't count towards the ABIM cap rules. But 8 IM admits seems like a lot for an intern -- unless they are all just UTIs or PNAs.

 

[Freggle]

Let's just say there is a resident shortage where I am.
I'm just trying to get a general idea of what your average PGY1 gets to do on a typical call night.

 

[angel80]

We cap at 5 admissions a night.

 

[Mumpu]

No ****, them's the work hours violations.

I cap at 5 news plus 2 ICU transfers per night and cross-cover on 30-40 patients tops.

 

[orientedtoself]

- All IM admissions in the ER, about 8 per night.

you are getting scrwd, my friend. your program should have some sort of backup system to call in an additional resident. you are supposed to cap at 5 new admissions per night as an intern.

 

[DRDARIA]

Yup, the rule is that you should cap at 5 admits a night (even if some, nay all, turn out to be non-educational), no new admits after 24 hours on duty, and not to carry more than 12 patients total, per intern. (So, theoretically, if you started a call day with 11 patients, you should only be allowed to admit one).

At my institution, we cross cover for the other intern on our team, plus the other team(s). So max for cross-cover is 12 x (number of interns on the rotation). Hospitalist service takes the other admits, and covers their own patients at night. They are available if questions arise, as is a senior resident, and the team's attending is on call from home.


To the OP, something is not right at your program if you're doing EVERY ED admit.

 

[MD2b06]

How many patients does an intern see on a typical call night at your institution? On my calls, I combine the following:

- All IM admissions in the ER, about 8 per night.
- The 10-bed medical ICU
- Managing the problems presenting on 6 IM wards of 25 patients each.

The attending is also in the hopspital for help in emergencies, and for catching everything I cannot handle.

How does this compare to others?

no way any intern could or should be expected to handle that load. I mean come on, to admit 8 pts, all the while covering an icu w/ 10 very sick patients, not to mention cross covering 150 pts? the sheer number of pages you would have to return from covering that many patients would virtually make it impossible to do anything, let alone admit 8 pts. We admit 5 new pts, not including icu transfers, and cross cover a max of ~50 pts. There is a separate intern covering the icu pts each night.

 

[JackBauERfan]

no way any intern could or should be expected to handle that load. I mean come on, to admit 8 pts, all the while covering an icu w/ 10 very sick patients, not to mention cross covering 150 pts? the sheer number of pages you would have to return from covering that many patients would virtually make it impossible to do anything, let alone admit 8 pts. We admit 5 new pts, not including icu transfers, and cross cover a max of ~50 pts. There is a separate intern covering the icu pts each night.

we have 5 new patients, 2 consults/transfers, and cover approximately 40 inpatient folks (from all the different ICU's), and handle calls from worried folks about wheter they should come in to the hospital or stay at home!

but i agree with everyone here, 5 is supposed to be the new admission cap.

 

[Freggle]

Okay. I see.

I posted this because I had no reference and felt bad about not getting my work done properly.

But not any more so

I'm afraid there isn't much I can do about the situation as this kind of regulations doesn't exist where I live (at least not to my knowledge), but at least I can stop feeling like a bad doctor for not being able to manage all of this.

(runs back into jam-packed ER while simultaneously answering pager and making ICU progress note)

 

[Mumpu]

Are you not in the United States? The residents' work hours rules apply to all accredited US programs.

 

[DRDARIA]

Is your program abiding by the 80 hour part of the rules? And are you in IM? I know that the 5 patient cap doesn't seem to apply to all specialties. At my own institution, while we in IM have a cap of 5 for long call, the FP program doesn't have caps-- but regardless the 80 hour rules apply to every, as does the no more than 30 hours and no new patients after 24 hours.

 

[Freggle]

I'm in IM, but not in the US. (And I'm not going to say more, I know for a fact one of my attendings is also on these forums)

On the regulations: they're great for improving the learning experience. But who gets the rest of the work done when the intern goes to bed after his 5th admission? (and 5 really isn't that much, would be before midnight in our ER)

If there have to be more interns/residents in the hospital at any given time, that's a lot more call for everybody. Which would be equally gruelling. We just can't win, I guess....

 

[RuralMedicine]

How many patients does an intern see on a typical call night at your institution? On my calls, I combine the following:

- All IM admissions in the ER, about 8 per night.
- The 10-bed medical ICU
- Managing the problems presenting on 6 IM wards of 25 patients each.

The attending is also in the hopspital for help in emergencies, and for catching everything I cannot handle.

How does this compare to others?

When I was an intern at our county hospital we took team call (2 interns/ resident) and the team "capped" at 9 admissions, with the 10th or 5th for the second intern saved for a critical patient that could not be tucked in and held over for the next day admitting team. Teams usually admitted 10 patients a call but until 80 hour rules were phased in teams could take a few more if ICU admits came in after they had already capped. My worst call as a resident we got 13 but I only made the interns admit 10 and so I was the lucky person doing 3 ICU admits alone between 1 and 6 AM. You get into an "intubate, initial vent settings, place CVL, start pressors, place a-line, time to check ABG, adjust ventilator settings, write a few more orders, very quick H&P, repeat for next admit" rhythm after awhile. After work hours came in they added a resident night float so those critical ICU patients are admitted by that resident and then turned over to another team in the morning.

Interns cross covered 50-60 patients in various settings the ICU is open so if your intern colleagues are particularly unlucky you could be covering theoretically all ICU patients but usually more like 15-20 ICU/stepdown patients per intern is more reasonable.

In your situation I would presume that you and the attending should alternate admissions in some fashion. Obviously they need to see all patients and I would presume that they are the ones called with admissions so they could triage them and go ahead and see the straightforward ones alone. I did this sometimes before we had night float if we were close to capping and we were getting a seemingly straightforward chest pain rule out (or cellulitis needing IV antibiotics etc) I'd offer to just do the admission and follow them until discharge (usually the next day) because I didn't see that there was a lot of potential learning there. (Or these were good cases to give to the Sub-I if there was one because working up simpler cases the first time or two can be educational as a student, it's the 100th time as an intern that makes people tear their hair out.)

 

[u_r_my_serenity]

I go to a very large program. We cap at 5 admits per night but with all the cross cover I hardly ever get more than 2 hours of sleep for a thiry hour shift and that's if I'm lucky.

 

[souljah1]

Q4 overnight call
can get: 2 night floats plus 4 new admissions -or - 1 night floast plus 5 new admissions -or - no night floats plus 5 new admissions.
admit from: morning until 9:30 or 11:00 weekends
cross cover: all night long, ~3 interns (15-30 pts)
# of times going over 80hrs: none
ICU: closed

 

[APACHE3]

Our teams cap at 10 (5 per intern), but this can change based on how many each intern carries (last call, I went in with only one pt, while the other initern still had 4, so guess who admitted more that night?? , we have a separate cross cover intern, who really gets killed some nights because we have an open ICU and the pager wont stop (100+ pts). We also have a separate night float admit team that admits for the hospitalist, max admit for them is 10. Nice thing is that hospitalist take over at 0700 so medicine teams can focus on rounds, notes in the am without having to run to ED to admit, anyway, no program is perfect..just try to survive..sounds like you'l come out a good doc anyway!