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Any tips/things you wish you had known, for the new nightfloat intern who is cross-covering floors (medicine)?
Nightfloat- Everything you wish you had known
- Thread starter Voxel
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Ah, Night Float. I remember you well. If you have a PDA, and haven't already downloaded the ePocrates program, do that. Nothing like being on roller skates the whole night from the time the gun goes off around 5 PM until 8 AM the next morning; you might get two to (if you're really lucky) four hours of sleep. If you are adjusting meds, you don't want to go looking for a PDR for each call you get from nursing. Trust me on that. If you want, you can use the little pocket pharm book that all have as well.
The key I found with Night Float is, no matter how much you would like to, there is no way you are going to know the details about 60 some-odd patients that are not yours. Depending on your hospital this number may average smaller or larger. When you accept the sign-outs for the float, I found that the nitty gritty is to ask: of all of that intern's patients which ones are unstable; who might have a change in status overnight; what labs do you need to check overnight (if that is the case); what specific allergies they have to meds; what specific drugs, albeit not an allergy per se, can you NOT give for some idiosyncracy of the intern or the attending; list of meds they are on; and anything else that the intern feels needs to be flagged. There is no way you will know the history of each intern's patients in a thumbnail sketch. Just use the intern's list of medical problems as the history. It's enough. The idea of Night Float is just to put out any little fires that may start overnight. Rarely will you find the floor patients crashing and need to be transferred to the MICU in the middle of the night, but it does happen. Hopefully it won't happen to you on your first night as it did with me. I think those are the bare bones of the rotation. I did it that way after the first night when I realized I had three patients with the identical clinical history and the same age and I thought when I needed to see one it was one of the other ones. Keep it simple and you'll be OK. Good luck.
The key I found with Night Float is, no matter how much you would like to, there is no way you are going to know the details about 60 some-odd patients that are not yours. Depending on your hospital this number may average smaller or larger. When you accept the sign-outs for the float, I found that the nitty gritty is to ask: of all of that intern's patients which ones are unstable; who might have a change in status overnight; what labs do you need to check overnight (if that is the case); what specific allergies they have to meds; what specific drugs, albeit not an allergy per se, can you NOT give for some idiosyncracy of the intern or the attending; list of meds they are on; and anything else that the intern feels needs to be flagged. There is no way you will know the history of each intern's patients in a thumbnail sketch. Just use the intern's list of medical problems as the history. It's enough. The idea of Night Float is just to put out any little fires that may start overnight. Rarely will you find the floor patients crashing and need to be transferred to the MICU in the middle of the night, but it does happen. Hopefully it won't happen to you on your first night as it did with me. I think those are the bare bones of the rotation. I did it that way after the first night when I realized I had three patients with the identical clinical history and the same age and I thought when I needed to see one it was one of the other ones. Keep it simple and you'll be OK. Good luck.
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Originally posted by Tussy:
•••quote:••• Hmmmm, I'm just curious. What is night float, and how is it different from call? ••••The Night Float system allows for the team on call to cover their own admissions as well as their teams patients without cross-covering all the other teams' patients during the night. This can amount to quite a number of patients for a limited number of folks on the on call team. More and more hospitals are seeing this as the most humane way for folks to have a medical residency as well as a life outside the hospital. As we did Night Float at our hospital, we were on from 5PM until 8AM the next morning, with a day and a half off in between to just sleep and catch up. We did this for a period of two weeks and then two weeks later in the year.
I hope that clarifies it a bit for you.
•••quote:••• Hmmmm, I'm just curious. What is night float, and how is it different from call? ••••The Night Float system allows for the team on call to cover their own admissions as well as their teams patients without cross-covering all the other teams' patients during the night. This can amount to quite a number of patients for a limited number of folks on the on call team. More and more hospitals are seeing this as the most humane way for folks to have a medical residency as well as a life outside the hospital. As we did Night Float at our hospital, we were on from 5PM until 8AM the next morning, with a day and a half off in between to just sleep and catch up. We did this for a period of two weeks and then two weeks later in the year.
I hope that clarifies it a bit for you.
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NIght float actually varies in scope at different places. Here night float takes cross cover (except your team) after 10pm and then takes ALL cross cover and new admissions after 1am.
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Night float is horrible in my opinion. For anybody who has actually been on night float, do you actually learn anything from this. Personally, I would rather be on call every 4th or 5th night and actually have someone from my team cover my patients so I know what was going on. I have seen both systems this year and I like call better. Deal with a smaller number of patients. It is horrible for patient care to have someone who has never seen you taking care of them.
Secondly, thank you to all internal medicine residents. Those guys are up all night on call with complex patients. I prefer peds call because the patients are too young to complain about pain and insomnia.
Secondly, thank you to all internal medicine residents. Those guys are up all night on call with complex patients. I prefer peds call because the patients are too young to complain about pain and insomnia.
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These type of cross-cover arrangements are convenient for our lifestyle, but honestly they frequently put patient safety @ risk due to unfamiliarity with sick patients.
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Originally posted by droliver:
•••quote:••• These type of cross-cover arrangements are convenient for our lifestyle , but honestly they frequently put patient safety @ risk due to unfamiliarity with sick patients. ••••Granted, there are problems with the Night Float system, but I think it's worse if you have a call situation where you are covering new admissions as well as several teams' worth of patients that you do not know. I think the latter situation is more dangerous.
It's not all about "our lifestyles". It's trying to find a way to make sure all patients who are not critical, have housestaff coverage in the most amenable way possible.
•••quote:••• These type of cross-cover arrangements are convenient for our lifestyle , but honestly they frequently put patient safety @ risk due to unfamiliarity with sick patients. ••••Granted, there are problems with the Night Float system, but I think it's worse if you have a call situation where you are covering new admissions as well as several teams' worth of patients that you do not know. I think the latter situation is more dangerous.
It's not all about "our lifestyles". It's trying to find a way to make sure all patients who are not critical, have housestaff coverage in the most amenable way possible.
•••quote:•••Originally posted by NuMD97:
Granted, there are problems with the Night Float system, but I think it's worse if you have a call situation where you are covering new admissions as well as several teams' worth of patients that you do not know. I think the latter situation is more dangerous.
[/QB]••••When I'm on call for surgery I cover consults in the ER, trauma, and the floor, and then cross cover all the other gen surg floors as well as thoracics and vascular including the step-down units. This works out to about 80 patients on the floor in addition to the very busy ER. I do this call every 3 to 4 nights and there is no going home early after. I think this night float system would be great!!! Are a lot of American hospitals using this system???
Granted, there are problems with the Night Float system, but I think it's worse if you have a call situation where you are covering new admissions as well as several teams' worth of patients that you do not know. I think the latter situation is more dangerous.
[/QB]••••When I'm on call for surgery I cover consults in the ER, trauma, and the floor, and then cross cover all the other gen surg floors as well as thoracics and vascular including the step-down units. This works out to about 80 patients on the floor in addition to the very busy ER. I do this call every 3 to 4 nights and there is no going home early after. I think this night float system would be great!!! Are a lot of American hospitals using this system???
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Originally posted by tussy:
•••quote:••• I think this night float system would be great!!! Are a lot of American hospitals using this system??? ••••I can't speak for surgery only medicine, but this past year as I interviewed, more and more hospitals seemed to indicate that they either had it (as a selling point) or were considering switching to one.
•••quote:••• I think this night float system would be great!!! Are a lot of American hospitals using this system??? ••••I can't speak for surgery only medicine, but this past year as I interviewed, more and more hospitals seemed to indicate that they either had it (as a selling point) or were considering switching to one.
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