Night float

Frequent NY Times contributer Sandeep Jauhar has a piece in Slate talking about night float, where interns take a 12 to 14 hour shift overnight to cross-cover the entire hospital.

Sometimes the problem of caring for another doctor’s patients can lead to medical errors:

The nightmare of night float raises a central question about work limits for interns: Is it better to be cared for by a tired resident who knows your case or a rested resident who does not?

While capping resident’s work hours seems like a no-brainer, the very real downsides of doing so has been underpublicized.

As for my take, night float is where one grows the stones to become a real doctor. Taking care of 50-70 patients with a minimal safety net makes you learn what sick and SICK is in a hurry.

It make be hell for interns, but a necessary evil in medical training.

(via DB)

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  • Mike

    Kevin, could not diagree more about night float. It’s essentially a lot of blood cultures and bogus Tylenol reorders. And when the chest pain patients occur, you just run and do the EKG, check the troponin. You have no clue if the patient is a complainer or the real deal because you’ve nevr seen them before. And then the admissions come. It’s just mindless work with little payoff since you go home before rounds. Night float is just patchwork for a broken system. I hated being up all night, but its a no-brainer… it was better than night float./ For patients and interns.

  • Anonymous

    I think Kevin’s comment really meant learning comes when interns have to make decisions on their feet. I think that happens on both 30 hr long calls and on night float. Although I agree with Mike in the way that cross-covering leads to a lot of mindless drone like activity in the middle of the night…

  • Anonymous

    Mike, it’s how medicine is coming to be practiced in the hospital. What hospitalist still works q4 overnight call? And you do know something about the patients because you are on every night and check in with the day team every morning and evening, and get sign out – not that it’s a perfect system but you aren’t blindly flinged into the hospital. I’ve worked both systems and I much prefer night float. It makes you not absolutely hate life when an admission comes in at 3 am, and I’m actually awake enough to care about the patient rather than find the quickest way to finish my work and try to sleep.

  • Panda Bear

    You know what? I don’t care. I just want to sleep every night (or day). Missing sleep every fourth night for two to five years is a crappy way to live and if the cost of doing this is that a few things will be missed in incredibly co-morbid, horrifically sick patients for whom most medical care is only marginally effective then that’s the price we’re going to have to pay.

    For my part, I have done plenty of cross-cover and night float and while it may not be ideal, most patients will keep overnight. The real problem is that interns don’t know anything, not that they don’t know anything about patients. I am in my fourth year of residency and I can easily cross-cover even our busy ICU because:

    1) Most of the patients are on autopilot anyway and are “meta-stable.”

    2) Those who are not do not require complicated diagnostic skills but mostly just a good grasp of basic medical principles, facility with ACLS, and the ability to make a decision. Most of my calls over-night for all fifty beds in our ICU are relatively minor and the ones that aren’t get my full attention.

    3) The beds are staffed by excellent nurses who know what they are doing.

    4) Everything is not a friggin’ emergency.

    I’d also like to point out that the real problem is that most teaching services are not “capped.” Once you go past twenty patients or so it doesn’t matter who is covering because between the admissions and everything else you cannot possibly know about all of your patients, patients who are an order of magnitude more complicated than they were back in the Golden Era of residency training when residents knew their place and didn’t complain.

  • Chet Morrison, M.D.

    I think the take on this is horrendously wrong. How would you like to be the patient that the intern is learning to ‘grow stones’ on?

    We need a much better system of patient care

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