In-hospital call is a valuable experience in the professional development of resident physicians, and is one mechanism for placing the resident in a position of increased responsibility for patients. On-call duty in the hospital is one of the requirements of the ACGME for an accredited neurology residency. Our program was an early adopter of the night-float system, and for that reason the number of overnight calls each resident has each month is greatly reduced. Neurology residents take in-house call at Yale-New Haven Hospital (YNHH) only on Saturdays. There is a traditional call system in place at the VA without a night-float system.
In order for new residents to become familiar with on-call responsibilities, and to be comfortable with managing neurologic emergencies, the first two months of the year have traditional call schedules at YNHH, without nightfloat. The sudden transition from internship to neurology can be challenging, and for that reason the first five calls are personally supervised in-house by PGY4 neurology residents, so that this transition is as smooth as possible. During the first two months, call is from 4:00 PM to 8:00 AM on weekdays, and 8:00 AM to 8:00 AM on weekends and holidays.
In September, when nightfloat begins, residents in the call pool (PGY2s and PGY3s) cover Yale on the weekends (Saturday from 8:00 AM to Sunday 8:00 AM as well as Sundays during the day from 8:00 AM to 8:00 PM). There are 2 residents on-call at Yale on the weekends and they cover the inpatient neurology services (ward and NICU), all inpatient adult and pediatric consults, and consults in the Emergency Rooms (adult and pediatrics). On average, PGY2 and PGY3 residents take one Saturday and one Sunday call per month.
As VA call is much lighter than Yale, a nightfloat system has not implemented there, and there is resident on-call there 7 days per week. Residents on call at the VA are responsible for adult ED consults and admissions, as well as all floor consults.
There are 2 night-float residents at YNHH. There is a dedicated resident that covers all of the inpatient Neurology services, including the Neuro-ICU, at 5:30PM on the weekdays. The second night-float resident responds to all consults in the hospital. The resident arrives at 7:30PM on the weekdays and Sunday and receives sign-out from the Second Consult Resident (evaluated all inpatient and pediatric consults on Weekdays) and the Emergency Room Consult Resident (evaluates all consults and stroke codes in the adult ER). The three consult residents help each other distribute the sometimes heavy workload during the busy evening hours.
During the first-half of the year PG2s are assigned to the Inpatient Night-Float block and PG3s the Consult Night-Float block. During the second-half of the year the responsibilities are switched and the PGY2s discuss all consults with the in-house PGY3 resident. For more information about the night-float system please refer to Description of Rotations.
The PGY4 residents are not in-house after the first five calls of the year, but are expected to come to the hospital to assist the junior residents when the workload is heavy or when patients are seen whose care is difficult for the senior resident to supervise from home. All discharges from the ED, as well as all ICU admissions must also be discussed with the on-call attending.