Hi everyone,
Twenty-eight hour call is ending in our residency, beginning next June.
You may ask, what took so long? The answer is we needed to overcome decades of tradition (inertia) and grow the residency to staff night teams.
The concept of overnight call emerged with the 20th century need for hospitals to have doctors “reside” in house to admit patients and address emergencies. Through much of the 1900s, physicians spent hours at the bedside, monitoring blood sugars, titrating insulin drips, following hematocrits, placing IVs, and more. Before the emergence of true multidisciplinary care, no responsible physician would leave the bedside, let alone leave the hospital, if their patients were “active.”
When I was a resident in the late 1980s and early 90s, we accepted overnight call as a given. Our seniors thought we had it easy because our class was the first to take call every fourth night instead of every third. Post-call days had regular schedules: we stayed until our work was done and sometimes we had clinic. Thirty-six hour shifts were typical. Heide can tell you stories about my returning home, babbling and hallucinating, just minutes after signing out.
But in some ways, call was easier then. Patients were generally less sick. On many nights, I’d admit several patients for cardiac catheterization (we called them “CAD for Cath”). I could interview and examine these patients, enter orders, and write their H&Ps in under half an hour. There was no EMR to wade through and medicine reconciliation wasn’t a concept. Because turnover was slower, cross coverage was simpler; our teams included patients completing courses of antibiotics and awaiting test results. On most nights, we’d cap around midnight and lie down for a few hours before morning rounds. Sleepless nights were rare.
Today’s patients are sicker and more complicated. Residents sleep less if they sleep at all. And although there’s surprisingly little evidence for call-related medical errors, there’s no doubt that sleep-deprived residents aren’t functioning at their best. Patients and residents deserve better.
We’ll be able to end overnight call because we’ll have more senior residents next year, which will allow us to create a new night float position. We’ll also end the VA triage role to create a second night resident, ending 28s at the VA. If residual coverage is needed, we’ll tap into our backup system, but that number should be small.
Someday in the future, we’ll ask how we rationalized overnight call as long as we did. The truth is if I could, I’d end call tomorrow. It’s taken years of negotiation, persuasion, logistic planning, and financial support to meet this milestone, and I’m grateful to hospital leadership and the many residents who helped with their ideas and advocacy. With your input, better education, patient care, and resident well-being are on their way.
Enjoy your Sunday, everyone. It looks like a good day to stay inside and drink hot chocolate.
Mark