A Single-Resident Experience of Overnight Call Activity at a Multi-Site Academic Health System

Abstract

BackgroundAfter-hours clinical coverage models vary significantly by specialty and institution. Coverage decisions must balance quality clinical care with a safe provider workload. Here, we characterize urology resident on-call activities overnight at a multi-site academic medical center and model the expected volume of clinical activity using inpatient beds, emergency room visits and attendings covered. Materials and MethodsOn-call activities for 70 thirteen-hour overnight shifts spanning five nonconsecutive months between May 2022 and February 2023 were recorded. Clinical coverage included five academic hospitals encompassing 1,761 staffed inpatient beds and an expected nightly volume of 255 Emergency Department visits. The time, source, and clinical features of every call were documented. ResultsAn average of 15 unique calls were received during each shift. Of these, 35% required an in-person evaluation and 12% required a bedside or operative procedure. Approximately a third of calls (36%) were received after midnight. An in-person evaluation occurred within the first hour of 53% of shifts and every shift required at least one evaluation. When normalized for inpatient bed volume, an average of seven unique patient communications occurred per 1,000 beds, leading to two in-person evaluations. When normalized for an expected number of overnight ED visits, an average of one new ED consultation occurred per 100 ED visits. ConclusionsPatient needs were appropriately addressed by a single overnight on-call resident, providing a robust clinical experience. The volume of patient care activities in this experience supports the practice of a “night-float” resident with the clear expectation on-site care is required.