Innovative On-Call and Team Schedule
The Neurology Department at Case Western Reserve University / University Hospitals Cleveland Medical Center adopted a new service schedule in 2012 that optimized the team structure seven days a week, both during the day and night. Teams include the day teams, short-call evening team and the night service team.
During the day, the stroke and general services admit patients and see consults in their respective specialties. The stroke and general teams have an attending, senior neurology resident (PGY4), an assistant senior neurology resident (PGY3) and two or three junior neurology residents (PGY2). In addition, there are rotating residents from internal medicine, emergency medicine and psychiatry, as well as fourth-year acting interns and third year medical student clerks. The stroke team also has a vascular neurology fellow.
Short Call Evening Team
From 4 p.m. through 9:30 p.m., the short call evening team consisting of a supervising PGY3 resident and one junior neurology PGY2 resident, as well as rotating residents from other services and medical students. This team covers new admissions and consults up to 9:30 p.m., as well as covering the patients previously admitted on the stroke and general services. Attendings from the stroke, general, epilepsy and neuro ICU services are on pager call the entire evening.
Night Service Team
From 9:30 p.m. through 7 a.m., the night service team consists of a senior PGY4 neurology resident and a junior PGY2 neurology resident. The night service team covers all consults and admissions, as well as takes care of issues on the regular stroke and general teams. Attendings from the stroke, general, epilepsy and neuro ICU services are on pager call all night.
There are formal verbal and electronic sign-outs twice a day between the day and evening teams and between the evening and night service team.
The advantages of our on-call team system include the following:
- All neurology residents will sleep in their own bed at home every day during the residency.
- Working all day and then being on call at night no longer exists.
- No resident will work longer than a 16-hour shift.
- Junior residents on the Stroke and General Services will never need to miss rounds where in the past they were required to leave post-call.
- Junior residents on the stroke and general services will never need to miss any of their continuity clinics where in the past they were here required to leave post-call. If their clinic time fell on a date post-call, the clinic needed to be cancelled in the past.
- Junior residents on the stroke and general services are able to attend more educational conferences, as in the past they were required to leave post-call and were not permitted to stay, even to attend teaching conferences later in the day.