Work Hours II

So then, what is the solution? We want our doctors to be well rested, thinking clearly, and wary of mistakes, but we also want our doctors to be ours, not a succession of hand-offs between providers we've never met. I would suggest decreasing the number of patients each team takes. With fewer patients, the interns can focus more attention on fewer people, delivering better care. There's more likelihood that an intern can get some sleep on call without introducing more hand-offs.

The question is how to accommodate the same number of patients if each team has a lower cap (maximum number of patients admitted each call night). At Moffitt, the only admitting services separate from medicine are cardiology and a cancer research institute service for "liquid tumors." So we take a lot of "chemotherapy babysits" for solid cancers. When a patient with a diagnosed cancer needs inpatient chemotherapy, they get admitted to medicine for housekeeping while oncology writes all the chemotherapy orders. These patients are of low educational value since the primary medicine team does very little in their management. I think introducing a separate chemotherapy service run by oncology reduces the number of patients admitted to medicine without substantially increasing work for oncology.