Johns Hopkins Medicine - ACCM: Call System
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Resident, Dr. Christy Gray, prepares the code bag for her shift on the CA-2 night float rotation.

Call System: Optimized for Maxiumum Learning

Here at Hopkins, we realize that each resident is more than just a physician. Each of our residents has an active life outside the hospital, and we seek to keep call from making too great an impact on life. We are also exquisitely sensitive to ACGME restrictions on resident work hours, and care is taken to ensure that no resident ever violates a work hour regulation.

Most clinical duties have a night float system that covers call. In the Zayed Building Operating Room (ZBOR) there is a CA-1 and CA-2 on night float. Monday - Friday the night float team will arrive at 7pm and leave after morning debriefing with the night attending by 8am. Call on Saturday and Sunday are covered by a traditional 24-hour call system. Each resident has at least 2 weekends per month free of clinical duties, the other 2 weekends may have a 24-hour call on Saturday or Sunday. This maximizes resident time on each specialty rotation, ensuring their weekday schedule is minimally impacted by the presence of call duties or post-call days. The CA-3 for call is responsible for administrative duties and OR supervision, this resident is expected to arrive at 3pm on the day of call (the day of call is free of clinical duty before 3pm) and will leave after morning debriefing with the rest of the team (by 8am). This CA-3 is not a part of the night float team which will allow the night float team to work with a different CA-3 each night. The ZBOR call team of an attending, CA-3, CA-2, and CA-1 have a structured teaching system that will provide a cohesive curriculum over the 2 week night float period.

There is another night float rotation staffed by CA-2 residents to cover OB anesthesia at the main Hopkins Hospital (Sunday-Thursday 7pm-7:30am). There is a night float rotation staffed by CA-3 residents to cover OB anesthesia at Johns Hopkins Bayview (Monday-Friday 7pm-7:30am). Finally, there is a CA-2 or CA-3 resident that will arrive at 3pm on their call day (the day of call is free of clinical duty before 3pm) to cover the Weinberg building airway pager, acute pain questions, and emergency Weinberg OR cases that will debrief with the ZBOR call team and leave by 8am on their post-call day.

Most residents will have 2 weeks of night float as a CA-1 (Monday-Friday), 2 weeks of CA-2 night float for the ZBOR (Monday-Friday), 2 weeks of CA-2 night float for OB (Sunday-Thursday), and 2 weeks of CA-3 night float for Bayview OB (Sunday-Thursday). Some CA-1 residents and some CA-2 residents may have to take up to 2 weeks of additional night float. But, in general, night float will not exceed 4 weeks in the CA-1 year, 6 weeks in the CA-2 year, and 2 weeks in the CA-3 year.

Please see the table below for a summary of call requirements outside of night float requirements:

Rotation Call Frequency Notes
General OR Call Pool, CA-3 q5-6 Report for call at 3pm on weekdays and 7am on weekends.
General OR Call Pool, CA-1/2 2 24-hour weekend calls per month Report for call at 7am on weekends.
SICU q3 24-hour call Residents on Saturday call have the Friday before Saturday call off. No clincial duties on Saturday or Sunday unless on call.
WICU 24-hour call on Friday or Saturday each week Day float and night float from the Department of Surgery covers Sunday-Thursday evenings and nights, residents on call Friday will have Sunday off and residents on call Saturday will have Friday off.
NCCU No more often than q3 24-hour call Residents on Saturday call have the Friday before Saturday call off. No clincial duties on Saturday or Sunday unless on call.
Vascular/Thoracic q4 Call is from home once that day's cases are done.
Cardiac q4-5 Call is from home once that day's cases are done.
Post-call residents do not do cases.
Residents that stay after Midnight on call
days do not come in the next day.
Outside Rotations No Hopkins call Call determined by hosting institution.

The call pool for weekend call in the ZBOR (24-hour Saturday and 24-hour Sunday) and weekend call in OB anesthesia and OB anesthesia at Bayview (Friday 5pm-7am, 24-hour Saturday, and Sunday 7am-7pm) is pulled from ZBOR rotations (other than Vascular/Thoracic and Cardiac), Weinberg PACU rotation, Pre-operative Evaluation Clinic, Acute Pain rotation, Chronic Pain rotation, and OB rotations. Weinberg call pool is drawn from the previous list, but from only the CA-2 or CA-3 class. Residents on Research rotations are generally expected to take call as well.

Hopkins uses a "jeopardy" call system to cover for residents who are sick or who have family emergencies. Each resident gets an equal number of jeopardy call days per month, which typically amounts to 1-2 per month. A jeopardy day is like any other day unless a resident who is on call is sick or cannot perform his or her clinical duties. Residents on jeopardy are expected to be available by pager. To avoid abuse of the jeopardy call system, any resident who has to take advantage of the system is required to pay that call back to the resident who was "jeopardized."

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