Abstract
Background
Current work hour restrictions have required some programs to have staff surgeons
cover in-house call. Other programs have considered in-house staff coverage at night
for the billable tasks performed during these hours. However, there have been no data
published describing the load or value of work that an in-house team performs at night.
Therefore, we prospectively recorded tasks performed in a pediatric surgery training
center after staff had left for the night.
Methods
Between April 2005 and March 2006, all services rendered from 6:00 pm to 6:00 am that would require staff presence were prospectively recorded by a pediatric surgical
fellow on-call. Tasks performed while staff was in the hospital were excluded. Time
of service was recorded and assigned to an hour of the night. Billing codes were identified
for each task, and relative value units were assigned. The collectable amount for
services was calculated using 2006 Medicare reimbursement. Data were analyzed in functional
blocks (6:00-10:00 pm, 10:00 pm-4:00 am, and 4:00-6:00 am).
Results
Data from 111 call nights were collected over the year. Attending staff was in-house
10 of those nights. Of the remaining 101 nights, peak hour of activity was from 12:00
am to 1:00 am (35 nights). In the 10:00 pm to 4:00 am time block, service was rendered 80 nights considering all activity, 68 nights if
trauma/burns were excluded, and 45 nights excluding trauma/burns and nonoperative
admissions. The sum collectable for all overnight services for the year was $25,855.
Conclusion
The in-house resident team performs tasks through the middle of the night on most
nights. However, billable revenue generated by these tasks is very small compared
with revenue generated from the normal operative schedule.
Key words
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References
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Article info
Publication history
Accepted:
February 8,
2008
Received:
January 28,
2008
Footnotes
Presented at the 59th Annual Meeting of the Section on Surgery, American Academy of Pediatrics, San Francisco, CA, October 25-27, 2007.
Identification
Copyright
© 2008 Published by Elsevier Inc.
