Background: While many Hospital Medicine groups employ overnight providers to exclusively care for previously admitted patients (cross-coverage), little data exists regarding factors contributing to the perceived workload of this role. The NASA-Task Load Index (NASA-TLX) is a validated questionnaire used to quantify perceived workload. Methods: Overnight providers completed the NASA-TLX at the end of each [...]

Background: While many Hospital Medicine groups employ overnight providers to exclusively care for previously admitted patients (cross-coverage), little data exists regarding factors contributing to the perceived workload of this role. The NASA-Task Load Index (NASA-TLX) is a validated questionnaire used to quantify perceived workload. Methods: Overnight providers completed the NASA-TLX at the end of each [...]

Background: One of the challenges in hospital medicine is the care of patients overnight, when the primary team is unavailable, and care is being provided by those who are not as familiar with the patient. This is compounded by the high volume of pages at night. At UNC Rex Hospital, these factors resulted in delays [...]

Background: Feedback from last year’s Residency Essentials course identified cross-cover as a deficiency. We designed a simulation based cross-cover exercise for fourth-year medical students. The objective was to have students address common cross-cover scenarios and determine need to respond to a page in-person versus telephone. Purpose: Interns are expected to cross-cover but lack formal training. Cross-cover requires gathering pertinent [...]

Background: Cross-covering patients overnight is part of standard Hospitalist practice, however there is little understanding of the workload contribution. Much of the current literature for hospitalist productivity focuses on wRVU, day census, or number of admits per shift. These metrics are not applicable to cross cover since it is largely non-billable work. A cross sectional, [...]

Background: Cross cover as a new intern can be daunting. A 2019 survey of interns across medical specialties showed the majority had no formal cross cover training or experience and felt unprepared to serve in this role. (1) Residencies have been increasing night float experiences and cross cover roles with careful attention to assure duty [...]

Background: When the Accreditation Council for Graduate Medical Education established new regulations for resident work hours, this resulted in an increase in patient handoffs and discontinuity of care in residency training, necessitating resident rotations requiring night cross-cover.(1,2) The annual survey of clerkship directors in 2014 showed only 38.7% of students experience nights during their clerkship [...]

Background: Cross-cover is defined as caring for hospitalized patients for whom one is not the primary provider. This is a common, daily practice for residents and hospitalists. It has been demonstrated that the primary intern for a patient is available for only 39% of a patient’s hospital stay. Despite this, no guidelines currently exist regarding [...]

Background: At many academic institutions, medical students in their last year of training participate in transition-to-residency (TTR) courses. At our institution, our TTR course includes residency-specific tracks including one for students transitioning into Internal Medicine. Purpose: Despite the frequency of cross-cover care, studies note that this skill is not often formally taught, and most incoming [...]