Does Tulane have a Nightfloat System? Yes and No.

Let me give you my take on nightfloat…

Nightfloat seems like a really good idea when you think about having the time to focus on your admissions on a call day without the hassle of nightfloat duties. Then you realize that someone has to be that nightfloat, and when it is your elective month, guess what? In most programs, that person is going to be you. Nightfloat in most programs is also ultimately non-educational… you are on your own with no resident assigned to teach you, no attending physician to teach you the following day; the result is that you end up making the same mistakes again and again.

For nightfloat systems that take admissions overnight and then sign them out the following morning, you also introduce the pain of multiple handoffs, the pain of trying to re-do an admission in the morning (the nightfloat work doesn’t really save you much time), and the loss of quality of care that goes with each handoff.

Yet you do not want a program that has no support for you while on call. The Tulane nightfloat compromise is this:

Each team has two interns instead of one. On alternating call days, one of the interns does 70% of the admissions and 30% of the nightfloat; the other intern does 70% of the nightfloat and 30% of the admissions. Since both interns are part of the same team, they both enjoy the support of having a resident and an attending responsible for their teaching: they don’t make the same nightfloat mistakes again and again. All of the admissions go through the on-call team, so there are no patient handoffs the following day. Since there are two interns, there is always the opportunity for one of the two to hold both pagers for a few hours to allow the other to get some sleep (and vice versa). And best of all, when you are on call, you are on call; when you are not on call, you are not on call. Namely, when you are on one of your six non-call months, you will not be called in for nightfloat duties. You can enjoy these months and make the most of developing yourself and your life within and without medicine without the hassle of having to do nightfloat duties.