In our anesthesiology residency program, we rotate across six hospitals in the Texas Medical Center. Our county hospital, a level 1 trauma center, is also our primary teaching hospital and where senior residents do many… many… in-house call shifts. I often get asked on social media “what does a senior do on call”, so here it goes!
I get to work around 2:00 PM and “run the board” with the operating room (OR) front desk. We discuss the nurse/staffing availability, how many rooms we can run at certain times throughout the shift and the current operative cases plus add-on case list. Certain days of the week, SRNAs or junior residents need to attend afternoon lectures, so I’ll shift personnel accordingly. This is usually when people are expecting to hear from the senior resident regarding their fate (ie, when they can go home). It’s important to be as fair as possible… but still have enough coverage to staff the ORs and a potential floor emergency or stat operative case.
For the rest of the shift, the senior anesthesiology resident basically guides inflow and outflow from the operating rooms in conjunction with the various surgical specialities. If we can only run two operating rooms for elective cases and a third for potential stat cases, we have to be fair to everyone – orthopedics, neurosurgery, general surgery, etc. They all have countless cases they want to finish during off-hours, but sometimes it’s just not feasible. Rarely I’ll even postpone a purely elective case if the patient strikes me as someone who requires much more workup or optimization prior to proceeding to the operating room… especially at 3 AM with an exhausted skeleton crew.
After the entire day team has gone home (usually around 8 PM), the call team remains consisting of an attending anesthesiology, senior anesthesia resident, and 3-4 junior trainees (usually PGY-2s and/or SRNAs). I’ll be responsible for helping them consent and complete a pre-op assessment for each of their patients, discuss an anesthetic plan, perform said plan, safely maintain the anesthetic, emerge from anesthesia, and transport post-operatively.
I encourage the junior residents to try new things when they’re on call with me like using advanced airway equipment or performing their own peripheral nerve blocks for their cases. Depending on the case load, I’ll create teaching sessions, arrange for breaks (especially dinner), and hopefully give them enough time to catch a few hours of rest.
The senior also runs the post-anesthesia care unit (PACU) ensuring that patients are comfortable, stable, and ready for transfer to the floor, step-down unit, or ready to be discharged home. Occasionally there are post-op complications (like an expanding neck hematoma) which need to be explored further.
We respond to call “code 1 traumas” in the EC and provide airway/line assistance to our colleagues in the emergency department. This gives us a quick preview of the patient in the event that they come to the operating room for a stat laparotomy, thoracotomy, etc. Similarly, we provide similar aid in code blues around the entire hospital.
Being the senior anesthesiology resident requires a lot of organization and communication between physicians, nurses, techs, and other staff to provide safe, coordinated care for our patients each shift. 🙂