A Strategy for Surge Management: Senior Residents on the Admitting Frontlines

Hospitals adapt to surges in a variety of ways, including expediting admitting and discharge procedures, hiring temporary staff and locums to meet increased demand, and temporarily expanding or creating facilities. To mitigate negative effects associated with surges, a small community-based hospital's Internal Medicine (IM) residency program and hospitalist program collaborated by shifting senior residents into admitting physician roles with indirect supervision to meet increased surge needs. This shift allowed an admitting attending physician to shift to a newly created rounding service and, on average, the number of rounding services was increased from seven to nine. Over a fifteen-month period (five quarters), there was a substantial increase in patient census and rounding physicians, paired with minimal differences in individual physician loads, suggesting that this approach helped alleviate strain on the hospital system. Additionally, this approach was well-received by residents, with residents reporting that the workload during the surge was appropriate, that the balance between service and education was appropriate, and that the surge experience was beneficial for their education and ability to practice independently. In summary, this innovative surge management technique has the potential to help mitigate the risk of burnout among hospitalists, while prioritizing resident wellness and education. Importantly, this novel approach may be reproducible in other community hospitals and scalable in larger institutions with residency programs.