Residency Policies & Procedures
V. CLINICAL ROTATIONS
GOALS AND OBJECTIVES FOR PSYCHIATRY NIGHT FLOAT
Goal: The goal of the psychiatry night float rotation is
to provide a supervised clinical experience in managing and triaging urgent
issues arising at night in psychiatric emergency, inpatient, and consultation-liaison
Supervision: Night float residents will be supervised by
backup attendings immediately available by telephone or (in some cases)
on-site. The resident must discuss with the attending any case in which:
a) the resident has any questions or concerns about the patient or the
care provided; b) a patient requests to leave against medical advice (AMA);
c) the resident intends not to hospitalize a patient seen in the emergency
room who has expressed ideas of self-harm or harm to others; d) the resident
intends to turn down a request for admission; e) the resident plans to
send home from the emergency room a patient who has had a rapidly deteriorating
clinical course (e.g. recent onset of mania, anorexia with significant
recent weight loss). The resident will also call the backup attending
to review all consults. Additional requirements to call the backup attending
may be mandated at individual hospital sites. Each night float resident
will also receive one hour per week of dedicated 1:1 faculty supervision.
On completing the psychiatry night float rotation, the resident is expected
to be able to:
1. Patient Care
- Perform pertinent psychiatric diagnostic interviews.
- Gather collateral information, as indicated and as possible, to facilitate
an accurate acute assessment.
- Develop an initial working diagnosis and differential diagnoses.
- Establish rapport with and assess acutely disturbed patients.
- Make rapid assessments of acutely psychotic patients.
- Effectively evaluate dangerousness (suicidality, homicidality) and
- Effectively assess alcohol and drug intoxication and withdrawal.
- Document the database and describe the assessment and plan in a complete
and succinct manner.
- Understand the medical, neurological, and other physiological causes
for psychiatric symptoms and seek medical, neurological, or other specialty
- Effectively assess the need for inpatient versus outpatient treatment.
- Effectively evaluate and triage emergency room, inpatient, and consult
cases at night, determining, with supervision, which issues must be
addressed immediately and which should be addressed by the daytime treatment
- Display appropriate knowledge of basic and clinical sciences relevant
- Display knowledge of the assessment and treatment of psychiatric emergencies.
- Understand the usefulness and indications for stat laboratory and
other diagnostic tests.
3. Practice-Based Learning and Improvement
- Locate and critically appraise scientific literature relevant to
- Regularly use information technology in the service of patient care.
- Participate in practice-based improvement activities, including discussion
during supervision of cases seen and areas for potential improvement
in the resident's care or triage of patients.
- Follow up on patients the resident has admitted and their hospital
course and discuss this follow up in supervision, to learn from these
cases and from the subsequent diagnoses and treatment by the inpatient
4. Interpersonal and Communication Skills
- Create and sustain effective therapeutic relationships with patients,
families, and caregivers.
- Display empathic listening skills " Work effectively with social workers,
nurses, and medical staff.
- Communicate effectively with daytime clinical teams regarding patient
- Check in with staff on the inpatient units and in the emergency room
at the beginning of each night float shift.
- Demonstrate respect for others, compassion.
- Demonstrate integrity, accountability, responsible and ethical behavior.
- Demonstrate understanding of patients and their illnesses in a sociocultural
context, including displaying sensitivity to patients' culture, ethnicity,
age, gender, socioeconomic status, sexual minority status, and/or disabilities.
6. Systems-Based Practice
- Display familiarity with community referral sources available at
- Display understanding of relevant issues of Washington State Mental
Health Law and be able to assess the need for civil commitment.
7. Educational Attitudes
- Display openness to supervision; accept constructive criticism.
- Seek direction and consult the backup attending as appropriate and
required; demonstrate eagerness to learn.
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All rights reserved.
Psychiatry Residency Training Program
1959 NE Pacific Street, Box 356560
Seattle, WA 98195-6560