Fig. 2

Pages per hour, by service and year of training. Even within a given service, not all hours of the day are equal. A heatmap of paging patterns helps visualize hotspots across the program. The 8 p.m. hour for interns covering the University night float service is, on average, the most frequently paged role and time in the entire residency program. On the night float services at both hospitals interns are paged in a bimodal distribution, with consistently heavy paging from ~8 p.m. to 1 a.m., and then another peak at 6 a.m., anecdotally known to house staff as the “morning labs” pages, when the night float team must respond to new abnormalities discovered on that morning’s labs. For the inpatient medicine and subspecialty services, on non-call days, paging is relatively steady throughout the day. On call days in contrast, paging frequency increases as the day goes on, peaking towards the end of the shift. This is more pronounced at the University Hospital than at the VA, and more pronounced for interns than senior residents