ED shift patterns: day, evening, night and overlap

Base patterns

In a national survey of EM residency programs run in early 2023, 9 hours was the most common shift length for first- to third-year residents. ACGME caps resident ED shifts at 12 continuous scheduled hours.

Overlap shifts

Some programs build overlap into every handoff. One runs 9-hour shifts with a 1-hour overlap; another uses its 1-hour overlap so the outgoing team can finish charting while the incoming team sees all new patients.

Others add whole shifts that start between the main changes, often called mid or swing shifts. One residency adds swings at 12:00 and 18:00 to its 07:00, 15:00 and 23:00 shifts; another runs swings starting at 11:00, 15:00 and 17:00.

A third option staggers start times through the day, often called a waterfall. One academic ED with about 54,000 visits a year ran seven overlapping attending shifts starting at 06:00, 09:00, 11:00, 14:00, 17:00, 20:00 and 23:00. Each physician spent the first 2 to 3 hours of the shift in triage, then moved on to finishing the patients they had seen.

Count coverage hour by hour

In this example the physician shifts run 07:00 to 15:00, 15:00 to 23:00 and 23:00 to 07:00, and the APP shift runs 10:00 to 20:00. Counting clinicians on duty hour by hour gives two from 10:00 to 20:00 and one at every other hour.

Set that count beside your own arrivals by hour of day. Where arrivals regularly outrun the count, an overlap shift adds a clinician for those hours without adding another round-the-clock line.

Check what the pattern does to rest

Overlap shifts that end late shorten the next turnaround: a swing ending at 01:00 leaves 6 hours before a 07:00 day shift. In Capillary, the scheduler builds a month of physician and APP shifts, and saving checks role, overlapping shifts and minimum rest for each person. Try it in the demo.

Common questions

Is there a standard ED shift pattern?

No single pattern is standard. Published residency schedules mix 8-, 9-, 10- and 12-hour shifts, and the right overlap depends on each department's arrivals.

What is a waterfall schedule?

A set of overlapping shifts with staggered start times, so a new physician arrives every few hours instead of at two or three fixed changes. In one published version, each physician started with 2 to 3 hours in triage.

How long should the handoff overlap be?

The programs above use 1 hour, or end each shift with a half hour for sign-out. Choose a length that lets the outgoing clinician finish charting.

Sources

1. Kern Medical EM residency: Emergency FAQ
2. NewYork-Presbyterian Queens EM residency: Clinical Curriculum and Rotations
3. NewYork-Presbyterian Brooklyn Methodist EM residency: Rotation Schedule
4. UC Irvine EM residency: FAQs
5. Spiegelman L, et al. West J Emerg Med 2021
6. Medical College of Georgia EM residency: Shift Structure
7. University of Missouri EM residency: FAQs
8. Parsons M, et al. AEM Educ Train 2024
9. ACGME Program Requirements for Graduate Medical Education in Emergency Medicine (effective July 1, 2026)

Related

• Shift schedulingSwing shift and mid shift
• Shift schedulingEmergency physician shift length: 8, 10 or 12 hours
• Shift schedulingHow to build an ED physician schedule
• Shift schedulingForward rotating shift schedules: day, then evening, then night