A 52-year-old male patient presents in your Emergency Department with a chief complaint of chest pains and shortness of breath. The physician orders an EKG. Now she wants the strip reviewed by the Cardiologist on-call. Where do you go to find out who is on-call for Cardiology? How do you know if you have an Interventionalist “on” tonight? Do you trust the information you find or do you have to call and verify? How do you know if there has been a recent change and you’re not calling the wrong doctor?
Accurate, up-to-date, on-call information is paramount to running an efficient, modern Emergency Department and Transfer Center. That was the goal of a hospital CIO on a call last week who told us, “We need to build one source of truth” for this on-call information. I was intrigued by his choice of words “one source of truth”. When asked to clarify, he told us that the volume of schedule changes are “chaotic” and are often documented incorrectly. Worse, they are then redistributed throughout the organization. What has happened in this specific organization is that the current system is seen as “broken” due to its inaccuracy.
In a hospital, inaccurate physician on-call information affects everyone from patients to providers and everyone in between. You might be surprised to learn that accurate on-call information starts at the individual medical practice or department. According to prominent healthcare leaders creating, updating, and communicating physician on-call schedules is one of the largest time sinks in modern healthcare.
When a healthcare system creates an initiative to build “one source of on-call truth”, the foundation will be implementing an enterprise-wide physician call scheduling software solution throughout the organization. There are two types of scheduling systems, manual entry and automated. In order to get the most value from an on-call scheduling software, it’s best to choose a fully automated system that has a few basic functions.
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Allow each provider and assignment to have a unique set of rules. Once configured, an automated system can generate a fair and evenly distributed on-call schedule in seconds. This automated process can be used over and over to save a significant amount of time.
Allowing providers to electronically submit time-off and vacation requests from their phones will organize and systematize the process of time-off for both physicians and schedulers.
A feature-rich set of tools can help managers prove fairness and schedule transparency to providers.
One of the largest culprits of schedule inaccuracy involves changes and swaps to the schedule that are not properly documented and communicated. A formal scheduling solution standardizes this process so that all changes are captured and the appropriate parties notified in real-time.
Sadly, most organizations still manually assemble the “daily call roster” and fax or email this sheet throughout the organization every day, burdening staff with time-consuming, unnecessary steps. Modern systems automatically merge and feed telecom and ED dashboards to display a live feed of who is on-call and immediately updates schedule changes.
TigerConnect’s role-based communication allows busy mobile hospital users to message a role or team without having to know who is “on-service” for a specific assignment. Sophisticated role-based messaging systems like TigerConnect Clinical Collaboration Platform include the ability for a new role owner to inherit conversations of the previous role owner at shift change to reduce any loss in continuity of care.
At this point, some of you reading this might be thinking, who cares about how the schedule is created, we just need to find the right provider? So, what if it takes a few extra minutes to find the correct on-call physician? Those are fair questions, let me dive a little deeper into the pain that not having an integrated on-call can cause within a busy hospital.
Without accurate information, the wrong physician can be called or messaged when not on service. Each time this happens, depending on the individual physician, this call can cause frustration and stress to the doctor. This is often referred to as physician dissatisfaction. I think we can all agree that most of the doctors that we interact with are extremely busy and a lot is expected of them not only in the clinic but also in the hospital. The last thing a busy person wants on their day-off or in their downtime is someone calling for a consult when they are not on service. Often, calling the wrong physician when they are not on-call will be brought up and investigated by the Vice President of Medical Affairs. Physician dissatisfaction is the leading cause of someone deciding to leave and find another organization.
This is the other side to the wrong doctor getting called. The person calling the wrong doctor will often be verbally reprimanded on the phone for the error. Too often, we see a telecom person, or someone in the ED looking at outdated, inaccurate on-call information. Rarely is the person who calls the wrong doctor the same person who made the scheduling mistake. The mistake is traced back to an outdated paper system that cannot keep up with the large number of changes in coverage that we see today.
Extended wait times in the ED inevitably cause a delay in patient care while trying to locate the correct physician. This area is one that seems the most obvious to me. In 2014 the CDC reported that the average ED wait time was about 30 minutes, plus another 90 minutes waiting for treatment. Ask any mother of a young, sick child what the experience is like in the waiting room of your favorite hospital—it feels A LOT longer. There should never be a delay in care due to outdated, paper on-call information, especially not when there is robotic surgery going on in the basement.
How easy or difficult is it to make a transfer into your hospital ED, Cath Lab, or ICU? Do others have to call you to see if you even have coverage of that particular service? Why is it that many ED’s have wait times posted on their website, but they make other hospitals call them to see if they have an on-call Neurosurgeon available for a case? Remember that transfers are a source of revenue for your hospital. Make them as easy as possible for other hospitals to work with your hospital.
Finally, the Emergency Medical Treatment and Labor Act (EMTALA) is a Federal requirement for participation in the Medicare program. It requires hospitals to maintain a list of physicians who are on call for duty after the initial exam to provide treatment necessary to stabilize an individual within an emergency medical center. Failure to do so can produce fines of $50,000 for both the hospital and the physician. An automated on-call physician scheduling solution can help ensure coverage across all required roles and keep costly fines at bay.
Where do people in your organization go for one source of on-call information truth? By now it should be apparent that sophisticated, cost-effective on-call management solutions can quickly and easily transform your hospital for greater efficiency, happier staff, and more satisfied, cared-for patients.