Managing Physician On-Call Changes Through Policy

It’s 10:30 p.m. on a Tuesday evening, you’re the Obstetrician on-call at your local memorial hospital and you start feeling ill. You call one of your partners and they graciously agreed to cover the rest of your on-call duty until morning. Now, how do you let the Hospital know? Who do you call? What is the process for notifying all critical areas of the hospital?

I understand that a scenario like this is one of the top reasons that physicians get called incorrectly when they are not on-call. You may be surprised to learn that many organizations do not have a written process for physicians to follow in the event they need to change on-call coverage mid-way through a shift. So what happens, often no one is notified or the right doctor is identified by the wrong doctor who is getting called incorrectly (It’s not me, call Jon, we switched!). Patients’ medical expectations are too sophisticated for this to continue to happen.

Section 1866(a)(1)(I)(iii) of the EMTALA Act states, as a requirement for participation in the Medicare program, that hospitals must maintain a list of physicians who are on call for duty after the initial examination to provide treatment necessary to stabilize an individual with an emergency medical condition. If a physician on the list is called by a hospital to provide emergency screening or treatment and either fails or refuses to appear within a reasonable period-of-time, the hospital and that physician may be in violation of EMTALA as provided for under section 1867(d)(1)(C) of the Act.

Although I may be “preaching to the choir”, but there is a risk of severe consequences when the hospital is not able to identify and contact the correct on-call physician. The worst-case scenario includes a hospital being forced to transfer (board) a patient to another facility because they do not have the resources that they have stated are available for an emergent presenting patient. This could be a violation of EMTALA (emergency medical treatment and labor act) which if cited, will cost both the hospital and on-call physician several thousands of dollars in fines. Not to mention the outcome of the patient that was forced to be sent to another facility due to a process failure.

It may be easy to forget how many people rely on accurate on-call information. The chart below illustrates who needs to know what physician is on-call for what specialty.

If you or your organization does not have a current policy regarding “on-call schedule changes”, it’s very easy to create. Here are some things you will want to consider.

  • What is the policy for a change needed to the on-call schedule during the day, on the day you are scheduled to work?
  • What is the policy for a change needed to the on-call schedule, during the day, several days before you are scheduled to work?
  • What is the policy for a change needed to the on-call schedule after 5 p.m. until 8 a.m.?
  • What is the policy for a change needed for the on-call schedule on a holiday or weekend?
  • Is it acceptable to send an email or leave a voicemail message when making a change?

As many hospitals transition from a paper-based on-call management system to an Internet-based system how changes are made to on-call information becomes very important. Especially if management convinced the physicians that a new system was a good investment because it would decrease calls-in-error to them when they are not on the schedule.

In addition, as a physician’s free time become more and more valuable, being on-call may have serious financial benefits. Tracking the fairness of the assignments as well as who worked and showed up in the ED must be accurate. And that accuracy must span multiple organizations. Both the doctor’s office and the hospital need to have mirrored information. Without mirrored information one of the systems will not be accurate. In order to create the next physician on-call schedule, the “scheduler” must pick up where the last one ended. That is how fairness is achieved and that’s why accuracy is so important, even outside of the Emergency Room.

Key Takeaway: Changes to the on-call schedule is important. Especially if your organization has a focus on providing excellent patient care and a strong desire to satisfy physicians.

For more information about EMTALA check out this FAQ post.


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