Ripple Effect of “Off-Line” Physician On-Call Schedules on Stakeholders

Are you continuing to use paper, Word, or Excel to create and publish your on-call?
Are you possibly printing or emailing the updates?
Are you contributing to the problem?

Are you pissed off enough to change?

On-Line, interactive physician on-call schedules are just what the doctor ordered. The consequences of inaccurate on-call schedules ripple across Healthcare, hurting various Stakeholders… Including Grandma and Babbly Jr.

Here’s how the “pain flows”:

1. Clinic-Staff/ patient scheduler

    • Cancelled elective procedures because MD no longer coming in post-call
    • Calls to patients and rescheduling* Overload of urgent cases to staff on duty.
    • Overload/underload of daily staff.

2. Clinic-Scheduler-creating schedule

    • Hours spent getting it together. Who wants what?
    • Multiple places for error (vacations, tallies, rules, swaps, tracking of requests)
    • Never “right”, always feels inadequate.
    • Feeling exploited
    • Defending schedule. Justification for decisions in resulting schedule
    • Proof of fairness (time-consuming)
    • Audit trail for requests (cumbersome, scattered)
    • Multiple re-publishing/ re-distribution
    • Fuzzy rules. Paper too easy to change?

3. Telecom- Communications- After Hours center

    • Supplied old schedules
    • Non-standard format. Difficult to read.
    • Paper trail audits. Phone messages for incoming changes
    • Incorrect phone numbers supplied
    • Last to know or first to know changes? (communication to/ from original Group)

4. Hospital ER – ED

    • Wrong MD called or doesn’t show up. (Wrong MD listed)
    • No backup flagged, so MD not available
    • Long wait times for coverage arrival (didn’t know on-call)
    • Lack of MD cooperation/ coordination of care. Won’t come in
    • Not enough or too many staff
    • Having to close ED if not sufficiently staffed for certain specialty (especially small/rural)
    • Incorrect phone numbers
    • Non-central contact for call schedule updates.
    • Communication delays and errors in patient hand-off or coordination. (MD-MD and specialties)
    • Increased transfers to another hospital with responding specialty
    • Last to know or first to know changes? (communication to/from original Group/Clinic)

5. Provider at home

    • Interrupted, inconvenienced
    • Feeling cheated of pay (free on-call care instead of paid scheduled procedures)
    • Feeling exploited, overworked,
    • Lack of control, fuzzy rules, lack of clarity, transparency
    •  Lifestyle impact, cheated of family time
    • Uncompensated for physical ER time (showing up instead of only phone consult)
    • Open to lawsuit for ER duty
    • Stress due to specialty shortage
    • Called when not on –call (canceled events)
    • Frequent changes to the schedule due to inability to schedule out further (manual)
    • Loss of income due to elective surgery cancelation post-call.
    • Decreased responsiveness… “crying wolf”
    • Communication to/from scheduler for requests

6. Group overall

    • Loss of revenue if patient leaves altogether
    • Bad mouthing/ reputation
    • Fines due to EMTALA violation
    • Difficulty recruiting specialties unless paid
    • Lack of cooperation/ in-fighting amongst MDs
    • Overall sense of unfairness, decreased moral
    • Loss of revenue for Group due to canceled elective Procedures. canceled due to fatigue
    • Liability outside of outright violation (patient sues due to perception of poor care)
    • Group shared call to get coverage and politics involved.

7. HR- Recruiting

    • Not enough coverage, too many call nights, can’t recruit
    • Can’t promise “fairness and transparency”. Impacts perceived lifestyle
    • Retention issues. Unhappy staff leaves
    • Pay for Call to get coverage
    • Increased subspecialties do not require call. Specialty shortages.

8. Nurses

    • Can’t get patient care accomplished. Feels responsible /frustrated.
    • Yelled at by MD (tired, wrong one, overwhelmed)
    • Nurse burnout and retention issues
    • Old schedules, wrong MD called or shows up
    • Non-standard layouts and abbreviations,
    • Wrong or no numbers available. Calling for numbers.
    • Not centralized location. Where do I find the most current/correct schedule?
    • Increased stress and patient suffering due to delayed care

9. Patient and their family… Grandma or Baby Jr.!

    • Rescheduled if MD cancels and not in the office on scheduled day.
    • Ripple effect on chain-of-care.
    • Medical errors if MD proceeds while fatigued.
    • Long ER waits if wrong MD called or long response time
    • Possible tragedy if no specialty available or delayed
    • Feeling confused and underserved by ED/ER, Clinic, and MD
    • If feeling bad enough, triggers lawsuit
    • Spreads bad news of bad service
    • Communication delay and error to the Patient/family from multiple sources.
    • Increased suffering if waiting for surgery

10. Ambulance

    • Transport to different hospital
    • You get the point!

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