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
- Badmouthing/ 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.
- 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
- Transport to different hospital
- You get the point!
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Tags: Physician On-Call Schedules