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.

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!

 

Connect Physician Scheduling & Care Team Collaboration See How Automated On-Call Scheduling Makes Work Easier Download Booklet

 

Tags: Physician On-Call Schedules