Where the “rubber meets the road”: the On-Call Schedule and the Patient.
I hear Schedulers everyday referring to rules, fairness, tallies, and pleasing the physicians. When we are up to our elbows “alligators”, sometimes we forget that the schedule is much more than a set of abbreviations in a date-square.
Behind every calendar abbreviation is a caring individual with a family and friends, who wants to do the right thing. Also on that same date-square is a patient, perhaps a little Baby, relying on that scheduled individual to be the Right Person, arriving at the bedside at the Right Time.
To the patient, the schedule is not about numbers or preferences. It is about Life.
The following is a much abbreviated version of my experience at a well-staffed Boston Birth Center, attending the birth of my first grandchild.
After a perfectly normal pregnancy and labor, things stopped progressing. Several interventions had been tried. However, Baby simply would not “cooperate” for the delivery itself. She was large, her head tilted at an angle, and she displayed distress every time the midwife tried to change her position. Labor had started before 4am, and now it was just before 10pm. Mom was totally exhausted. It was frightening to me (a layman) to see the Baby’s heart rate sink so low well after the contraction passed. Mom and Baby needed help STAT. The midwife advised consultation with the on-call Ob/Gyn and said a C-section might be needed, much to Mom’s disappointment.
All was going well during the labor/delivery for my first grandchild… until it wasn’t.
The Ob/Gyn on call affirmed the need for a C-section straight away and soon as the couple agreed, an amazing dance began. The anesthesiologist appeared. The surgeon and pediatrician were contacted. The hall speaker announced “Dr. Baby… Immediate C-section”. At one point there were six professionals in the room including the various nurses; that’s a lot of brainpower “on-tap” after hours! Mom was wheeled off to the OR just down the hall, with anxious Dad in tow, while Grandma-to-be paced in the recovery room waiting. At 10:11pm Baby Girl was born strong and healthy!
Like a well rehearsed dance, people flowed in and out of the room with calm purpose.
How did the on-call schedule contribute to this happy outcome?
- The on-call schedule enabled a rested, qualified team of professionals to be present when needed.
- The on-call schedule was available in a timely manner and communicated clearly to the professionals who needed it.
From a patient point of view, it was “magic”. We felt informed, well cared for, reassured, and tearfully grateful. However, I teach and support on-call software for physicians and I know it’s not magic. It’s hard work by all parties: long discussions and sometimes heated conversations, missed family gatherings and extended hours, joyful outcomes and sometimes simple frustration. It only looks effortless to the patient; the rest of us know better!
The “name” in the date-square meets the “patient” in the date-square!
Notice, it didn’t matter how the schedule was created, but how it was communicated and implemented that contributed to the patient outcome.
Does software make it easier, quicker and more accurate for both the on-call schedule creator and everyone else involved? No doubt it does. But “quick” does not mean “better”. I’d like to see a study with a direct overlay of the on-call schedule and patient outcome. I wonder, how many of the rules Schedulers use to create the on-call schedule have to do with provider work/home balance and provider convenience vs coverage needs and provider fatigue?
I came away from my Boston experience with a renewed respect for all the parties involved in the “dance” of patient care, particularly regarding the on-call teams, the unsung staff who schedule them, and a keen awareness of the vital role the on-call schedule plays in patient health everyday across the nation.
Thank you so much for the difficult work you do!
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