Amy's blog about training

The Value of an Accurate Protocol in On-Call Information

Posted by Amy Engebretson on Thu, Jun 06, 2019 @ 11:27 AM

 success smart medical doctor working with operating room as conceptImagine it's 3:00 am and a patient arrives in the Emergency Department at a local small hospital with chest pains.  According to a June 2016 Harvard Medical School article When chest pain strikes: What to expect at the emergency room "Every 43 seconds, someone in the United States has a heart attack. " Once evaluated by a nurse and Emergency Department physician, many times a specialist is needed to further treat and/or perform advanced procedures.  When this happens, a call goes out to figure out who the on-call Cardiologist is that is covering the ED that evening.  Depending on the organization that process alone may take several minutes or much longer. 

Some hospitals still use three-ring binders, hand typed and faxed call rosters and even post-it notes to keep on-call information accurate and up to date.  Often these organizations "dial-and-pray" that they have called the correct physician at 3:00 in the morning.  If not, they will be meet by an angry person on the other end of the phone informing them that they are not on-call and to call someone else. 

More advanced hospitals rely on web-based on-call management systems that maintain a live view of who is on-call for what specialty and how to reach them when needed.  These systems like Call Scheduler also include detailed protocol for each physician in order to speed up the process and locate them faster and more efficiently.

Would you be surprised if I told you that some physicians only take call for their own private patients?  Did you know that sometimes there is a different physician on-call for "other or unassigned" patients? 

Many practices and physicians have different processes in dealing with on-call requests depending on the time of day.  For example, if its during office hours, call the clinic or answering service first.  If it's between the hours of 5pm-11pm, call the physicians cell phone or send him or her a secure text message using systems like TigerConnect.  If it's after 11pm, call his or her home phone (not the cell phone) because they don't hear their cell phone when sleeping.  

In some circumstances where physicians are working remotely and must stay in a hotel or a hospital on-call room, the protocol may be to go and wake the doctor if she or he didn't respond to the first call or message.  In larger teaching environments the protocols may be to always call the resident physician first, followed by the chief resident and lastly the attending doctor.

Considering that every 43 seconds someone in the US has a heart attack, imagine how often “who’s on-call for stemi?” is asked every day in every hospital ED throughout the US?  Being able to manage complex protocols that are physician specific and time specific are paramount in quickly locating and communicating with the right doctor at the right time.  On-call information management isn’t just about “who is on-call”. Systems like Call Scheduler have transformed well beyond who and now also include how and preferred ways to locate and communicate with physicians.