Who should manage on-call in the hospital? That’s a great question. In a hospital on-call has many sides. There is the creation of the individual specialty clinic call schedules, the creation and maintenance of the daily on-call roster, maintaining providers contact numbers and maintaining provider protocol information.
The purpose of on-call in the hospital first and foremost is to serve the emergency department physicians who need specialists to assist them in the admittance and treatment of presenting patients. This is done via a daily on-call roster that is used to determine which physician is responsible by law to respond and help. Secondarily it is used by many others within the organization, physicians, nurses, and administration to support patient care.
Although each hospital is very different, I have seen on-call management over and over in the following areas; Medical Staff Office, Emergency Department, Information Systems, Telecommunications and Nursing Support. Med Staff, nursing support and the ED are all medical units. IS and Telecom are administrative units. They both have a different view point.
Who are the players involved in on-call at a hospital?
- The hospital Medical Staff Office dictates who and how on-call will be covered for each specialty.
- Specialty clinic staff creates, maintain and publish a call schedule for their group of physicians.
- Physicians agree to the oncall assignments they are responsible for covering.
- Someone in the hospital receives and manages all of the on-call schedules from specialty clinics.
- Someone in the hospital creates a daily on-call roster.
- Someone in the hospital distributes the daily on-call roster throughout the organization.
- Someone in the hospital makes changes to the daily call roster as they come up, both day and night.
- The Emergency Department uses the daily call roster to determine which physician to call.
- The hospital operator often pages the requested doctor.
- The patient who is sitting in a bed waiting for all of this to happen so that they can be seen and admitted or discharged.
We have found that organizations may have better results if on-call is managed in the Medical Staff Office. Here's why.
- The Vice President of Medical Affairs has clout and a title that can get things done in an organization. When they mandate that something is done a certain way, it is usually done that way. For example, standing orders or credentialing. Other physicians respect this person and will comply with their requests.
- The Medical Staff Office already deals with the physicians on a daily basis.
- If there is a issue with a specialty clinic not complying, the Medical Staff Office can deal with it from a physician management point of view.
- Policy and procedure will be created with the best interest of the patient in mind. No politics or job protection going on.
When on-call is managed properly every player listed above is considered when making decisions regarding on-call. On-call information is readily accessible by all the players listed above, and to the patient the process is seamless and they think that the specialist was already in the hospital when they presented to the ED. It just works.
When on-call is not managed properly, you can and will have a host of problems. Be sure to check out my next Blog Post when I will highlight what those problems look like and provide some proposed solutions.
To answer my above question, I think it is better to manage on-call in a medical department; I have seen better results (regarding compliance and data accuracy) and faster implementation of on-call management.
Remember, the right provider in the right place at the right time does not happen by accident.