On-Call Strategies

While most emergency physicians were attracted to the specialty because of the carefully delineated work hours, we may start needing an on-call arrangement. This will likely be a result of surges and the new extremes of volume variation. This may contribute to the need for on-call backup. Hospital leadership should articulate triggers for both calling in and sending home physicians and APPs. Real-time data should inform these triggers, which will be location specific. A few examples of triggers are listed below:

• Calling in a physician or nurse
  1. More than six people waiting in the waiting room
  2. More than 30-minute waits to see the clinician
  3. A sick clinician
• Sending a physician or nurse home
  1. Fewer than two arrivals per hour for a zone
  2. No nurse or tech to support the clinician
  3. Zone closure

The most progressive emergency departments are learning to build flex into their operations. Ideally, emergency departments should have these flex options mapped out beforehand and standardized to avoid confusion. In the emergency department, we are known for being very creative (anyone remember using a Foley catheter for a posterior nosebleed?), but inventing operations on the spot will be less successful than deliberately gathering your team together to brainstorm how to create more flexibility to manage the inevitable variability in your emergency department. Map out these plans, educate staff, and achieve buy-in in advance. By flexing your geography and your shifts and by planning for contingencies with on-call strategies, your emergency department will be able to bend without breaking as the situation around it changes.

References

1. Pedder H, Jones T, Rejon CS. COV.12: impacts of absenteeism in doctors and nurses in primary care and community care. National Institute for Health Research website. Accessed Sept. 24, 2021.
2. Kanwal N, Riaz G, Riaz MS, et al. Identify the causes of absenteeism in nurses Mayo Hospital Lahore Pakistan. Int J Soc Sc Manage. 2017;4(2):110-114.