• E-mail
• Print
• RSS

Editor's pick: Coverage models

Hospitalist Leadership Connection, February 20, 2008

When customizing your hospitalist program schedule, carefully consider the pros and cons of the following coverage and practice models to determine the right fit for your organization.

Daytime coverage: Daytime coverage is typically defined as 7 a.m. to 5 p.m. coverage. The hospitalist conducts daily rounds on all patients on the practice service and conducts all admissions that occur during these hours. Referring physicians that use the hospitalist service provide the night call. Another option is to have the hospitalist participate in nighttime call on a regular rotating basis with the same frequency as the outpatient physicians. This model requires the least amount of staffing, is cost effective, and maintains continuity of care. However, providers are responsible for participating in night call.

24/7 coverage: This model is a full-time hospitalist program that requires in-house hospitalist presence 24 hours per day/365 days a year. Staffing requirements are typically greater for this type of coverage.

Traditional call: This coverage arrangement requires all members of the practice to cover night call on a regular rotating basis. Thus, the hospitalist frequently works a 36-hour shift. This model is cost effective, maintains continuity of care, and enables flexibility in scheduling. The disadvantage is that night call and weekends can be overwhelmingly busy.

Block scheduling: In this coverage model, multiple providers work days, one or two providers work nights, and some combination of providers works during the weekend. The hospitalists' schedules are "blocked" so that each works for four to 14 consecutive days, followed by a number of days off. The advantages of this model include continuity of care, lack of call, and increased availability, which fosters communication and effective case management. The disadvantages include a decrease in scheduling flexibility and potential for provider burnout.

Shift work: Shift work is often confused with block scheduling, but it is a distinct model in which providers are scheduled to work a day, evening, or night shift. The shifts may vary from day to day, and a hospitalist's work schedule may be fragmented. Advantages of this schedule include the elimination of call, flexibility in scheduling, and predictability for hospitalists. Disadvantages include discontinuity of care, loss of teamwork and practice camaraderie, and potential disruption in communication.

Seven days on/seven days off: With this schedule, hospitalists are divided into two or three teams depending on practice size. They are scheduled to work for seven consecutive days followed by seven consecutive days off. The team rotation is staggered so that all hospitalists do not change at one time. This model appears to provide continuity and many physicians are attracted to it for lifestyle purposes. The disadvantages of this model are that the physicians may not be available to provide the added-value services on their weeks off. Additionally, scheduling flexibility and communication decline.

Editor's note: The above information was excerpted from "Tools and Strategies for an Effective Hospitalist Program," published by HCPro, Inc. Click here for more information about this book.

• Comment
• E-mail to a Colleague
• Print
• RSS
• Archive

Comments