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Policy: Determining the need for on-call backup

Hospitalist Leadership Connection, May 11, 2010

Policy: The [name of hospitalist service] will use staffing patterns aimed at maximum use of provider resources adjusted to patient census and/or acuity of illness. If a decrease in on-site provider resources is needed, the following will be used to make said adjustments.

Purpose: To facilitate access to the [name of hospitalist service] by assuring the availability of adequate resources to meet patients’, families’, and referring providers’ needs while providing safe, efficient quality care.

1.    At morning MD rounds, all patients will be assigned a point value based on acuity. The assigned points are as follows:

• Critical care: 1.5 points
• Medical/surgical/telemetry: 1.0 points
• Critical care consults: 1.5 points
• Medical/surgical/telemetry consults: 1.0 points

2.    If the total points are equal or less than 30 on a day when a third physician (float) is scheduled from 0900 to 2100, the float physician will be called off from 0900 to 1500 and be placed on call from 1500 to 2100.

3.    When the float physician is reassigned to on call to 1500, the point total will be recalculated using 2.0 points for new medical/surgical/telemetry admissions and 2.5 points for all critical care admissions.

4.    If the new total is greater than 40 points, the on-call physician will be called in to work the second part of the 0900-2100 shift (1500-2100).

5.    If the new total is equal to or less than 40 points, the on-call physician will be called off for the remainder of the assigned shift.

6.    The float physician will not be placed on call on any day that the [name of the hospitalist service] is scheduled on the emergency department medial unassigned roster.

7.    The hospitalist administrator on call will be called prior to any schedule changes.

8.    The hospitalist administrator on call will be responsible for ensuring that all schedule changes are recorded on the original time schedule.

The above excerpt is adapted from Tools and Strategies for an Effective Hospitalist Program, published by HCPro, Inc.

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