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Obtain data that illustrates the extent of the ED coverage problem

Medical Staff Leader Connection, March 8, 2007

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When working with your medical staff to better managing your facility's emergency department (ED) on-call coverage challenge, obtain data that illustrates the extent of the problem. One of the principles of fairly sharing the pain of ED call is that physicians whose burden of call is disproportionately greater in intensity or frequency than that of their peers should be compensated for this additional burden. The only way to determine the true burden of call is to measure it. The resulting data are powerful. Gathering this information could include any of the following processes:

1. Inventory the on-call and patient-care burden for individual specialties
2. Count the total number of on-call days for each specialty and each participant for several months
3. Determine the frequency of call and the number of insured and uninsured patients
4. Research what other hospitals in the area are doing
5. Summarize the total burden of consults, admissions, surgeries, and inpatient follow-up responsibilities
6. Assess the office burden for follow-up care, including the total number of visits and out-of-pocket costs

Collecting this information will allow you to begin to chart a course of action, as well as respond to your medical staff's fears and concerns about their on-call burden. One of the key elements for discussion is how much call each medical staff member can fairly be asked to assume. Data on how much burden is created each time a physician in a particular specialty agrees to a slot in the ED on-call schedule is helpful in this dialogue. Physician may have a distorted perception that the call burden is greater than it actually is. Conversely, members of the administration and board may underestimate the true burden physicians take on with each call slot.

Excerpted from Emergency Department On-Call Strategies by Kimberly Mobley, Richard Sheff, MD, and Bradley Zlotnick, MD, FACEP, published by HCPro, Inc.

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