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Use Incentives, Moonlighters to Staff the Holidays


Dr. Simone

Holidays can pose a challenge for hospitalists who have to balance proper patient care with appropriate staffing. Good communication and chart documentation can make all the difference.

Bradley A. Sharpe, MD, assistant chief of medical service at the University of California, San Francisco, department of medicine, says patients admitted on holidays should be able to know treatment they receive is as good as on any other day of the year.

“All groups should probably act under the premise that a patient admitted on Thanksgiving day should get exactly the same care as one who gets admitted the following Tuesday,” he says. “Because there are fewer admissions, fewer tests, [and] fewer procedures, groups can probably dial down their staffing a bit. But it should not be a skeleton crew that could put patients at risk.”

Certainly, maintaining a high level of patient care depends on the attitudes of the caretakers.

Ken Simone, DO, president and founder of Hospitalist and Practice Solutions in Veazie, Maine, suggests making holiday work worthwhile for your staff.

“Hospitalist programs can make holidays more attractive to the hospitalist staff by offering a pay differential or by rewarding holiday work with additional days off,” he says.

Dr. Sharpe also recommends getting staff involved in the scheduling process early so they feel empowered.

Excellent communication, excellent chart documentation, and appropriate staffing are keys to maintaining continuity of care.

—Ken Simone, DO, president and founder, Hospitalist and Practice Solutions, Veazie, Maine

“There is plenty of evidence that a lack of control contributes to unhappiness and burnout,” Dr. Sharpe says. “If the staff feels like they have been part of deciding how to do this, they will be less likely to complain.”

He also discourages using rank or seniority in dealing with holiday schedules.

“For our group, regardless of rank or seniority, everyone is expected to do the same number of major holidays over a three-year period, and then the cycle starts over,” he says.

Brigham and Women’s Hospital in Boston uses blocks of time—usually two weeks—rather than typical shifts; residents are available to cover off-hours, says Sylvia C. W. McKean, MD, FACP, medical director of the hospital and Faulkner Hospitalist Service.

“If there are difficulties with the availability of the existing staff, consider hiring moonlighters such as established physicians in the community, internal medicine or family practice residents, or utilizing locum tenens,” Dr. Simone says. “Non-physician clinicians can also be a resource.”

He notes that staffing needs should be estimated by the hospitalist inpatient census and average number of admissions and discharges per day.

Once that is determined, he recommends “a defined checkout process” between providers who will be off and the providers who work on holidays, similar to checkout protocol on weekends.

“Provider-to-provider checkout is a key component to ensuring patient continuity and safety,” he says. “Appropriate (e.g., clear and detailed) documentation in the patient’s medical record is also important.”

Dr. Sharpe agrees, adding that moonlighters especially should be made fully aware of the process.

“Groups should be sure they have a robust signout and sign-in system to make sure nothing is lost in the shuffle,” he cautions.

The bottom line is that working holiday shifts should not compromise patient care, Dr. Simone says. “Excellent communication, excellent chart documentation, and appropriate staffing are keys to maintaining continuity of care, quality patient care, and patient safety,” he says. TH

Molly Okeon is journalist based in California.

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