After gathering more information from the emergency team, Dr. Suciu spent 30 minutes examining the patient and talking to the patient’s family. Next she ordered testing, including a stroke work-up. She planned to monitor the woman through the night.
At 10:45 p.m., the patient was ready to be moved from the ED for a battery of tests to determine if she was suffering a stroke.
By her 8 a.m. hand-off, Dr. Suciu reported that the initial tests on the 21-year-old were fine. Her condition may have been related to a migraine headache. The 90-year-old man was stable.
Communication is Key
Facilitating admissions, moving treatment forward, and reconciling medications are typical duties for a night-shift hospitalist. A critical skill is communicating with the specialists and other outpatient doctors who will care for the patients longer-term.
“I always call the consulting specialists at night because 90% of the time they help a lot,” says Dr. Suciu. “We help them because we give immediate care, which improves the patient’s condition, even saves lives, and gets the patient ready for treatment the next day by the specialist.”
Dr. Laumeyer, who started working nights when it was impossible to juggle the needs of her children—then ages 1, 4, and 6—with her 2,400-patient clinic work, says hospitalists must work hard at night to determine the right time to call a specialist.
“I don’t call a specialist until a patient is stabilized,” she says. “Then I try to have clear questions, a sense of when the patient will be admitted, what I will have done, and what needs to come next. Even if they have to come in before morning, I try to make one call.”
An advantage to working nights often, Dr. Laumeyer says, is that hospitalists can learn what specific physicians like to know, how they want to work, and at what point they want to be involved. “Our chief cardiologist says she starts getting dressed as soon as she knows it’s me on the phone because she knows she’ll have to come in,” she says. “I take pride in that.”
While she feels strongly that hospitalists need to be prepared and clear when they call specialists at night, they should never hesitate to call. “If they’re sleepy or cranky, it doesn’t matter,” Dr. Laumeyer says. “What matters is advancing patient care.”
Her Kaiser colleague, Dr. Nagamine, teaches teamwork and communication skills. “This is critical for hospitalists,” she says. Especially at night, “they must be specific about what they need and its urgency.”
Dr. Nagamine believes structured communication systems, such as those used by the military and in aviation, would benefit medical professionals and patients. One example is the Navy’s situation, background, assessment, and recommendations system. “We’re pretty good at background, but we don’t always clearly state the situation and expectations,” she says. “We assume the person will take the information we’ve given them and come up with the same thinking we have. But just by being present in a situation, you know more.”
Dr. Nagamine believes the onus is on night-shift hospitalists to convey a clear picture of what is needed from a colleague because, obviously, “communication failures take patients down.”
She believes the healthcare industry needs to better understand these issues and notes that the Joint Commission on Accreditation of Hospitals urges a standardized structure for communicating that reduces variability in information. “A shy, inexperienced person will say less,” she says. “These systems help to take the person out of the conversation to be sure communications are effective.”