Last month I discussed my concern regarding how often hospitalists are interrupted. In fact, I suspect frequent interruptions to our train of thought and workflow might lead to as many problems and errors as the sleep deprivation associated with long on-call shifts.
Every hospitalist group should think carefully about the effect their practice organization has on interruptions. Variables, such as the work schedule, the use of communication tools (or interruption tools) such as pagers, cell phones, and e-mail, and the use of clerical support staff, have an impact on the number of interruptions. This month, I will discuss the use of a “triage pager,” which is one example of practice organization that can have a huge impact on physician interruptions.
Worth the Interruptions?
Many large hospitalist groups have a pager to which all calls about new referrals go, and the pager is passed from one hospitalist to another each day or shift. This pager often is referred to as the “triage” or “hot” pager. It makes it easy for emergency room (ER) doctors and others to know how to reach the correct hospitalist about a new referral–they always call the same number. Typically, the hospitalist holding the pager calls the ER doctor back, learns about the patient, and then pages whichever hospitalist actually will care for the patient. The second hospitalist calls back and learns about the new patient from the “triage” hospitalist.
Although this is a valuable service for ER doctors and others referring patients to the hospitalists, it is terribly disruptive for the hospitalist carrying the pager. The unlucky person is interrupted constantly, and likely will have a very hard time providing patient care. Is there a better way to handle the triage function? Is there an alternative triage method, one that reduces hospitalist interruptions and switch tasking? There are three potential adjustments to the triage system you may want to consider (and remember, this is an issue only for larger groups–say more than 15 or 20 hospitalists).
During business hours, Mondays through Fridays, have incoming referral calls go to a clerical person working for the hospitalists. A call received by this person might go something like:
- Phone rings;
- Clerical staff answers: “Hospitalist referral line;”
- ER doctor (or ER secretary): “I have a patient to be admitted to the hospitalist service;”
- Staff looks at the roster and determines the appropriate hospitalist for the next new patient;
- Staff: “That patient will go to Dr. Lovett. Give me the patient’s name and I’ll page Dr. Lovett, who will call you back to discuss the case in a couple minutes.”
This system preserves the easiest way to call referrals to the hospitalists, but decreases hospitalist interruptions and prevents the daisy chain of communication between the ER doctor, the triage doctor, and, finally, the hospitalist who actually will see the patient. Outside of regular business hours, these calls could go to another clerical person on duty in the hospital, or, perhaps, the ER secretary could field the calls and keep track of which hospitalist is up for referral.
If your group can’t, or doesn’t, want to have such calls funneled through a clerical person, the calls could go to an on-duty hospitalist. Rather than calling the ER to learn the details of a new patient who will be cared for by a different hospitalist, the “triage” hospitalist simply looks at a list to determine which hospitalist is up for the next new referral, then sends a page to the physician to call the ER. The triage doctor is interrupted, but immediately hands off the burden of communicating with the ER doctor to the hospitalist who actually will care for the patient.