Hospitalist scheduling is one of the tools in the toolbox of hospital medicine practices.
“And like any other tool, it can be used for good or ill, depending on the skills of the operator,” said Greg Harlan, MD, MPH, director of medical affairs for IPC The Hospitalist Company, Monday at HM12 in San Diego.
Dr. Harlan encouraged hospitalists to make their schedule a target for systematic process improvement, using quality improvement techniques such as survey/plan/implement/evaluate improvement cycles. Work with various constituencies to clarify their concerns and identify up front the appropriate metrics to track (e.g., length of stay, readmissions, and morning discharges). Dr. Harlan also emphasized the value of hospitalist-led multidisciplinary daily rounding on patients, which can improve communication and efficiency.
There are a variety of scheduling models, including seven days on/seven days off, weekday/weekend, admitters and rounders, zone scheduling, and the CICLE (Creating Incentives and Continuity Leading to Efficiency in Hospital Medicine) model, said co-presenter Shalini Chandra, MD, assistant professor of medicine at Johns Hopkins University. “The key is to find your best fit,” she noted, which may be a hybrid of different approaches that reflects the hospital, the patient population, and the needs of the hospitalist group by considering its members’ stages of life.
Responding to surges in patient census, honoring group members' needs for flexibility in scheduling, may present competing dilemmas for the schedule. An electronic scheduling software could be a helpful adjunct, presenters said.
Wayne DeMott, MD, of Victoria Hospitalist Physicians, Inc., in Victoria, British Columbia, said he came to the session to learn how American hospitalists handle the usual problems of managing schedules.
“I’m pretty convinced that there isn't a Holy Grail of scheduling,” he said, adding that the concerns sound similar on both sides of the border. He also said American hospitals have managed to bring down lengths of hospital stays far beyond their Canadian counterparts.