Every hospitalist program needs night coverage. Noctumists are in high demand and short supply and rotating hospitalists from days to nights is a dissatisfier. Night coverage is Typically more expensive than day coverage because of lower volumes. Many practices face similar obstacles in night coverage. Coverage issues are exacerbated in areas where recruiting is difficult. The alternative to in‐house coverage is a call‐based model, but these tend to be very unpopular, which makes recruiting efforts even more difficult. Some hospitalists cover more than 1 site at night, which can affect timeliness of care and satisfaction.
To describe our unique and innovative Remote Presence (RP) telemedicine noctumist service in a hospitalist program providing 24/7 coverage for 2 hospitals.
We provide hospitalist services in a468‐bed suburban medical center and an affiliated 166‐bed hospital about 30 minutes away. Continuing dedicated night coverage for the smaller hospital was no longer financially viable and recruiting coverage became increasingly more difficult. We obtained state licensure and hospital privileges for our coverage Team of RP physicians living in different states — one of whom lives outside the continental United Stales. They completed a proprietary course for RP certification. Hospital staff was in‐serviced, and implementation staging was completed. Go‐live was successfully executed with a seamless transition from on‐site night coverage to RP noctumist coverage. The full range of services customarily provided by on‐site night hospitalists were provided by the RP noctumist with the exception of procedures requiring hands‐on presence — arrangements for these were made in advance as part of the implementation staging. Of note, a successful code‐blue resuscitation with subsequent transfer to the ICU on a nonhospitalist patient was accomplished by the RP noctumist early on in the implementation. This received widespread acknowledgement and praise from the nursing staff. We have had many satisfied patients and families with this innovative care delivery model.
An RP noctumist service offers an innovative solution to the dilemma of night coverage. By leveraging an RP noctumist, a hospitalist program can secure coverage when needed while eliminating reliance on an in‐house or hospitalist on‐call for frsl calls. RP noctumist coverage can also provide a surge capacity solution to a busy in‐house hospitalist when there is sufficient variability in admission volumes and/or cross‐coverage demands that staffing with a second hospitalist would not be cost effective. RP noctumist services are a solution for hospitalists covering more than 1 hospital. Our experience at this site and others is that RP services are well accepted by patients, families, and nursing staff and that safe, effective, patient‐centered, timely, efficient, and equitable care is provided using this innovative mode of health care delivery.
D. Giarrizzi, none; M, McCormick, none; R. Sanders, none.
To cite this abstract:Giarrizzi D, McCormick M, Sanders R. Tomorrow Night's Coverage Today!. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 164. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/tomorrow-nights-coverage-today/. Accessed March 20, 2019.