Who is covering for you on off hours? Process can break down without a plan
Risk managers encourage employees at all levels to contact them if they have concerns about a patient safety issue, or when any situation arises that could result in a lawsuit or other liability. But when one of those issues arises when you’re not at work, who is covering for you?
Off-hour call coverage should be designed to make sure a risk manager is available any time the person at the hospital needs one, says John C. Metcalfe, JD, FASHRM, vice president of risk management services with MemorialCare Health System in Fountain Valley, CA. That availability means at night, on weekends, and even when you’re away on vacation.
But that requirement doesn’t mean you can never relax. Not every incident needs to be handled by a risk manager, and even when it does, the director of risk management probably is not the only person to call, Metcalfe says.
The important point, he says, is that you should carefully construct a plan that ensures risk management concerns are never given short shrift on off hours. All of your risk management efforts can go awry if hospital staff don’t call for help during off hours and you subsequently lose hours or days of response time after an incident.
"Each week we assign off-hour call coverage to one of our nine Department of Risk Management Services team members. The call schedule is circulated to each campus within our MemorialCare healthcare system," Metcalfe says. "In addition, each campus has telephone numbers for back-up risk management call coverage should the team member on-call not respond in a timely manner."
That system makes the Department of Risk Management services available 24/7, 365 days a year, he says.
That approach might be more difficult for smaller hospitals or health systems, notes R. Stephen Trosty, JD, MHA, ARM, CPHRM, president of Risk Management Consulting in Haslett, MI, and a past president of the American Society for Healthcare Risk Management (AHRM) in Chicago. He has worked in facilities ranging from 45 beds to 600 beds. In the larger facilities with several staff in risk management, on-call duty was rotated among them in the same way as at MetCalfe’s hospital.
When he worked for medium size facilities in which there was only one risk manager, that person was on call, but only for extreme emergencies. Examples include any serious and significant injury to a patient, such as a severed spinal cord or brain injury due to too much anesthesia, as well as legal minefields such as a pregnant patient who refused a blood transfusion necessary to save the baby. "Staff also called when it was felt that family should be spoken with before Monday, on a weekend, or even before morning in rare occasions," Trosty says. "In these instances, we wanted a risk manager called."
This same approach was used in the small facilities, in which the risk manager usually was also the quality improvement person and often the utilization review person. In these small hospitals and nursing homes, there was not the luxury of having a dedicated risk manager, Trosty explains.
"Therefore, it became even more important to educate and train all staff on identification of risk management issues and basic risk management approaches and responses before the risk manager was again in the facility," he says.
Payment for on-call service should not be an issue because risk managers, administrators, heads of nursing, and chiefs of medical staff are salaried, and off-hour call is part of job description, Trosty says.
Train others to back you up
Jane McCaffrey, DFASHRM, MHSA, recently director of compliance and risk management at The Blood Connection in Greenville, SC, and a past president of the American Society for Healthcare Risk Management (ASHRM) in Chicago, says, "When you are a risk management department of one, it is crucial that clinical supervisors and medical staff leaders are coached in the first actions necessary in a risk situation." Those first actions include communication with patient and family, staff communication, factual documentation, preservation of evidence, and understanding what can be evidence.
The training should emphasize that the first few minutes and hours are critical to gathering the necessary information and evidence, and for proper communication with the patient and family. Because such off-hour situations are infrequent, checklists can provide the best support, McCaffrey says. The training and checklists should extend to public relations staff as well as administrative staff, she says. (For more on training staff and using checklists, see the stories on p. 87.)
"I have even heard of facilities conducting crisis or risk event exercises to be sure training and support material maximizes intent," McCaffrey says. "I also suggest that each sentinel event review should include questions such as What if this happened at night? What if it was during a storm? Did the checklist and training guidance give support? Were the right people available? And so on...’"
When staff members should call a risk manager also is another point that should be established from the outset. Training and checklists can eliminate some questions, but there still will be gray areas. Metcalfe says he wants a call any time someone even wonders about calling for help, and he educates hospital staff that there are no barriers to calling an off-hours risk manager.
"We promote and encourage call to our service anytime a MemorialCare facility believes it has a need for it. We believe it is imperative that our organization understands we are here to be called and consulted each and every time one of our facilities believes they have a need for us," he says.
McCaffrey and Trosky take a similar approach to this issue, and they say that they would rather have the occasional call for an issue that doesn’t truly need their attention than find a memo on their desk Monday morning about a crisis that happened over the weekend.
"As risk management champions we have to be ready to serve 24/7/ 365 days a year, year in and year out," Metcalfe says.
- Jane McCaffrey, DFASHRM, MHSA, Director of Compliance and Risk Management at The Blood Connection in Greenville, South Carolina. Phone: (864) 751-3092. Email: email@example.com.
- John C. Metcalfe, JD, FASHRM, Vice President, Risk Management Services, MemorialCare Health System, Fountain Valley, CA. Phone: (562) 933-2000. E-mail: firstname.lastname@example.org.
- R. Stephen Trosty, JD, MHA, CPHRM, President, Risk Management Consulting, Haslett, MI. Phone: (517) 339-4972. E-mail: email@example.com.