Seek nocturnists dedicated to the job

To address the problem of increased risk to patient safety in off hours in your own facility, risk managers should first assess the risk. Study the off-hours calls to the rapid response team, cardiac arrest outcomes, sentinel events, and other incidents relative to safety and outcomes, says Carol A. Burkhart, RN, MS, ARNP, CPHRM, CHC, senior vice president with Marsh/Clinical Healthcare Consulting in Chicago.

Your own data should indicate how strongly the facility or health system needs the assistance of nocturnists, she says.

When seeking physicians to fill those roles, Burkhart advises seeking those who are hospitalists and dedicated to the subspecialty of nocturnal medicine. Also look for good communication skills, because that skill is one of the most influential factors. Peer references should be strong, and the nocturnist should understand the job duties clearly, she says. Medical staff should be onboard and understand why you are bringing these specialists on staff.

The physician who serves as nocturnist should be able to dedicate substantial time to the role, says William Hanson, MD, professor of anesthesia and critical care and the chief medical information officer at the University of Pennsylvania School of Medicine in Philadelphia. That dedication means scheduling a week or two at a time, if not every week, rather than just a night or two here and there. To improve safety and outcomes, the nocturnist must be prepared to work off-hours on a regular basis, and that schedule usually means finding someone whose family life and personal disposition can match that schedule.

The nocturnist must be committed to providing the highest standard of care on hours, Hanson says. Ideally, the nocturnist will be just as committed to the actions that improve safety and outcomes, such as discharge planning, as the best physician working more typical hours.

"The key is to get someone who sees this as their work, the importance of being up and about at these hours and how that can benefit patients," Hanson says. "There are a group of people who are happy to paid as placeholders, but they aren't necessarily interested in being up and actively engaging in care during the night. Don't settle for having a warm body there during the night."