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Having the right set of ED physicians will reduce the need for specialist coverage, says Pascal Crosley, DO, vice president of CEP America and medical director at St. Agnes Hospital in Baltimore, MD. The more experienced and skilled that the ED physicians are, the less often they will need to call in specialists, he says.
Top-tier ED physicians can cut in half the number of consults, he says.
“Without the right training, physicians will tend to over-consult,” Crosley notes. “The more your physicians are able to address the patients’ needs on their own, the less you will need to call in consultants, and that can significantly reduce the number of consultants you have to have on call. As it reduces the frequency with which those consultants are actually called into the hospital, you will also see more willingness to be on call.”
Another strategy is fostering relationships with inpatient physicians who can make room to see ED patients first thing the next morning, Crosley says. Some patients in the ED need a specialist consult soon, but not necessarily within hours, he says. If you have inpatient specialists, such as hospitalists, who will agree to see those patients early the next morning, it may be possible to avoid waking a specialist to come into the hospital in the middle of the night. That situation, in turn, improves the chances that a specialist will agree to be on call for those patients who do need that care at an inconvenient time, he explains.
Innovative use of data also can help hospitals plan for ED usage and the related need for on-call specialists, says Rich Krueger, CEO of Hospital IQ, a company in Newton, MA, that uses predictive analytics to help hospitals with ED boarding and capacity planning. Patterns of use can help hospital administrators narrow down the safe limits for specialists on call rather than guessing or using generic benchmarks, he says.
“You can look at your data and data from other providers and see, for instance, that if you have this one specialist on call for 12 hours, there is a 90% chance that any patient needing that type of care can be seen within two hours,” he explains. “If that threshold is acceptable to you, you’ve reduced your risk to 10% with just one specialist, and you may determine that you don’t have to recruit a second or third to meet the demand.” That strategy also can be used to aggregate demand across several sites in a community also, Krueger says. “Usually EDs come up with their shift plans and try to line up on-call specialists to fill the shifts. There’s often not a lot of science behind what the demand is going to be and what is a clinically acceptable wait time,” he says. “The data can do that for you.”
Financial Disclosure: Author Greg Freeman, Executive Editor Joy Daughtery Dickinson, and Nurse Planner Maureen Archambault report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Arnold Mackles, MD, MBA, LHRM, physician reviewer, discloses that he is an author and advisory board member for The Sullivan Group and that he is owner, stockholder, presenter, author, and consultant for Innovative Healthcare Compliance Group.