Background:
Nighttime care of general medicine patients at University Hospital utilizes a night float cross‐cover system, with a single physician‐intern as the primary coverage. On average, this night float physician cares for 85 to 90 patients. The number of calls this physician receives in a 12‐hour period is perceived to be large, but has never been quantified. In an effort to minimize unnecessary workload for the night float physician, we sought to identify unnecessary calls and develop strategies to decrease them. After observing calls to the night float physician, we focused on calls regarding the results of routine laboratory tests ordered by the daytime service. A literature search did not yield any described methods to address this concern, so we used a process improvement approach to identify and implement solutions.
Purpose:
Reduce the number of pages to the night float physician regarding routine laboratory results by 15% after intervention.
Description:
Our intervention included the following components: 1) Instruction to the medicine teams on enhanced lab test sign‐out procedures. 2) Instruction to the nurses on circumstances when it was necessary to contact the physicians regarding laboratory results as well as on the Lab Quality critical results reporting procedures. 3) Instruction of the night float physician on the use of the “Flag New Result” feature of the electronic medical record at University Hospital. After intervention, there was an immediate reduction in calls to the night float physician with a short‐term reduction by 18%.
Conclusions:
This initiative is an example of low‐hanging fruit, with minimal costs related to time spent developing guidelines, no added staff needed, no major change in work flow except to remove unnecessary steps that were present only because of “tradition”, no expensive data gathering methods, and training conducted at regularly held meetings. In addition nurses are relieved of routine repetitive tasks, and the night float physician is available for more critical issues and has fewer interruptions. We conclude that even further reductions are possible, with sustainable long‐term results.
