Productivity Tips for Being on Call
This weekend, I'm on call in the hospital and covering the practices of several other physicians. I'll be caring for more than 40 patients today. I'm curious: are there tips people would like to share for staying productive, focused, and sane while on call? I'll post a compendium of the best advice (with attributions and links, if you'd like). Please either leave a comment or email me at efficientmd@gmail.com. Thanks.
Being on Call can be overwhelming especially if you have to see over twenty patients. I usually get my list of patients in the morning and then geographically I make a 'plan of attack,' and then I go full steam ahead. Try not to chat with people although it can be tempting. Staying focused on the patients and their issues rather than what you want to do when you leave the hospital really makes my speed remain fairly contstant. There is nothing so novel here that you haven't heard before- make yourt plan of attack, stick to it, focus on the work without getting distracted.
Certain period of the day are more conducive to rounding. 8AM is notoriously hard because the nurses are signing out and there is no workspace available. Family visiting hours, usually from 10 am until the early afternoon, can be tough too if you have a lot of patients to see. If you only have a few patients to see, this is probably the best time as you can take the time to explain things to the family and patient together. Like another person has written, avoid socializing.
The best piece of advice for weekends on call came from one of my mentors. The people who are the most bitter are those who think that just because it's a weekend that somehow they can still make plans to attend some event in the early afternoon.
I find that I do best when I treat it just like a regular work day. I go through my same routine. I don't come in later, but rather at my usual time. I avoid nurse signout time (7am at our hospital) and I start with the most critically ill.
PLAN TO BE THERE. If you don't try to rush out...you'll be far less aggravated if the beeper goes into status beepicus or the ER has "another one for ya".
I try to avoid socializing but I also try to recognize when I've hit the wall and I need a break. I try to take 10-15 minutes to recharge in the late morning and then again in the early afternoon. It sounds silly but getting nourishment is important too. If you remember back to your intern days, you usually had a snack in your pocket or at least knew where the food was on the nursing units.
Just some thoughts.
MAKE SURE YOU KNOW WHERE THE PATIENTS ARE IN THE HOSPITAL:
WE HAVE A RATHER LARGE HOSPITAL. IT'S IRRITATING, AND TIME-WASTING, TO GO TO THE ICU TO SEE MRS X, ONLY TO FIND THAT SHE'S JUST BEEN TRANSFERRED TO THE REGULAR NURSING UNIT -- USUALLY THE ONE YOU WERE JUST AT -- WHICH IS THE EQUIVALENT OF 2 BLOCKS AWAY. SOMETIMES, EVEN THE PHYSICIAN SIGNING OUT TO ME MAY NOT KNOW THAT HIS/HER PT HAS BEEN OR WILL BE TRANSFERRED.
WE ALSO HAVE A TERRIBLE HOSPITAL EMR WHICH ITSELF MAKES IT HARD TO FIND PATIENTS, SO WE HAVE TO BE SURE THAT SIGN-OUTS AND CONSULTS GIVE US PATIENT'S EXACT FULL NAME. EG IF I WERE TOLD (ON THE PHONE) TO SEE A HARRISON BROWN, BUT HE'S REALLY HARRISON BROWNE, THIS EMR SYSTEM WOULD SIMPLY TELL US NO HARRISON BROWN IN SYSTEM -- OR WOULD GIVE US INFO ON WRONG PT.
FINALLY, MAKE SURE THE PT STAYS IN THE ROOM WHEN YOU'RE ON YOUR WAY. TELL NURSES TO VERIFY HE'S IN HIS ROOM AND KEEP HIM THERE. I'VE SOMETIMES GONE TO SEE A CONSULT (IN THE A.M.) FOUND, UPON ARRIVAL, THAT PT WAS DOWN AT MRI AND WOULDN'T BE BACK FOR AN HOUR, AND HAVE THEN HAD TO COME BACK LATER IN DAY (OR EVENING) TO DO WHAT I INTENDED TO DO AT 8 A.M. KEEP PT IN ROOM; THEY CAN DO THE MRI OR WHATEVER AFTER YOUR EVAL, UNLESS IT'S REALLY URGENT.
Have your fellow pre-round on everyone and come in at 8.
If you don't have a fellow, start ridicuously early. I am fond of showing up at 5 or 6AM.