Monday, October 31, 2011

Improving Hospital Safety at Night: Nocturnists & Systems of Care

A thoughtful blog by Dr. William Mills, currently the senior vice president of quality and professional affairs for the Upper Allegheny Health System.

Thought I would post my comments here to get others' opinions on the same:

I couldn’t agree with you more Dr. Mills. Many hospitals hire physicians just to have “night-time” coverage, but they are not integrated at all with the day-time team. Often times, the night-time role is just to respond to emergencies, and not to provide care.
In addition to being part of the professional team, I think hospitals and hospitalist programs should be working to improve systems of care at night:
- what are the communication standards between nocturnists and nurses?
- which patients need to be seen and how quickly?
- how will information be handed off between daytime and nighttime staff?
- are the night-time staff well oriented to the hospital – EMR, order sets, pharmacy, nursing supervisors?
- are there regular meetings between the nighttime staff (physicians and nurses) and “daytime” leadership in order to continue problem-solving any issues that arise?
The mere physical presence of a physician will not ensure safe delivery of care, however, it is a foundation upon which the system of care can be designed.

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