During a stay in a hospital, it’s unusual to see the same physician for consecutive days. This is a symptom of the typical shift work scheduling format implemented by most hospitals. Though this model of working intermittent shifts is routine for doctors and nurses, it’s not the most conducive to positive patient outcomes, physician well-being and efficacy, and efficient hospital operations. In this guest post, Snehal Doshi, MD, CEO of a national neonatology practice, explains why hospitals, especially NICUs, should re-evaluate this system and consider transitioning to a schedule where physicians work a few days in a row, as it will benefit all parties involved.
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Why working consecutive days is better
Medscape recently conducted a study that found when hospitalists work several consecutive days, as opposed to working intermittent shifts, patient outcomes improve and costs decrease.
In fact, when receiving care from the same hospitalist consistently, results from the more than 114,000 patients observed demonstrated a significant, beneficial influence on major outcomes, including 30-day mortality risk after discharge, readmission risk and discharge to home.
The beneficial impact of phasing out shift work cannot be denied by serving as a catalyst for positive change in three crucial areas of hospital operations:
Consistent, individualized care
Scheduling a physician to work consecutive days allows them to become better acquainted with patients and their families and develop a deeper understanding of their case. The results of this are two-fold – the hospitalist and patient/patient’s family are able to establish a trusting relationship, and the hospitalist is now at a much lower risk of making an error in patient care since they’ll have familiarity with the patient’s specific situation. Not to mention, the benefit of creating a bond with patients and their family extends beyond their stay in the hospital as it can increase the likelihood of following discharge instructions and feeling comfortable seeking medical advice moving forward.
For NICUs specifically, where the attending physician is fully responsible for the health of newborn babies, working consecutive days provides doctors and nurses the opportunity to closely monitor a patient’s condition and collaborate on a personalized plan of action or treatment if their condition improves or declines – which can greatly help neonatologists with a diagnosis.
Less burnout, better outcomes
Staff burnout is a huge issue in the healthcare industry. According to a study on the impacts of shiftwork and long work hours, nearly one-third of healthcare workers report they don‘t get enough sleep, which increases the risk of fatigue related injuries and errors. When monitoring the working hours of nurses and their errors/near-errors during work hours, one study found they had over three times the odds of making an error when working 12 or more hours, compared with 8.5-hour shifts.
Working intermittent long shifts with a day or two off in between makes it really difficult for hospitalists to establish a schedule and catch up on some much-needed sleep and down time – both of which contribute to higher stress levels and exhaustion. However, by scheduling physicians to work consecutive days and then have off for the few days following, they’re able to establish a routine that allows for adequate rest and relaxation, among other benefits. By rolling out this scheduling model for the entire hospital staff, they’ll be well-rested, refreshed and able to provide the best care possible to patients – which is especially important for preemies in NICUs.
Improved business operations
Transitioning away from shift work provides a series of benefits to the business operations of hospitals. One important aspect impacted by this change is customer satisfaction. Hospitalist shifts greater than 13 hours have been linked to patient dissatisfaction with physician communication and level of care, which resulted in the patient not recommending the hospital.
The more a patient and their family know a doctor, the more comfortable they feel and the more confident they are in the quality of care received.
There’s also the aspect of cost savings associated with continuous care. The aforementioned Medscape study found that when hospitalists work a few days in a row, 30-day post discharge costs were $223 lower per patient. This is likely because standardizing care with one doctor decreases errors resulting from multiple handoffs, which shortens patient stays and improves outcomes, saving both hospitals and patients money.
Implementing the change
As a first step to implementing this scheduling model, you’ll want to evaluate the current scheduling system and present the idea to hospital staff, especially the neonatologists and mid-level employees. It’s important to clearly outline the benefits of transitioning away from shift work and highlight that it will positively impact patient outcomes, the issue of staff burnout and current hospital operations. Once everyone is fully on-board, ensure you have the proper management structure to effectively roll out this new system and start reaping the benefits of continuous care right away.
Dr. Doshi currently serves as Millennium Neonatology’s CEO and medical director in two level 3 NICUs in Texas. He severs on several community boards and the Texas Pediatric Society’s Committee for Medical Education, and is a state surveyor for TETAF. He’s board-certified in Neonatal-Perinatal Medicine by the American Board of Pediatrics.
