Emergency Room and Availability of Physicians for Referral During Long Holidays

Holy Week 2017 – April 10-16, 2017

Emergency Room (ER) of a hospital has a management system that calls for quick referral to other physician-specialists for patients who need further treatment outside the ER limited set-up.

There is no problem if the hospital or its ER has always teams of resident-specialists or consultant-specialists who are physically present within the hospital ready to answer referrals from ER.  If the teams are on-call, the ER staff should make sure they are physically nearby the hospital ready and quick to answer referrals.

During long holidays, such as the Holy Week and during Christmas season, consultant-specialists are often out-of-town or out-of-country for a vacation or for other reasons.  Thus, if they are on-call and if they do not inform the ER staff of their out-of-town or out-of-country travel, there will be hitches in the ER referral system.  The consequence will be difficulty of the ER staff to contact them with resulting delay in referral and management of the ER patients.

Recommendations:

  1. The hospital and ER should have a daily list of consultant-specialists on call for ER referral even during public holidays.
  2. ER should have a system of ensuring that the consultant-specialists are physically near the hospital when they are on call.  One procedure is to call each on-call consultant-specialist every day either a day before or in the morning of the scheduled day of on-call duty to remind them of the schedule and to confirm their ready availability.  Another procedure is to make it a hospital policy to require all consultant-specialists who will answer referral from ER to inform the hospital and ER of their leave of absence in advance.  The third procedure is to furnish the consultant-specialists of their schedule of ER-on-call duty in advance, say one month lead-time.  This schedule is supposed to be furnished to the ER by the departments of the consultant-specialists.  It should contain a second- or third-on call set-up in case the first on-call is not available.  This advance schedule of activity will serve two purposes: information and reminder for the consultant-specialists and timely adjustment in case the consultant-specialists are not available on the published scheduled dates. Note: the three procedures mentioned above, if done altogether, will ensure that consultant-specialists will be physically near the hospital to quickly respond to referrals from ER.
  3. Lastly, the hospital and ER should make it a policy for the consultant-specialists on call to answer the referral right away.  A time limit for answering the referral should be stipulated.  If the time limit is exceeded, the ER can refer to the second-on-call consultant-specialists.

If the procedures mentioned in No. 2 are being enforced to the letter, as mentioned these will ensure that consultant-specialists will be physically near the hospital to quickly respond to referrals from ER.  As an added preparedness measure, a recommendation is to put special attention during long holidays in which the consultant-specialists are commonly out-of-town or out-of-country, meaning ER should send out reminders on the policies and procedures a week or two before the holidays.

Outcome expected from these recommendations: no difficulty of the ER staff to contact on-call consultant-specialists with no delay in referral and management of the ER patients.  

This will promote excellent patient experience with the ER and hospital.

ROJ-TPOR@17apr14

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