END OF THE DAY RELIEF:WHEN EXPECTATIONS MEET

REALITY

SCOTT HOFFMAN, M.D.DEPARTMENT OF ANESTHESIOLOGY

VANDERBILT UNIVERSITY SCHOOL OF MEDICNE

NASHVILLE, TENNESSEE

PREMISE:

• EVERYONE WANTS TO GO HOME.....EVENTUALLY!!!

SO…….

• WE NEED A PLAN!!!

SUCH A PLAN WILL….

• ALLOW FOR SOME DEGREE OF PREDICTABILITY FOR FACULTY

• BE A TOOL TO ASSIST THE AIC IN PLANNING STAFFING FOR THE NEXT DAY

• PROVIDE STAFFING INFORMATION/PLANNING FOR THE EVENING/NIGHT CALL TEAM

CHARACTERISTICS OF OUR PLAN

• FAIRNESS• CONSISTENCY• FLEXIBILTIY

SUCH A PLAN WILL….

• MEET END-OF-DAY STAFFING NEEDS• TAKE INTO ACCOUNT SUPERVISION RATIOS• HAVE BUY-IN BY THOSE AFFECTED• CAN BE EASILY MODIFIED AS NEEDS DICTATE

OUR PLAN AT VANDERBILT

• DOES NOT INCLUDE OUR CARDIAC ANESTHESIOLOGY DIVISION

• DOES NOT INCLUDE OUR OB ANESTHESIOLOGY DIVISION

• MIGHT INCLUDE AN ON-CAMPUS AMBULATORY SURGERY CENTER

END-OF-DAY RELIEF

• BASED ON PRE- AND POST-CALL STATUS

OUR PRIORITY LIST

OUR PLAN IS A GOOD ONE…BUT NOT PERFECT

• OOR LOCATIONS• LATE CALL SWITCHES• FACULTY WHO “ARRANGE” THEIR OWN RELIEF• A SHORT CALL TEAM

OUR PLAN IS A GOOD ONE….BUT NOT PERFECT

• COMPLEX CASES (e.g. BIG VASCULAR CASES)• FACULTY WHO WANT TO FINISH THEIR CASES

TEMPORARY RELIEF DURING THE CLINICAL WORK DAY

• WHAT ABOUT RELIEF FOR FACULTY WHO MUST ATTEND MEETINGS DURING THE CLINICAL WORK DAY?

WAIT…..

• NOT ONLY ATTENDING FACULTY WANT TO GO HOME!!!

THE C-1 POSITION

• MANAGES COVERAGE FOR IN-ROOM STAFF ABSENCES

• COORDINATES AFTERNOON RELIEF FOR IN-ROOM PROVIDERS

RESIDENT RELIEF

• EDUCATION VS. WORK HOUR REQUIREMENTS

TRACKING WORK HOURS

• WE TRACK OUR RESIDENTS’ AND SRNAs’ WORK HOURS

24/7

• VANDERBILT UNIVERSITY HOSPITAL’S MAIN OPERATING ROOM IS A 24/7 OPERATION

THE END

• EVERYONE HAS GONE HOME!• SEE YOU TOMORROW!

LIAM IS WAITING AT HOME!