We set up a "Backup" Call system in 1996 and have utilized it at least 3-4
times per month. When we implemented this system we had to guarantee the
physicians that the backup system would be utilized very specifically ONLY
for "volume surges" and no other unforseen, hospital or physician dictated
A trigger for volume surge is patient wait times (in the exam room),
emergent: > 30 minutes, Urgent > 1 hour and Non-emergent > 2 hours. In
addition there should be a nurse dedicated to the backup physician and rooms
available for the backup physician to "fast track" patients.
The trigger can be recognized by the team leader nurse or the attending
physician, either of whom can call the PEM administrator on call.
The role of the backup physician is to arrive and clear out the backlog of
non-emergent and urgent patients (in that order), while the regularly
scheduled attendings works on the emergent and urgent patients (in that
Implementation of backup involves calling the PEM administrator on call, who
determines the need and initiates backup. Response time 45 minutes. This
allows the physician geographically furthest away to respond.
Adequate renumeration for one to two backup calls: We discussed an hourly
rate/fixed rate for carrying the pager plus additional for coming in and
settled on no $'s for carrying the pager, but time and a half of salary when
called in. This has been changed to time and a half of the median salary for
the group(everyone gets the same.
The average time that the backup physician works when called in is 3 hours
(range 2 to 5 hrs.). Each physician does one to two backup shifts per 4 week
This would not have been possible to implement without having significant
involvement of all the division members in the implementation phase of
We also institute moonlighting shifts if we notice a trend ie. backup called
in every saturday to Monday.
All physicans take backup, including the urgent care docs and fellows. Since
I have the least number of clinical hours, I pick up extra backup.
In addition to the backup schedule we modify our schedule seasonally,
upstaffing for the viral/ asthma/ croup season which hits us between October
and January, and downstaffing between June and August. The majority of
vacation is taken between January and September. Time off in October is
limited to CME for the AAP or ACEP, for as many as want to go.
Kathy Shaw is presenting an abstract at the APA which gives data about the
impact of backup on wait times, TAT's etc. Check it out.
I would suggest talking to Hal, Jeff or some other member of the division
about their perspective on our backup plan.
To address the other issues raised on this bulletin board. We do need to
protect ourselves from becoming the solution to patient jams in the ED.
Physician times and a need for upstaffing should be determined by looking at
how long the patient waits in the room prior to being seen by the attending
ie. Time for patient in room to time MD in room. This time is attending
physician specific. Labs and Radiology and inadequate/inefficient nurse
staffing will effect the segment from MD in room to MD disposition.
If you have an ED log include these times and track them. Share them with
your administrators. We are looking at implementing the "Em-Stat" system
with our Scottish Rite counterparts, so that we do not have to hand log
these times into our database.
I hope this helped.
From: Peter Glaeser, M.D. <[log in to unmask]>
To: Multiple recipients of list PED-EM-L <[log in to unmask]>
Date: Tuesday, April 28, 1998 1:58 PM
Subject: staffing during high volume
>We are considering beginning a call system to bring in additional
>physicians (attendings) when high volume or other conditions create
>extended waiting times for patients/families. I would appreciate
>hearing from groups who have implemented processes to accomplish this
>and specifics regarding:
>* Threshold criteria; what triggers call in.
>* Reimbursement/incentive plan.
>* Acceptance by physicians/impact on moral/burnout/scheduling.
>Data on improved throughput times/customer satisfaction.
>Thanks in advance for any help/comments; feel free to e-mail me
>directly: [log in to unmask] <[log in to unmask]>
>For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
>The URL for the PED-EM-L Web Page is:
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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