Overnight cross-coverage on hospital medicine services: perceived workload based on patient census, pager volumes, and patient acuity

Bates, Ruth; Kesselring, Gina M.; Breunig, Michael; Rieck, Katie M.

doi:10.1080/21548331.2020.1741951

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…This was accomplished with the successful recruitment and onboarding of PC specialist night-shift APRNs. Although there are reports of APRNs covering other specialized services, [17][18][19][20] this is, to current knowledge, the first such report about an overnight inpatient PC consult service. The implementation of 24/7 onsite overnight staffing resulted in an increase in specialist PC onsite presence, inpatient calls and pages, and the number of follow-up visits evaluated, although there was no significant change in the number of new consults seen during the night.…”

Section: Discussionmentioning

confidence: 97%

Beyond 9 to 5

Pandey

Goldberg

Kapoor-Hintzen

et al. 2022

J Hosp Palliat Nurs

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For seriously ill hospitalized patients with a diagnosis of cancer, there exists a need for specialist palliative care, 24 hours a day, 7 days a week. This article describes the expansion of a palliative care consult service in a metropolitan, dedicated cancer hospital to provide 24/7 specialist palliative care including onsite overnight presence by advanced practice registered nurses and to evaluate the impact of this change on nighttime utilization of the consult service. Inpatient management encounters and outpatient calls were compared before and after the expansion. The onsite availability of a palliative care specialist between midnight and 8 AM increased from less than 10% of the time in 2019 to 100% of the time in 2021. The number of inpatient overnight calls and pages increased from a median of 4 to 16, and the number of follow-up visits evaluated increased from a median of 0 to 6. However, the number of overnight palliative care consults and outpatient calls evaluated did not change significantly. Expansion of a hospital-based palliative care service to include 24/7 onsite overnight presence increased patient, family, and night staff access to high-quality palliative care, prompt symptom management, and staff coaching on primary palliative care skills.

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Section: Discussionmentioning

confidence: 97%

Beyond 9 to 5

Pandey

Goldberg

Kapoor-Hintzen

et al. 2022

J Hosp Palliat Nurs

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“…Therefore, in this typical practice setting, the ideal patient volumes should perhaps be skewed lower. The perception of workload on the night shift is also affected by patient acuity, number of pages, and RRT activations [13,14], so the ideal patient census to ensure patient safety is uncertain and clearly does not have a one-size-fits-all solution. For instance, we found that more than 25% of night hospitalists provide intensive care coverage, so these clinicians would likely need to care for fewer patients.…”

Section: Discussionmentioning

confidence: 99%

“…The negative impacts of higher census for day-shift hospitalists have been evaluated and included increased costs and longer length-of-stay [11,12]; however, the ideal scope and volume of work for a night hospitalist have not been quantified. Moreover, in addition to patient census, patient severity [13], the number of pages, and rapid response team (RRT) activation/intensive care unit (ICU) transfers [14] also contribute to nocturnist workload.…”

Section: Introductionmentioning

confidence: 99%

The scope of hospital medicine practice at night: a national survey of night shift hospitalists

et al. 2021

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Introduction: Although in-person hospitalist presence, increasingly staffed by dedicated nocturnists, has become the norm overnight in the hospital, the scope of nocturnist practice and typical workload has not been defined. This study examines the clinical responsibilities and patient safety perceptions of hospitalists who work night shifts in the United States. Methods: In the fall of 2019, a cross-sectional, webbased survey was administered to physician and nurse practitioner/physician assistant (NP/PA) hospitalists who work night shifts. The questionnaire assessed night staffing structure, typical responsibilities, patient volume, perceptions of safety overnight, as well as demographic information. The survey was posted on the Society of Hospital Medicine (SHM) Hospital Medicine Exchange (HMX) Online Discussion Forum. Additionally, the survey was distributed by 'snowball method' by respondents to other night hospitalists. Responses were collected anonymously. Results: Of the 167 respondents, 157 reported working night shifts. There was at least one respondent from 32 different states. In addition to performing admissions to medicine services and covering inpatients, night hospitalists cover ICU patients, participate in RRT/Code teams and procedure teams, perform consults, participate in medical education, and take outpatient calls. Across institutions, there was a large distribution in numbers of patients covered in a night shift; however, patient volume fell into typical ranges: 5-10 admissions for physicians, 0-6 admissions for NP/PAs, and 25-75 patient crosscoverage census. When physicians perform more than five admissions per night, hospitalists were less likely to agree that they could provide safe care (88% vs. 63%, p = 0.0006). Conclusions: This is the first national study to examine the clinical responsibilities of hospitalists working overnight. Overnight responsibilities are heterogeneous across institutions. As hospitals are increasingly employing nocturnists, more research is needed to guide night staffing and optimize patient safety.

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“…Excessive workload can occur due to a mismatch between health workers and their care (Russeng n.d.). The working hours of health workers vary greatly, and it is essential to evaluate the workload, which aims to understand the situation and condition of health workers so that the performance that will be produced is in line with expectations (Bates et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

The Role Of Workload And Work Motivation In Influencing Performance Through Job Satisfaction

I Nyoman Swedana

2023

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Job satisfaction is quite an exciting and essential issue because it has greatly benefited the interests of the individual, the company, and the existing community. This study aims to analyze the performance of nurses who are influenced by workload and motivation through job satisfaction. This research was conducted on nurses at Undata Hospital, Palu, where 152 were used as respondents. Data collection techniques used questionnaires with Likert scale measurements and interval scales. The analytical method used is Partial Least Square (PLS) using WarpPLS 7.0 software. The results of this study indicate that motivation has a positive and significant effect on nurse performance. At the same time, the workload does not affect performance. Satisfaction does not affect performance. These results are expected to be considered by related parties in maintaining nurse performance.

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Overnight cross-coverage on hospital medicine services: perceived workload based on patient census, pager volumes, and patient acuity

Cited by 6 publications

References 20 publications

Beyond 9 to 5

Beyond 9 to 5

The scope of hospital medicine practice at night: a national survey of night shift hospitalists

The Role Of Workload And Work Motivation In Influencing Performance Through Job Satisfaction

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