The On-Call Crisis: A Statewide Assessment of the Costs of Providing On-Call Specialist Coverage

McConnell, K. John; Johnson, L. J.; Arab, Nadia; Richards, Christopher F.; Newgard, Craig D.; Edlund, Tina

doi:10.1016/j.annemergmed.2006.10.017

Cited by 64 publications

(34 citation statements)

References 11 publications

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“…For example, as resident work hours are shortened, surgeons work longer hours and have less job satisfaction than previously [10]. In addition, fewer surgeons are enthusiastic about taking emergency surgery or trauma call, which has been described as a "crisis" in today's surgical environment [11]. Overworked surgeons may delay appendectomies until the following morning to gain a few more hours of sleep or to utilize the daytime OR nursing and anesthesia staff.…”

Section: Discussionmentioning

confidence: 98%

Acute Uncomplicated Appendicitis: Case Time of Day Influences Hospital Length of Stay

Crandall

Shapiro

Worley

et al. 2009

Surgical Infections

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Section: Discussionmentioning

confidence: 98%

Acute Uncomplicated Appendicitis: Case Time of Day Influences Hospital Length of Stay

Crandall

Shapiro

Worley

et al. 2009

Surgical Infections

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“…11,12 The call-pay stipends have been reported as ranging from $300 per day to $3,000 per day with a mean of $1,000. Both this proposal and the hospitalist model incur significant additional costs to the CH, tipping the financial analysis strongly to a regionalized model.…”

Section: Discussionmentioning

confidence: 99%

Regionalization of Surgical Services in Central Florida: The Next Step in Acute Care Surgery

Block

Rudloff²,

Noon³

et al. 2010

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Regionalization of ACS to TCs is a viable option from a business perspective. Access to care is preserved during an approaching crisis in emergency general surgical coverage. The referring hospital is relieved of an unfavorable payer mix and surgeon call problems. The TC receives a new revenue stream with limited impact on resources by absorbing these patients under its fixed costs, saving the CH variable costs.

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“…30 Of the 1427 hospitals that responded, 17% noted that some specialists had negotiated with their hospitals for fewer on-call coverage hours, 33% noted increased levels of transfers, and 37% were offering specialists incentives to be on call. 31 Because health planning is organized at the state level, there is no standardized system for the definition of specialty centers and service regionalization throughout the United States. The most frequent regionalized services are adult trauma, pediatric trauma, and burn care.…”

Section: Misconception 8: Emergency Physicians Are Employed By the Homentioning

confidence: 99%

Ten common misconceptions about emergency care

Sax

Shesser

2014

Emergency Care and the Public's Health

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Misconception 1: EDs are crowded because large numbers of medically indigent patients use EDs for "primary care"Multiple factors cause emergency department (ED) crowding. The current rate of annual ED utilization in the United States is slightly above 400 visits per 1000 population, and has increased 15% during the past decade. 1 The Institute of Medicine's 2006 report "Hospital-Based Emergency Care: At the Breaking Point" cited several drivers of ED crowding including increased numbers of ED visits, a shortage of on-call specialists, and lengthy delays prior to admission ("boarding"). 2 While the ED serves as a "safety net" for the underserved, high volumes of low-acuity visits are not a major contributor to ED crowding. A recent study found that increasing diagnostic and treatment intensity was strongly associated with worsening ED crowding and that low-acuity use exerted a minimal impact. 3 In addition, multiple studies have found that prolonged times between an emergency physician's admitting decision and patient transfer from the ED to an inpatient bed ("ED boarding") is a major factor causing crowding. 4,5 Boarding has several causes, including inefficiencies resulting in slow transitions of care, inadequate inpatient capacity (bed space), and inadequate inpatient nurse staffing.Peak ED patient arrival in many hospitals occurs in the late morning through mid-evening. The decision to admit generally occurs about 2.5 hours after arrival in the ED, so inpatient bed demands from most EDs accelerate during the late morning and early afternoon. Many hospital Emergency Care and The Public's Health, First Edition. Edited by Jesse M. Pines, Jameel Abualenain, James Scott and Robert Shesser.

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The On-Call Crisis: A Statewide Assessment of the Costs of Providing On-Call Specialist Coverage

Cited by 64 publications

References 11 publications

Acute Uncomplicated Appendicitis: Case Time of Day Influences Hospital Length of Stay

Acute Uncomplicated Appendicitis: Case Time of Day Influences Hospital Length of Stay

Regionalization of Surgical Services in Central Florida: The Next Step in Acute Care Surgery

Ten common misconceptions about emergency care

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