Nocturnists, the Newest Medical Staff
Hospitals are now working on reducing the risk a patient faces, whether as an inpatient or being admitted to the emergency room, during late night hours.
The highest rate of poor patient outcomes – death, complications and medical errors – happen outside the normal working hours of 9:00 to 5:00. Not only is this unacceptable, but it opens up a hospital to legal liability from night shift medical errors.
On-call doctors and swing shifts are now being replaced with “nocturnists,” medical staff who work almost exclusively for the hospital, are not in private practice, and work strictly the “graveyard” shift.
We all know that people get sick 24 hours a day, yet there is a huge gap in the quality of care given at night and on the weekend (which is when patients suffer the highest rates of medical errors and when 50 percent to 70 percent of sick people may be admitted).
One published study found that more of half of the heart attack patients who arrived off hours, was 66 percent less likely than daytime patients to get an angioplasty- frequently a life saving procedure.
The “old” standard has been to have “on-call” doctors rotate between their normal daily practice schedules and be “on-call” to staff the hospital at nights. This has put a great strain on the quality of care that both emergency and non-emergency patients receive.
Hospital groups are now realizing that having a dedicated staff of nocturnist doctors takes pressure off the rest of the doctors, letting them work fewer nights, and providing more flexibility in scheduling. This solution gives added protection to the patients because a doctor who does not need to alternate between day and night shifts is not prone to being mentally or physically overtired, which can lead to medical mistakes.
In 2007, there were reportedly 1,200 hospitals that had a nocturnist or doctors sharing night coverage. Compare that to just 700 hospitals in 2003.
Here are some suggestions when being admitted to the hospital about “after-hours” care:
- Ask the hospital about whether its night staffing plan includes an attending physician on staff 24 hours a day
- Make sure you know how to contact your personal doctor after hours and not rely strictly on the hospital staff to know how to contact him/her
- Ask your personal doctor which hospital he/she has “staff privileges” or is allowed to treat you as an “in-patient”
- Always have a copy of your medical history and list of medications (including dosages) with you in case the hospital you’re taken to does not have access to your records or you’re unable to communicate with the medical staff.
Above all, if you or a family member should have a problem at the hospital, regardless of the hour, let the hospital staff know immediately and do not allow them to tell you, “there’s nothing we can do at this hour.”
That simply is not true – there is always something that can be done to make sure your needs or your family member’s needs are met at any hour.
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