Guidelines for on call scheduling are crucial for any hospital, particularly for departments that operate with a smaller team. One such hospital with a small obstetrics staff learned this important lesson during safety initiative carried out by MagMutual risk and patient safety consultants.
On the last day of the initiative, the consultants were assessing the labor and delivery area. While walking through the facility, the consultants happened upon a nurse attended delivery. When asked about the whereabouts of the attending physician, the nurses informed the consultant that the physician was performing a scheduled surgery.
While the physician was physically present at the hospital during his scheduled surgery, he was not able to attend to his call duties to patients in labor. The on-call physician for deliveries should be readily available for deliveries and patient emergencies and not scheduled for time with another patient while on call.
The unexpected event offered the consultants a look into the facility’s on call policies. The incident became a teachable moment, reinforcing the need for required policies, procedures and risk management and patient safety activities.
The recommendations made to the facility included:
- Improving physician call schedules that are consistent with the American Congress of Obstetricians and Gynecologists (ACOG) guidelines;
- Creating accountability with the use of checklists and identification of responsible parties;
- Implementing supplies and equipment storage in a state of readiness for emergencies;
- Scheduling regular drills on unattended delivery, post-partum hemorrhage, maternal and neonatal resuscitation, shoulder dystocia, emergency C-section and other scenarios for all staff; and
- Documenting specific training provided to support staff and healthcare providers.
While the observation, policy, review, and particularly the medical record review guided the recommendations made by the risk management and patient safety consultants, the actual event provided added emphasis. The consultants’ presence during the nurse assisted labor and delivery event reinforced the need for action. Partnering with the consultants, the facility was offered the education regarding the importance of each team member’s involvement in responding to unanticipated patient events.
As a member of the National Patient Safety Foundation Patient Safety Coalition, MagMutual is an active participant in Patient Safety Awareness Week. Find out more.
The risk management advice presented in this Site is intended as general information of interest to physicians and other healthcare professionals. The recommendations and advice published on this Site do not reflect or establish a standard of care and do not establish rules for the practice of medicine. The publication of this information is not intended as an offer to insure such conditions or exposures, or to indicate that MAG Mutual Insurance Company will underwrite such risks for the reader. Our liability is limited to the specific written terms and conditions of actual insurance policies issued.