MD / Emergency Medicine / Nevada / Locum tenens / BC / VAMC
Posted on Nov 14, 2018 by Confidential
2. We are expected to provide 24/7 coverage for VA patients. The VHA directive that we have to follow specifies that there has to be a provider in the ED at all times, so we have to have 2 providers in the ED at all times to respond to in house emergencies (Code Blues/RRTs)- one provider can respond to the floor emergency, and the other once stays in the ED area to ensure that all patients have access to a provider in that area.
3. Resources/ancillary services: When it opens, the new facility will have a radiology technician in house 24/7 to do plain films. CT tech will be on call for after hours studies. Lab services will be available 24/7. When the facility initially opens, surgery will not yet be open due to construction/modification of the OR suites. Patients requiring surgical evaluation or if there is a concern that the patient may have a surgical problem will need to be transferred to another hospital. We also will not have dialysis/cardiac cath lab/ interventional radiology/endoscopy after hours; patients presenting with medical problems requiring this support will also need to be transferred out. The VAs facility activation plan for bringing up additional services indicates that the ICU/dialysis will be open 5/1/13, the OR on 5/15/13, interventional radiology 6/1/13, and the cath lab (diagnostic only, initially) 7/1/13. Subspecialty consultation with pulmonary/CCM, cardiology, and nephrology is available 24/7.
4. There will usually be a hospitalist in house 24/7. Since the patients that will initially be admitted to the planned 12 bed unit will be of necessity very low acuity given the limited resources that we are opening with, there will initially not be a hospitalist in house. However, I anticipate moving one of the hospitalists over to the new facility within the first 4 weeks of opening, assuming that other services come up as planned. The hospitalist typically manages admissions and responds to calls on the floor and in the ICU. There is an expectation that the ED physician will come to assist with Code Blues/RRTs and may be asked to perform emergent procedures (intubation/line placement in emergencies). We do not have in house anesthesia after hours. Nursing service indicates that they are working on a 24/7 PICC line service, but I am presently unsure as to what its status will be at the time that the facility opens.
5. Shifts: the physicians at the MOFH presently are working all 10 hour shifts. I think having a mix of 12 hour and 10 hour shifts would work. From my standpoint, as long as the 24 hours are covered, I dont have strong feelings either way. The current VA ED providers do not want to work 8 hour shifts, and would probably not tolerate working 12 hour shifts. Again, I think a mix of 12/10 hour shifts would work. We have some tentative schedules based on the work