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Emergency rooms need adequate coverage around the clock. Many patients arrive at a hospital by way of the ER. Without the right number of physicians, nurses and other staff on every shift, with the necessary training and skill, patients will be shortchanged in their medical care.
But getting the right people in the right spot 24/7/365 is not easy, as every shift scheduling manager in charge of an ER department knows. It is complicated by the fact that not just the needs of the patient need to be considered. The needs of the staff need to be factored in as well.
If physicians are not physically or psychologically ready for emergency medicine scheduling, they won’t be able to provide a high level of care for patients.
Here is a look at the needs of physicians for ER scheduling.
Circadian Rhythms
Circadian rhythms are a person’s biological patterns throughout the day. Everything from the sleep and wake cycle to a person’s vital signs follow circadian rhythms. They have two components, internal or endogenous, and external or zeitgebers. Two of the easiest to spot are the external light/dark cycle and temperature, which is both internal and external.
Much like travelers who suffer jet lag, those on shift work suffer through the effects on their body of biological changes causing grief to their normal circadian rhythms. It takes time for rhythms to adjust to a new schedule. Resetting the body clock is not easy, which is why it is called circadian disharmony.
Sleep Issues
Each person goes through several stages of sleep during the night. Each set of stages typically lasts about 20 minutes and is important to the overall quality of a night’s rest. When this structure is altered, a person wakes up already feeling fatigued.
This means that a physician working shifts has to deal not only with interrupted circadian rhythms, but also interrupted sleep. All of this affects her energy, alertness and fatigue.
Psychological Stress
The biological stressors end up putting pressure on the physician’s social and family life. These psychological demands wreak havoc on family time and doing things together. The physician needs to get sleep during the day, when children want to have friends over and have fun. But noise just makes it harder to sleep.
Disrupted circadian rhythms, sleep problems and pressure to keep up with a social life and family time cause grief for ER staff. That’s why physician scheduling is a real art form and a major challenge for scheduling managers.
Strategies for Effective Scheduling
The use of automated ER scheduling software makes it possible to deal with a myriad of factors when trying to keep the ER staffed properly. The software lets managers construct schedules that follow strategies making it easier for physicians, trying one, then the other to find the right mix.
There are two approaches recommended by those who monitor the effects of shift work. The first is to never rotate shifts, which works best for circadian rhythms. Sadly, it works very poorly for family and social life.
The next best approach is to have people work on one schedule for an extended period, at least four to six weeks. This reduces the number of times a person has to disrupt circadian rhythms and sleep patterns.
The second is to schedule physicians so they work as few nights in a row as possible, with the optimum number being one night. This means a physician won’t have to worry about disruption, simply deal with the occasional long night.
It is important to consider the needs of physicians when you schedule shifts. Do that is complicated and seemingly endless. The effort is worth it for the better biological and psychological health of the physicians and the improved care they can give their patients.
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