Best practices for call—to make for a sustainable career
Extended duty can be onerous. Recommendations from 2 OBs who surveyed their peers can vastly improve the experience.
IN THIS ARTICLE
Here are more ways to improve call
Depending on the size of your call pool and volume of deliveries, you might consider the following options to improve your call system.
A few simple measures can boost mental and physical alertness during extended duty.
Physical activity—This is the best strategy to counter fatigue. Stretch often, and walk around. Bright lights help.
Talk—Active participation in a conversation helps keep you focused; passive listening does not.
Drink caffeinated beverages—This calls for moderation, of course. Caffeine isn’t, and shouldn’t be, a cure-all.
Eat well and keep hydrated—A healthy diet and lots of uncaffeinated fluids keep your body running smoothly.
Take short naps—Even 20 minutes can help.
Support your colleagues—Cover another physician long enough for him or her to take a nap, and then take your turn.
Call for help—Call in backup if you are faced with a difficult situation and sense symptoms of serious fatigue in yourself. Also, watch for those symptoms in your colleagues.
Take a shower—A change of clothes helps, too.
Source: Adapted from “Fatigue countermeasures: alertness management in flight operations.” Available at https://humanfactors.arc.nasa.gov/zteam. Accessed March 12, 2009.
If you increase the number of obstetricians in your call pool, the number of calls you take may diminish. However, the volume of activity will probably increase as a result, so that you have a greater chance of being busy while on call. Hiring a nurse-midwife may decrease the number of uncomplicated vaginal deliveries you perform, but you still need to be prepared to provide backup.
Shorten the call duration
The most common duration of call in our study was 24 hours. However, some call pools take call for a weekend or week at a time.1 This gives the physician a longer interval between calls, but the unpredictability of the patient load may make this a horrendously long period of time.
Another potential disadvantage of a shortened call, especially when it is abbreviated to less than 24 hours, is that it increases the number of handoffs in patient care and, therefore, enhances the risk that the circumstances of any given patient will be incompletely understood at this time.
In a busy OB practice, handoffs usually involve a meeting of obstetricians in labor and delivery to “run the board.” When participants attempt to make these handoffs as complete as possible, patient safety is significantly improved.
One way to ensure completeness of patient handoffs is to borrow training and skills from the world of airline pilots. There, crew resource management has introduced the concept of SBAR [Situation-Background-Assessment-Recommendation] as a specific tool to decrease risk inherent in handoffs.
Another helpful idea is attending nurses’ report sessions. These reports can provide you with useful information that you may not have recognized otherwise. By giving them your attention, you may also strengthen relationships with the nurses, your first line of defense.
Develop in-house call
Dildy and colleagues estimated that a call volume of approximately 2,400 deliveries a year would justify a hospital developing 24-hour in-house obstetric coverage.10 In our study, almost all of the hospitals that required in-house call did so because they had residencies, and in-house staff call was required.
Although Clark and colleagues found 24-hour in-house call to be safer than regular call in their review of closed perinatal claims at one large hospital chain, there has been a paucity of studies that confirm or extend our knowledge in this area.11
Hire laborists
Weinstein introduced the word “laborist” into our lexicon in a 2003 paper.12 Barbieri suggested the addition of “nocturnalist” or “weekendist” as possible terms to describe specialists assigned to work certain shifts that prove particularly onerous to practicing obstetricians.13 A number of hospitals and groups are examining and developing this call model.14 However, little research has been conducted on its effects on patient safety and obstetric practice.
For more information, visit www.oblaborist.org and https://obgynhospitalist.com.
Balance—that is the goal
For some of us, perfect balance between safety and patient satisfaction, and between work and home life, may be impossible. Nevertheless, we all need to explore ways to make call a safe and sustainable practice. For many of us, the growing recognition that we have more beautiful, sunny Sunday afternoons behind us than in front of us may be the signal to shift our focus to less demanding, and time-depleting, call schedules.
