Tips for efficient night shift work in a psychiatric ED

Author and Disclosure Information



Attending psychiatrists who work night shift in a psychiatric emergency department (ED) or medical ED require a different set of skills than when working daytime or evening shifts, especially when working full-time or solo. While all patients should be treated carefully and meticulously regardless of the shift, this article offers tips for efficiency for solo attending psychiatrists who work night shift in an ED.

Check orders. Typically, multiple psychiatric clinicians are available on other shifts, but only 1 at night. This can lead to significant variability and potential errors in patients’ orders. Such errors filter down to night shift and often must be addressed by the solo clinician, who can’t say “that person is not my patient” because there are no other clinicians available to help. Carefully check orders (ideally, on all patients every shift) to ensure there are no errors or omissions.

Use note templates. While it is important to avoid using mere checklists, with electronic medical record systems, create templates for typical notes. This will save time when the pace of patients increases.

Be brief in your documentation. Brevity is key when documenting at night. Focus on what is necessary and sufficient.

Conduct thorough but efficient interviews. Be aware of how much time you spend on patient interviews. While still thorough, interviews must often be shorter due to a higher staff-to-patient ratio at night.

Be aware of potential medical issues. Many psychiatric EDs are not attached to a hospital. With other medical consultants not readily available in the middle of the night, be particularly alert for any acute medical issues that may arise, and act accordingly.

Focus on the order of tasks. Be aware of which tasks you complete and in what order. For example, at night you may need to medicate sooner for agitation because other patients are sleeping, instead of letting one patient’s agitation disrupt the entire night milieu.

Continue to: Don't let tasks pile up


Recommended Reading

After the Match: Next steps for new residents, unmatched
MDedge Psychiatry
Nurse makes millions selling her licensing exam study sheets
MDedge Psychiatry
Luxe vacations, private jets: Medical device maker, surgeon to pay $46 million penalty in kickback scheme
MDedge Psychiatry
New Medicare rule streamlines prior authorization in Medicare Advantage plans
MDedge Psychiatry
Health care in America: Let that tapeworm grow
MDedge Psychiatry
Physician compensation continues to climb amid postpandemic change
MDedge Psychiatry
Physicians may retire en masse soon. What does that mean for medicine?
MDedge Psychiatry
CMS inpatient payment rule for 2024: Key takeaways
MDedge Psychiatry
Surgeons, intensivists earn more than do colleagues from private insurance
MDedge Psychiatry
Proposed Medicare bill would raise docs’ pay with inflation
MDedge Psychiatry