Nighttime IR 'float' call coverage improves productivity and patient care
Using nighttime “float” call models for interventional radiologists boosts both productivity and well-being of IR staff.
Traditional call systems do not always offer providers a break from their routine daytime duties. Known to increase fatigue and impact performance, this model of nighttime IR coverage contributes to burnout and gaps in patient care. As such, there is a need for a system that gives providers ample recovery time while also ensuring around-the-clock coverage in busy hospital settings. This is especially important for interventional radiologists, as demand for their skills has seen significant growth in recent years.
To help address issues related to traditional call systems, many organizations have implemented IR call "night floats," which designate one resident to cover call while also excusing them from their daytime duties. However, until now, there have been limited data pertaining to the effectiveness of the night float system.
“IR physicians are increasingly consulted by both medical and surgical inpatient care teams, with their duties extending beyond standard daytime working hours (8 a.m. to 5 p.m.) for both consults for clinical evaluation and urgent procedures,” Jeffrey Weinstein, MD, with the department of radiology at Beth Israel Deaconess Medical Center, in Boston, and colleagues wrote. “This is particularly relevant for IR inpatient services, which affect a wide range of patients from almost all inpatient units in a hospital. The increased demand for IR clinical services, particularly during ‘off-shift’ night hours, has made clinical coverage essential to maintain care quality.”
In the summer of 2023, Beth Israel Deaconess Medical Center integrated the float system into its IR workflows. At the time, the IR program had 14 residents. The night float system requires a single resident to take the night float call shift for a full week.
During weekdays, the designated resident starts their shift in the hospital at 6 p.m. From 6 to 9 p.m., the resident responds to inpatient consult requests and covers urgent and nonurgent cases. Starting at 10 p.m., the resident takes overnight call either at the hospital or at their home. The following morning, they sign out during rounds (virtually or in-person) and do not have any scheduled daytime duties. This time is protected until their next call shift.
Six months after implementing the night float system, the institution compared data from before and after its integration to determine how it impacted staff well-being and patient care. The team included information on the amount of "IR short communication notes" and "full patient consult notes" that were entered between 6 p.m. and 7 a.m. in their analysis, as well.
Post-float system, the amount of these notes more than doubled. Short communication notes per resident increased from 4.5 to 9.5, while full patient consult notes rose from 16 to 53. Around a quarter of the IR residents reported improved overall well-being during this time, and 100% of others on the nighttime shift, including advanced practice providers, indicated that patient care was significantly enhanced during the study period.
“Despite a higher number of consults per resident under the night float system, residents reported better sleep schedules and overall wellness, resulting in improved readiness for next day responsibilities,” the group noted. “Similarly, faculty physicians and advanced practice providers perceived benefits to their well-being and patient care. Evaluation overnight may reduce the burden of daytime duties by reducing the volume of pending IR consults partially performed by APPs and ensuring patients are ready for procedures through overnight pre-procedural evaluation and workup.”
While the system removed one IR resident during daytime hours, the predictability of the schedule prevented workflow disruptions. The authors acknowledged more data need to be collected to determine the full impact of night floats, but suggested their findings could be used to develop more efficient resident schedules in busy hospitals.
Learn more about their findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.