Hospital vs Freestanding GI Unit staffing?

[endofan]

I'm looking for some creative ideas about staffing for GI procedures on inpatients in a hospital which has lost all of the outpatients to a freestanding endoscopy center owned by clinic doctors. On call? RN vs Tech? Any suggestions for 24/7 coverage or is it even necessary?

[jburris]

There isn't an easy answer to this problem and it will probably get worse before it gets better. We lost about 30% of our OPs when 2 new centers opened within spitting distance of the hospital. Your docs. are probably like mine, they do their IP early between 7 and 9, leave to go to their center and return around 3 or 4 to finish the day. This way they don't have to pay OT to their staff but it sure leaves us in a bind.

Depending on the size of your unit and hospital, be creative with your excess times. We flex staff according to the schedule, so staff never come and leave at the same time each day. This allows for early teams and late teams. We also talked admin. into purchasing pH and motility, the Givens small bowel capsule and EUS equipment. These procedures have helped fill the blank times during the day. See if there's any busy departments where procedures are done that your department can take over, i.e., blood transfusions, pic line insertions (get them trained), you could give sedation in the cath lab or radiology.

I really believe that the OPs will return someday if we wait it out because eventually reimbursement will be cut to these centers making it not worth their time. Just my opinion. Hope this helps.