The medical director of the ICU in which you work, is considering changing from a “traditional” specialist roster (based on Monday to Friday business hours) to an “extended hours” roster with rostered on-site specialist cover on weekends and weekday evenings.
Outline important aspects that will need to be considered in the implementation of such changes.
Though a trainee, upon reading the stem, would likely develop the broadest grin ("Good! make the bastards do some work"), there may be some unintended consequences to this decision. Reading the question requires some care. "Outline important aspects" does not mean "Fashion a mature administrative approach and detailed plan of implementation in the space of ten minutes", as none of the people writing this exam are going to be ICU directors. Nor, for that matter, could any ICU director cobble together a workable strategy and put it coherently on paper within the timeframe afforded by this SAQ. There must, therefore, be two possible types of answer here: one which is concise and basic, i.e what can be expected from the stressed exam candidate, and one which is a thoughtful and considered response to the problem as it is phrased. Unfortunately, what follows is neither one nor the other. A rambling and incoherent attempt at a detailed discussion of this subject can be found at the end of the chapter on ICU design and staffing, but the time-poor candidate is instructed to ignore it. Because there is no official college answer, the author has created this response from nothing, on the basis of no specific knowledge or experience.
Rostering aspects: decisions need to be made:
Clinical governance aspects need to be decided:
Patient safety aspects
Staff safety aspects
Change management aspects
Audit and monitoring
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