SHM Converge Scientific Abstract ePoster Gallery-A Cost-Efficient Telemedicine Model to Expand Nighttime Coverage

Pdf Summary

This document describes a cost-efficient telemedicine model designed to reduce the workload of hospitalist nocturnists during the busiest evening hours. At the authors’ institution, nighttime coverage had become increasingly demanding and expensive, with nocturnists handling admissions, transfer requests, and cross-coverage for many patients. Rather than hiring additional nocturnists or APPs, the team created a virtual cross-cover moonlighting service.<br /><br />The model used senior internal medicine residents as remote “first call” providers from 7–11 pm Monday through Thursday. These residents answered pages first and escalated only concerning issues to the onsite nocturnist, while remaining within ACGME duty-hour limits. The service cost about $100 per hour, or approximately $104,000 annually, which was far less expensive than hiring additional nocturnists estimated at $200,000–$500,000 per year.<br /><br />The team evaluated paging before and after implementation. Although the total number of overnight pages increased because more services were covered, paging during the moonlighting hours themselves decreased. The service received an average of 16.8 pages per shift, while only 1.3 pages per shift were escalated to the onsite nocturnist. Most urgent events still reached the nocturnist appropriately.<br /><br />The authors note that increased paging may have reflected staff confusion, paging errors across multiple nursing units, and the addition of traveler nurses and new hires learning the system. Despite these issues, nocturnist satisfaction was reported to be very positive. Resident moonlighters also benefited by gaining experience and supplemental income.<br /><br />Overall, the paper concludes that a remote telemedicine cross-cover service is a practical, scalable, and cost-effective way to support nighttime hospital medicine coverage, with potential expansion to weekend coverage in the future.

Asset Subtitle

Ernest Murray

Meta Tag

Author List Ernest Murray, Marc Heincelman

Category Innovations

Concept Telemedicine

Concept Cross-Cover Care

Concept Nocturnist

Concept Nighttime Hours

Concept Escalation

Distinguished Non-Finalist

Presenter Organization Medical University of South Carolina

Presenting Author Ernest Murray

Track Communication

Keywords

telemedicine

hospitalist nocturnist

cross-cover

nighttime coverage

resident moonlighting

remote first call

cost-effective model

paging escalation

ACGME duty hours

virtual service

Telemedicine

Cross-Cover Care

Nocturnist

Nighttime Hours

Escalation