SHM Converge Scientific Abstract ePoster Gallery-Development of a Census-Driven Equation to Predict "Cross Cover" Workload

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This study examined the workload of overnight hospitalist “cross cover” duties, which are often non-billable and not captured by standard productivity metrics such as wRVUs, day census, or admissions per shift. The authors noted that no objective standard exists to measure night-shift workload, and aimed to quantify how much time cross cover contributes to nocturnist work.<br /><br />At Intermountain Medical Center, researchers used a phased study design. First, they reviewed transcribed overnight Physician Answering Service pages from 48 randomly selected dates between March 2021 and March 2022, excluding admission requests and specialist consults. Second, medical students directly observed nocturnists on 8 random, non-contiguous 6-hour night shifts, timing each cross-cover encounter and recording whether bedside visits, orders, or interruptions occurred. They then built a linear regression model using morning census data to estimate total cross-cover workload.<br /><br />Key findings included an average of 32.2 cross-cover pages per night shift and an average of 11 minutes per encounter, though individual encounters ranged widely from 1 to 185 minutes. The resulting equation estimating total cross-cover minutes was:<br /><br />y = 2.4877x + 198.73  <br />(where y = total cross-cover minutes and x = morning census)<br /><br />Using this tool, the authors estimated that an average AM census of 111 patients corresponds to about 7.9 hours of cross-cover work per night shift. Annualized, this equals approximately 2,885 hours, or 1.4 full-time equivalents.<br /><br />The study concludes that cross cover is a measurable and significant component of nocturnist workload and should be considered in staffing decisions. This census-based model may help hospitalist teams build safer, more cost-effective staffing models that account for essential non-billable work.

Asset Subtitle

Monique Mahlum

Meta Tag

Author List Bivash Neupane, Linda M. Venner, Monique Mahlum, Ruth Hunter

Category Research

Concept Cross-Cover Workload

Concept Cross-Cover Encounter

Concept Direct Observation

Concept Phased Study Design

Concept Work RVU

Distinguished Non-Finalist

Presenter Organization Intermountain Health

Presenting Author Monique Mahlum

Track Value in Hospital Medicine

Keywords

cross cover

nocturnist workload

overnight hospitalist

morning census

non-billable work

workload measurement

linear regression model

hospital staffing

physician answering service

full-time equivalents

Cross-Cover Workload

Cross-Cover Encounter

Direct Observation

Phased Study Design

Work RVU