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Position opening We currently are looking at full-time Adult Hospitalist provider but are always interested in per diems as well. We are looking for someone to work 2 Night weekends/month.
Background Exeter Hospital is a 100-bed community hospital in the beautiful seacoast of NH. We are an hour from the Boston hospitals. It is a nice place to work with a collaborative approach to care. Paid time off is a benefit with 20 days per year and additional days earned though years of service. For regular providers, we have a Quality bonus program, an RVU bonus for physicians and CME Dues benefits as well. We are currently staffed with 10 regular physicians, 5 regular APCs (all NPs) and 12 per Diem provider (docs, NPs, one PA).
Shifts On a typical day, there are four physician day rounders, one APC day rounder, one APC admitter, one physician evening admitter and one physician nocturnist. We have added an additional rounder and evening help to address surge. We are organized by color team.
Nurse Practitioner Shifts:
Admit pager coverage During the day, the APCs take most of the admissions but the rounders take admits as needed - typically 1-2 new admissions per day:
Evening & Night Cross coverage After 7pm, when the day rounders go off service, the Admit APC is primary for cross coverage on the floors while the 5-9 Admit doc is primary for the admissions followed by the nocturnist at 9pm. Since the surge there has been an additional APC taking cross coverage from home so that the two providers on site (doc and APC) focus on admissions. At 11pm when the Admit APC leaves, the nocturnist is responsible for cross coverage and admissions until 7am. We try not to hold over admissions for the nocturnist.
If urgent, some specialists will come in to see their patients while others, such as vascular surgery, are not available in person during off hours, but may be available for a discussion.
Our nocturnist typically work 240 shifts per year and we have a per diem nocturnist as well. Most rounding docs do not work many nights at all. We do have a need for one or 2 weekend nights per month.
Surge Plan with the increased census, we have a daily 6th rounder (pink team) and a potentially 7th rounder (maroon team) as back up extra staff member depending on census. These are filled strictly on a volunteer basis and most days are filled and the number of hours vary based on the need and the availability of the paid volunteer. We have an amazing response to this request and the typical helper is available in the morning and will work approximately one hour per patient. When they leave for the day, the “pink” patients are distributed to the other rounders for cross coverage; focus is throughput. Most or our triggers for additional staff are typically when the providers have approximately 15 patients each. If we are at 17 each, we have the option to call in for assistance from the Specialists (Chief to Chief communication) and this has been used on occasion and demonstrates great teamwork.
Specialist Presence There is a strong specialist presence at Exeter and we work closely with Cardiology, Infection Prevention, Palliative Care, Pulmonary, Nephrology, Surgery, GI, Neurology and MGH Oncology. Cardiology does perform stents and intervention work but we transfer out some of the higher level tertiary care such as Neuro surgery and Cardiac Surgery. Some patients travel to Portsmouth 20 minutes away or Boston around an hour away for the services not offered in Exeter. The Hospitalists assist in consulting or arranging care for those patients.
Hospitalists do not perform procedures. Stemis are not on our service but on the Cardiologist service. We do manage routine stroke and TIA relying on Neurology to come and consult as needed. For acute stroke we utilize tele neurology thought MGH neurologist consult.
ICU/PCU We have an open ICU (10 beds) and most of those patients are managed by the intensivists. We also have a PCU (8 beds) that is mainly managed by the Hospitalists.
Codes/Rapid Response There one physician assigned “lead” daily and responsible to lead codes and rapid responses 7am – 5pm. The Admit physician takes over the lead responsibility 5pm – 9pm followed by the nocturnist 9pm – 7am.
EMR We currently utilize Meditech for our inpatient EMR. We have a home-grown system, Hospitalist Sign out sheet, for handoffs and patient distribution. The outpatient services utilizes NexGen.
Schedule Full time physicians work approximately 14 days every 28 days, inclusive of 2 weekends. Depending on the nocturnist and per diem coverage, full time providers typically work 2 admit shifts per month and a few nights per year.