Letter by Kessler Regarding Article, “Effect of Short Call Admissions on Length of Stay and Quality of Care for Acute Decompensated Heart Failure”
To the Editor:
I read with interest the article by Schuberth and colleagues1 on short call admissions. However, in my opinion, the authors failed to embrace the total system dynamics and variables of early daytime admissions. My observations have been that, unlike their long call counterparts, short call physicians are challenged by balancing new admissions with, at a minimum, morning rounds on current patients, attending rounds, subspecialty rounds, and teaching conferences, activities that all peak in the short call window. Furthermore, short call admission orders compete with the deluge of new orders that hit the nurses’ station and pharmacy each morning. Even stat orders compete with others. It is little wonder that diuretic dosing might be delayed, setting the stage for further delays in care. Focusing on “loss in continuity” of care oversimplifies very complex and perhaps largely unavoidable issues in the busy teaching hospital environment. Clearly, understanding the interrelationships of call and quality of care is important; however, the complexities of these relationships may limit our ability to easily define and remedy the problem(s).