With a limited number of staff, managing 24 hr emergency duty and labor duty can be quite tough. At our PHC, staffs on emergency duty worked 24-hrs – which meant those on duty would also work during the 10 to 5 office hours. During my second half of posting, I was the only doctor at the PHC and was on-call duty every day. It sounds crazy, looking back right now. Literally every day – Saturdays, holidays – I even spent my last Dashain and Tihar at the PHC, carrying my duty mobile and being on the edge that an emergency might arrive any moment and I might not hear my mobile ring. Haha! I guess my paranoia didn’t help me much, either. Anyways, I have listed some tips that helped us manage our ER duties better.
On-Duty Rules
Our PHC did not have a cafeteria. With a 24 hr work load and having to cook for themselves and attend nature’s calls – all duty staff wouldn’t be completely present 24/7; hence, easing communication became more important. A general consensus among our staff were as follows
- Never leave the PHC empty! With four staff on duty – a paramedic, 2 labor duty nurses, and an office assistant – this wasn’t a problem majority of the time. So even if somebody has to go to the loo, somebody must be present.
- Follow the 30 min rule! On-duty staff should never go further than when they can’t arrive within 30 mins of being informed.
- Any on-duty staff who has to leave for, e.g., go to the quarters and cook – informs the office assistant and the on-call so that the one taking charge is better informed. Usually, when the paramedic leaves, the on-call doctor replaces them while the nurses would take turns to go eat.
On Duty Mobile
While working on duty, we realized that we were spending a lot of time searching for phone numbers of on-duty staff. Whom to call was an additional hassle for our office assistants. One of our nurses also had an incident where she dropped her mobile in the toilet while trying to receive a call from the hospital. Mimicking the use of pagers, we instead bought four mobile sets – both have their own pros and cons. They cost us around 1k each – a one-time investment, apart from the cost of adding balance. We got four sim cards under the name of our hospital from NTC. The person on duty gets the mobile and hands it over to the next person on duty the next day at 10 AM. Don’t forget to specify the handover time. We had a few complaints of staff handing over the mobile too early. Carrying a small mobile to the toilet, while taking a shower, while shopping – came in really handy. Make sure to keep a tab on mobile recharges, though! We did so with a list where we wrote the date of recharge and marked whoever received it.
Record of Duty Mobile Recharge
24-hr Duty and On-call Board
We placed a whiteboard displaying the names of all staff on duty and updated it every day. Firstly, this saved us the trouble of having to look at a small A4 sheet with a 30-day duty list squeezed in. Second, we could efficiently figure out the on-duty staff and go easy on them during the usual duty hours. We placed this board before we had duty mobiles. This board served a similar function and made it easier for our office assistants, who would only have to search for mobile numbers. This can probably be used as a cheaper alternative to getting mobile sets.
