**24-Hour Solo Coverage for Rural Hospital**

**Overview:** This position involves 24-hour solo coverage at a Critical Access Hospital, typically entailing 12-15 hours of on-site work with the remainder on call. The physician is provided with nearby or on-site sleeping arrangements.

**Key Requirements:**

- Hospitalists must be proficient in performing emergency intubations, ventilator management, and central line placements. - 

**Required Procedures:** Ventilator Management, Central Lines, Intubations.

**Coverage Details:** - **Orientation:** 7/30 - **Shift Coverage:** 8/1 - 8/11

- **Schedule:**  - **Start Time:** Daily shifts commence at 12:00 PM.

  - **Orientation Arrival Time:** To Be Determined.  - **Typical End Time:** 12:00 PM daily.

**Clinical Settings:** - **Total Beds:** 25 (Critical Access Hospital) -

 **Average Daily Census:** 12 patients (14.5 average daily encounters).

- **ICU Capacity:** 6 designated ICU beds. - **Procedures Required:** Ventilator Management, Central Lines.

- **Nights:** Anticipate 1-2 admissions per night; transition orders are to be utilized post-10 PM unless the patient requires ICU care—protected sleep hours are between 10 PM to 6 AM.

**Specialty Support:** - Available specialties include General Surgery, Cardiology, Neurology, Dermatology, Obstetrics, and an outpatient pharmacy operating 24/7.

- Interventional Radiology is accessible Monday through Friday with physician-to-physician call support from hospitalists.

- Imaging services and Orthopedics typically manage their patient coverage, and surgical consults will engage with hospitalists as needed.

- Night and weekend coverage requirements may differ.

**Electronic Medical Records:** - EMR System: Cerner

**Administrative Notes:**

- **Sleeping Amenities:** On-site or adjacent accommodations for the physician.

- **Credentialing Timeline:** Expedite credentialing as soon as possible.

- **Licensing Expedite Availability:** Consideration for a “telemed” license that may serve as a temporary full license.

**Hospitalist Schedule:**

- **Shift Structure:** 24-Hour on-site coverage (typically 12-15 hours in-shift with overnight call responsibilities). - **Admissions and Rounding:** Shift handoffs occur daily between 12 PM and 3 PM.

**Morning Rounds:** - Typically commence between 7:00 AM and 8:00 AM, depending on facility protocol.

**Informal Evening Rounds:** - Conducting informal rounds between 9:00 PM and 10:00 PM can enhance collaboration with ED and nursing staff, potentially mitigating late-night admissions and allowing for adequate rest.

**Admissions:** - Given the rural setting, it’s critical to evaluate patients in the ED prior to admission to avoid unnecessary transfers, especially considering variable ED skillsets.

- Transition orders are to be used during overnight and busy daytime hours to optimize ED throughput.

**Overnight Admissions:** - Admissions between 11:00 PM and 6:00 AM will require transition orders from ED physicians to reduce documentation burden. Morning rounds should include evaluations of overnight admissions, particularly ICU patients requiring immediate bedside assessment.

**Discharges:** - Awareness of patients scheduled for discharge is crucial prior to rounding; these patients should be identified during interdisciplinary meetings and prepared by case management to ensure readiness for timely discharge.

**Patient Expectations:** - Patients should be informed of their discharge plans the previous day, aiming for an early release, typically by noon, to facilitate efficient care transitions and room turnovers for incoming admissions.

**Certifications Required:** - Board Certification: Yes

- ACLS: Yes

- Additional Certification: Stroke Certification.