Gig covering phone admissions overnight -- how much?

[st2205]

I'm looking at doing night coverage for a place 5pm - 8am via phone giving verbals for admits and any other issues in the units. I think there's maybe a 20-30 patient census, possibly less, kids included. They're wondering what I'd charge for 7 days on. Now, it's hard to know the nature of the call but I could only guess it'd be like phone call at a typical place. I figured for 7 days 2,500ish but not sure if that's too steep.

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[heyjack70]

It would be nice to know average calls per night. Do RNs save non urgent requests and call you one time with several? Are you staffing admits with ER docs or psych specific social workers?

 

[TexasPhysician]

How many admits and calls will you get/week?

 

[F0nzie]

I was doing this in residency 2 years ago. The going rate was $300 per night. That would be $2100 for 7 nights. You won't be offending anybody if you ask for $2500.

 

[st2205]

Appreciate all the comments so far. I'm really not sure how many admits over night, but I've got a hunch. The facility I'm at usually gets everything brought in by police within a 45 mile radius -- the police are literally bypassing this other facility to bring them to our ED because we do not require police to sit with them until dispo. I presume I'd be getting checkout from some kind of RN/SW screener (and perhaps a doc-to-doc) from their own ED. I've tried to transfer people over there all the time but only do that to look like I'm doing something as they rarely (<5% of the time) ever take transfers from our ED. Over night we may admit 2-6 people to our facility, so I don't imagine it being anywhere close to that. I presume maybe 3 but I plan to clarify.

There are a lot of variables in the equation that I don't have but I'm really wanting a somewhat rough but workable baseline range that I would adjust up and down accordingly.

 

[Indodo]

What happens if you need a face to face?

 

[milesed]

or if there is seclusion and restraint?

 

[st2205]

Here's what I learned:

~40 beds with ~50% capacity.
4-5 admits per day (over 24 hours).
No face-to-face for seclusion/restraint as nurses are apparently trained in this (other facilities in area handling it this way to).
Remote access EMR
Checkout from SW but also ER doc if needed (these guys usually don't know anything, anyway, and if they're medically sick you'll probably know more about it reading the chart than they do being responsible for them, but I digress.

I asked for 2,500.

 

[milesed]

You may want to read this unless you have an ARNP who will see patients for you
http://www.jointcommission.org/mobi...x?StandardsFAQId=260&StandardsFAQChapterId=78

 

[st2205]

You may want to read this unless you have an ARNP who will see patients for you
http://www.jointcommission.org/mobi...x?StandardsFAQId=260&StandardsFAQChapterId=78

Thanks. However, unless I'm missing something, this is what I read:

Q. Is the one hour face-to-face assessment still required if a patient is placed in restraints or seclusion for violent or self-destructive behavior?

A. Yes, in the Comprehensive Accreditation Manual for Hospitals, the one hour face-to-face assessment by a physician or licensed independent practitioner responsible for the care of the patient is required. The physician or licensed independent practitioner evaluates the patient in person within one hour of the initiation of the restraints. A registered nurse or a physician assistant may conduct the in-person evaluation within one hour of the initiation of restraint or seclusion if this person is trained in accordance with requirements in Standard PC.03.05.17, EP3. If the one hour face to face evaluation is completed by a trained nurse or trained physician assistant, he or she would consult with the attending physician or other licensed independent practitioner responsible for the care of the patient after the evaluation, as determined by hospital policy.(PC.03.05.11 EP2)Some states may have statue or regulation requirements that are more restrictive than the requirements in this standard.

 

[milesed]

Right^. My thought was that you have to know for a fact that these people actually know what they are doing and will actually be there when needed. It will all fall to you if there is someone out sick, on vacation, quits, makes a poor judgement call, etc. Phone only call for a unit that large is rarely phone only.

 

[vistaril]

I would give a kidney and a half for this sort of job(especially to be paid like that)

The vast majority of hospital systems now are just making their employees cover this for free as part of the job. You're being asked to do something pretty trivial....more of a slight annoyance than anything.

Also, you won't be bringing in any compensation to the system by doing this. The patient can still only get 1 intake/admission code...the phone call doesn't work it's way into that.

This is an incredibly sweet gig if it is what it sounds like and I would take it in a second if I could get something even half that good.

 

[vistaril]

I would take 4 quick phone calls from those hours for 100 bucks total a night. That's 25 bucks a phone call. Heck last night a drunk guy called me at 2am and it was uncompensated, so getting paid would be pretty cool.

 

[Shikima]

I would take 4 quick phone calls from those hours for 100 bucks total a night. That's 25 bucks a phone call. Heck last night a drunk guy called me at 2am and it was uncompensated, so getting paid would be pretty cool.

 

[doctorpilgrim]

The way I see it is liability vs compensation vs lifestyle issue. As said above for a unit that large, call can be tough and liability risk can be high.

 

[smalltownpsych]

As clinical director of a treatment center I would get calls for a a variety of reasons and part of the equation for me was how far away the location is because if when I was feeling uncomfortable from an ethical/liability standpoint it was a lot easier to just head in to handle the situation personally when I was five minutes away as opposed to over 30. It will also depend on how reliable the staff are to report the situation and carry out instructions. When our RN was there, I trusted her assessments and abilities and I could roll over and go right back to sleep. When it was the wannabee/former? EMT, I went in.

 

[Indodo]

I would give a kidney and a half for this sort of job(especially to be paid like that)

The vast majority of hospital systems now are just making their employees cover this for free as part of the job. You're being asked to do something pretty trivial....more of a slight annoyance than anything.

Also, you won't be bringing in any compensation to the system by doing this. The patient can still only get 1 intake/admission code...the phone call doesn't work it's way into that.

This is an incredibly sweet gig if it is what it sounds like and I would take it in a second if I could get something even half that good.

The overnight coverage is part of the compensation/facility fee.
Also, here is nothing trivial about this. The usual and customary thing in a unit this large is to have an on site psychiatrist. 40 beds is relatively large. Think of how many beds your training program had you cover as a resident. Most people were not covering 40 beds, even in mid to large programs and certainly not in smaller programs. You want to do it on the phone.

I don't care how trained they say the RNs are. You are the one that is responsible.
I would negotiate an on call rate and a rate for if you had to go in.

I did something like this where I got 175 for in house, including travel time and a 2 hour minimum, and a separate rate for phone calls. I didn't go in that often but I always went in for seclusion/restraints. But that was for 18 beds.

 

[st2205]

The overnight coverage is part of the compensation/facility fee.
Also, here is nothing trivial about this. The usual and customary thing in a unit this large is to have an on site psychiatrist. 40 beds is relatively large. Think of how many beds your training program had you cover as a resident. Most people were not covering 40 beds, even in mid to large programs and certainly not in smaller programs. You want to do it on the phone.

I don't care how trained they say the RNs are. You are the one that is responsible.
I would negotiate an on call rate and a rate for if you had to go in.

I did something like this where I got 175 for in house, including travel time and a 2 hour minimum, and a separate rate for phone calls. I didn't go in that often but I always went in for seclusion/restraints. But that was for 18 beds.

That's a good point about a rate going in. They seemed quick to tell me to come in for interview. Makes me wonder if they were anticipating it being more costly. Also, they have 40ish beds but are only around 20ish census. Naturally there may be some fluctuation and they may be under reporting.

Also, you won't be bringing in any compensation to the system by doing this. The patient can still only get 1 intake/admission code...the phone call doesn't work it's way into that.

I was going to respond to this earlier. Looking at everything in terms of generating the facility money often misses the mark on the larger picture. Remember, nursing, clerical and social work staff also don't generate any money. The bottom line is that if you're trying to operate a 24 hour psychiatric unit and you don't have 24 hour psychiatric coverage then you're not going to be running that unit for long and, hence, won't be generating any money.

 

[Indodo]

Yeah, the whole bringing in compensation stuff doesn't work inpt.
You won't bring in compensation if you just admit and leave them to go home...one side effect of this in a locked unit is death.