By Jack Seidel M.D.
For many years I took my own calls at night. I would try to take notes, but realized the next morning that I not only did not take very good notes when I was just awakened from REM sleep, but I had very poor memory of the call. Not only could I not document the call well, but I often had the nagging feeling that maybe I did not get the whole story and maybe I did not give the most prudent advice. I would frequently call the parent back in the morning to try to sleuth out what had transpired a few hours before in the middle of the night. This would take a lot of extra time, and when I couldn’t reach the parent, I would keep trying. I wanted to make sure that the child was OK and that my advice had been prudent.
I later kept a tape recorder by my bed so I could listen to what I said the next morning. That was helpful but extremely time consuming. I would sometimes hang up the phone and worry about a kid and then couldn’t fall back asleep for a long time. Sometimes I would just get up. My wife would sometimes be awakened with these calls as well. When one is putting in a long day at the clinic and then is frequently awakened at night, it is rough on the body and the mind. It can impair concentration, memory, cognition, efficiency, and judgment. It is also hard to be cheerful when one is sleep deprived.
There’s no question that a nurse who is wide awake and following a protocol is going to be more thorough and attentive than someone who is sleep deprived and suddenly awakened. Certainly the advice will be more detailed and will be better documented.
When the nurse triage call information is faxed or sent into the practice EHR on a timely basis, a nurse can review the call first thing in the morning and follow up with the patient. Parents love this demonstration of care.