As a small rural hospital that runs a full service, 24/7 Emergency Medicine Department, WesternMaine Health needs 24/7 general surgical call coverage. And yet over time as the population of Norway, ME has shrunk, the hospital has gotten to the point where they don’t have enough demand to support the number of surgeons required to maintain 24/7 in person on-call coverage. Together, WesternMaine Health (WHM) and Maine Medical Center (MMC) recognized this challenge and developed a novel care team model to address the issue.

The remote call coverage care model and supporting protocols ensure that there is coverage and effective hand-offs throughout the weekend. This coverage model allows for patients presenting to the Emergency Department with general surgery needs to be appropriately triaged for either transfer or admission to WMH managed by the hospitalist service with consultative support by the covering surgeon from MMC. On the bedded surgical side, when a WMH general surgeon signs off for the weekend, they sign out to the covering surgeon who is located at MMC. This means that WMH and MMC providers can all be looking at the same patient record and documenting in the same way, but that surgeon is providing remote consultative services to our hospitalist program, who is caring for that patient for the remainder of their stay. This care model is supported by a Community Call Plan based on EMTALA guidance. The plan was vetted by MaineHealth regulatory and legal partners.

We’ve been doing this for a year and half with good success! Patients that can remain local stay local, those that need transfer are transferred, and our local surgeons can maintain sustainable call expectations. –Team Member

TEAM:

Brad Cushing, MD, Surgery, Maine Medical Partners/Maine Medical Center
Baird Mallory, MD, Pediatric Surgery, Maine Medical Partners/Maine Medical Center
Jonathan Dreifus, MD, Surgery, Maine Medical Partners/Maine Medical Center
Greg Hardy, MD, Prior Chief Medical Officer, Western Maine Health
Ross Isacke, DO, Hospitalist, Maine Medical Partners, Western Maine Health
Daniel Meyer, MD, Hospitalist, Maine Medical Partners, Western Maine Health
Ryan Knapp, MD, Chief Medical Officer, Western Maine Health
Jane Lee, MD, Surgery, Western Maine Health
Eric Osborne, DO, Surgery, Western Maine Health
Chris Connors, MD, Anesthesiologist, Spectrum Healthcare Partners
Karen Gurney, Practice Manager, Western Maine Health
Jack Packham, Vice President—Surgical Services, Maine Medical Partners/Maine Medical Center
Josh Barnes-Livermore, Director—Surgical Services, Maine Medical Partners/Maine Medical Center

COLLABORATORS:

General Surgery, Maine Medical Partners, Maine Medical Center
Hospital Medicine, Maine Medical Partners, Maine Medical Center
General Surgery, Western Maine Health
Emergency Medicine, Western Maine Health
Spectrum Healthcare Partners