Pandemic flu buddy system

As part of pandemic (H1N1) influenza planning, clinical departments across Canada are creating physician coverage plans. Our hospital department of psychiatry created a buddy system to meet this challenge. We paired physicians with a buddy, leveraging physician goodwill and personal sense of loyalty to each other. Buddy pairs were created taking into account clinical capacity and skill sets. Physicians covering in-patients were paired with those who primarily cover outpatients so as to not overwhelm any one in-patient physician and thus slow in-patient flow. Physicians who provide consultation to intensive care units (ICUs) and other high acuity work were paired with a buddy who generally provides lower acuity duties.

If ill, step 1, a physician can call their buddy. It is then the buddy’s duty to cover, and triage their own duties as needed, or to do the phone calling to arrange for others to cover. Clinical triage priority principles were set to help guide workload triage decisions prioritizing the ICU and emergency department, then in-patient and general consultations, then day programs, then routine outpatient work.

In step 2, each buddy pair has another assigned buddy pair, with adequate clinical skills capable of covering each other, to go to next. Step 3 goes to the wider active staff then consulting staff lists. Physicians must start alphabetically with the name following theirs for a fair distribution of coverage requests. The algorithm is colour coded at each decision step. The plan has been well accepted by the department’s physician group. We hope that sharing our experience is of help to others needing to meet this challenge.