Risk
Management
Reference Library
After-Hours Calls
Studies
have shown that many after midnight calls are serious and require a response within 30
minutes.
After-hours documentation is an area in which clinicians are often less successful at capturing information exchanged while they are "on the run." Methods for ensuring that information gets back to the medical record should be implemented.
Documentation of after-hours calls should be handled in the same fashion as all other telephone messages. Documentation should include, but is not limited to, date and time of the call, the patient's complaint, and the advice given – including the point at which the patient should seek medical attention.
Good after-hours call documentation begins with written
approaches for the staff.
Suggested Approaches:
- Good telephone triage approaches in place.
- Specify whether your telephone triage system will cover after hours calls or just screening and referral calls during regular business hours.
- A policy must be in place for how each call will be documented, i.e.
If a triage system is in place for after hours calls, there must be clear identification of emergency situations. The staff must be clear under what circumstances the patient needs to seek emergency care. Post local emergency services and poison control center numbers for easy access.
- Phone encounter forms (available in pocket form for convenience).
- A phone log with or without duplicate copies for the medical record (retain all phone log records).
- Dictate phone encounters on the answering machine and then transcribe.
- Use computerized records with modem hookup.
- Avoid, if possible, sticky notes since they are often lost or misplaced.
- Keep a note pad by the phone at home.
- Don't wait until morning to document. There is a tendency to forget details of the conversation or that it took place at all.
- When using an answering service, evaluate for courtesy, efficiency, accuracy and proper record keeping.
- When using automated answering machines, keep the call distribution simplified to establish emergency numbers early and clearly in the message.
- The physician call schedule should be written clearly for ease of interpretation and available to all involved in the office practice.
- Changes in the schedule should be handled through one individual for certainty of facilitating communication.
- Follow up with the covering physician to update one's self on clinical changes within your patient population.
- All items listed should be filed in patient chart.