April - June 1996
(Volume IX Number 2)

Telephone advice is given by all medical practices even if it is as basic as determining and advising the patient how soon (s)he can be seen by the physician. There is indication that there is a greater tendency towards handling certain patient complaints by telephone in a capitated environment. It, therefore, becomes even more important for practices to establish appropriate policies and procedures regarding telephone advice.

Since patients will call regarding medical matters at times when it is not possible for them to speak directly to the physician, a practice must prepare its staff to respond to these calls. Written telephone protocols are recommended because they help to ensure that the information provided to the callers is what the physician wants the patient to be told and also that the response does not vary with the person answering the phone.

Some practices use published protocols to help staff respond to routine inquiries and triage calls. However, it is important that the physician ensures that these protocols suit the practice and conform to his own practice of medicine. Examples of these protocols may be found in publications such as Telephone Medicine: Triage & Training by Harvey P. Katz, M.D. and Pediatric Telephone Advice by Barton D. Schmitt, M.D. [This does not represent an endorsement of these protocols by PRI. The physician is responsible for evaluating and for developing protocols for his practice.]

The physician may want to begin by discussing with the staff, the several most commonly asked questions or problems with which patients call and the responses that they are given. This information may be used as the basis on which to develop the first protocols for the practice.

Protocols should:

be specialty/practice specific
The types of problems regarding which patients call, vary with the specialty of the practice as well as the practice itself. Therefore, each practice should develop its own criteria for what constitutes routine, urgent or emergency situations.

include questions to be asked of patients
In order to provide an appropriate response to the patient, it is usually necessary for the staff to ask certain
questions in follow-up to the complaints (e.g. How long have you had the pain?; Do you have a
temperature?). The protocols should include the questions that the physician considers to be important.
Responses to those questions must be documented since they may aid the physician's or other provider's
assessment of the patient's situation.

include time frame within which patients with urgent or routine complaints should be seen
For those patients who do not require immediate attention, the protocols should provide some guidance as to how soon an appointment should be given.

include specific advice/instructions to patients
Each such contact with a patient should end with specific advice or instructions to the patient. This information should be included in the protocol - e.g. "If diaper rash doesn't begin to dry up in 2 days, call us back". There should be no question in the mind of the caller nor the staff member, as to what the next step will be.

be reviewed periodically and updated as necessary
At least annually, and more frequently if deemed necessary, the physician(s) should review the protocols with the staff members who use them. The users may provide feedback which will indicate the need to revise or modify a particular protocol. Also, the standard of care may have changed or the physician may have some other reason to update protocols. Where such changes are made, all staff who are involved must be trained in the use of the revised protocol. The use of the protocols must be reviewed by the practice on an ongoing basis, to help ensure their appropriate and effective use.

be kept in a location which is easily accessible to the staff
It is a good idea to keep the protocols in a binder, according to categories that will help the staff find the information easily.

Where the protocols are modified at least one copy of the old protocol should be maintained, so that it will be available if in a future medical malpractice case, the physician is asked about this document. The dates of revision should be noted on revised versions.

In establishing telephone protocols, the physician should also set some basic guidelines for their use. These should include:

• the specific staff members who are authorized to respond to patients' medical concerns;
• when the protocols are to be utilized - e.g. only when the physician is away from the office or anytime that the physician is unavailable to personally respond to a patient's call;
• that if the staff is ever in doubt, they should err on the side of caution, and most importantly, discuss the matter with the physician or his/her designee;
• the staff is not to assume more responsibility for giving advice than that which has been given to them;
• that telephone advice is not to be utilized as a substitute for an office visit or other more appropriate management of the patient's complaint;
• that courtesy and good patient relations are very important in this area of practice;
• that all medically-related telephone contacts must be documented. This can be facilitated where written protocols are used - e.g. "patient advised as per diaper rash protocol".
  

Below is a list of our Loss-Prevention Techniques:

Telephone Matters | Patient Relations | Test Results and Follow-up Monitoring Patients | Patient Follow-up
Guidelines for Comprehensive Office Chart
Emergency Prepardness | Developing Telephone Protocols
Medical Office Personnel | Medication Matters
Issues in Physician Coverage
Discounting the Doctor/Patient Relationship