"We had a LOT of irate patients!"

This is what the secretary of my husband’s PCP office told me four days after we had left a message in the voice mailbox for prescription refills. It seems they had left for the holidays, but no one bothered to plan for handling incoming messages left in various mailboxes. Her response when I suggested that they develop protocols was, “Well, I guess we won’t do that again!”

Combine this lack of protocols (and lackadaisical attitude) with a second failure in their system. My e-mail message on the same day to the physician’s personal e-mail address (which he supplied) was never answered.

Imagine the risk to patients due to this lack of basic risk management procedures. What would my 80 year old mother have done if she phoned and couldn’t get a refill? You’re right…she would have gone without the medication and waited until she heard back from the doctor. How many patients in this practice went without medication for FOUR days?

Risk Management procedures must be developed for even the most basic processes. Every practice should develop policies and procedures that include:

1. Signing In. When calls are retrieved each morning (from answering service), how do you ensure that there is immediate follow-up and contact with those patients? Who is responsible and how are the calls documented?
2. Automated Answering vs. Answering Service. If you DO NOT use an answering service, is your automated message CHANGED when necessary? Is the message clear that you are not available, and does the message inform the patient what to do for urgent or emergent matters?
3. Patient Calls After Hours. If a patient is cared for after hours, via phone, how is that conversation documented in the medical record? If prescriptions are called in, how are they tracked? How do you ensure that patients are not calling each of your physicians on different nights to obtain controlled drugs?
4. Automated Voice Attendant. Do you regularly check and monitor your automated attendant to ensure that all extensions go somewhere? Do you include an immediate message that allows the patient to press “0” for a human? Do you include an immediate message that informs the patient what to do in case of emergency?
5. Voice Mailboxes. What policies are in place to ensure that EVERY mailbox is checked regularly (more than once per day)? When an employee who terminates from the practice has a voice mailbox, how is it changed or monitored?
6. Prescription Refill Mailbox. Is the mailbox checked HOURLY during the day? Are all refills called in to the pharmacy (or contact made with the patient) by 5 p.m.? Are these refills recorded in the patient’s medical record?
7. On Call Coverage. When you sign out to another practice or physician, is it made clear to your answering service? Is it clear in your automated message? Have you contacted the covering physician’s office to verify that she is covering, and is her office staff aware of the coverage?
8. Returning Calls. Are patient phone calls returned in a timely manner? Are all calls returned by the end of each day? Do patients know when to expect a call back so that they don’t keep calling you?
9. Reviewing test results while provider is away. When a physician is out of the office, is someone else responsible for reviewing test/lab results that are coming in? How are you handling “abnormal” test results while the provider is away?
10. Managing e-mails. Once you provide patients with your e-mail address, then e-mails must be managed like any other patient message. Are you checking them regularly during the day? Are you responding? How are these messages being recorded in the medical record?

These and other risk management policies protect your patients, your practice, AND the providers. Be diligent about establishing written protocols, train your staff, and hold everyone accountable.