Managing After-Hours Calls

Question: We are having problems with patient calls after hours. Currently, patients who call during lunch or before or after clinic hours on the weekdays hear a message that tells them to call 911 if they are having an emergency, and to call the hospital operator to page the physician for nonemergency issues. However, physicians are getting paged for very unnecessary items that could wait until the office reopens. Some physicians in our group want the hospital phone number removed totally, but others feel that this sets us up for legal problems. What are our options?

Answer: Here are some choices:

• Rather than having physicians paged at the hospital, direct patients to call a line that connects them to a triage nurse, physician assistant, or nurse practitioner. They take "first calls" and can respond to patient questions, schedule appointments, or page the physician as appropriate per written protocols worked out by the physicians. You may have to pay these folks for their time, but it's worth it to stop interrupting your physicians for silly things while providing patients prompt attention and avoiding phone tag.

• Schedule physicians so one of them is available to triage these calls for everyone. They'd rotate, of course.

• Enlist a hospitalist so no one needs to be paged at the hospital.

• Direct your calls to a call service that notes the nature of the inquiry in a text message or e-mail to the physicians. You'll have to replace their pagers with BlackBerrys or cellphones, but those devices are more multifunctional, anyway. Then, instead of rushing to a phone, physicians can assess for themselves whether a patient needs a call right away or can wait 15 minutes.

• Some practices don't allow patients to call physicians during lunch hours on weekdays. The message just directs patients to call 911 or call back after 1 p.m. This is slightly obnoxious, but it is an option.

• Collaborate with other practices in your specialty to hire a triage nurse who can perform a first-call function for everyone. The nurse sends notes on every call to the relevant physician, but if she handles a simple patient question by herself, the doctor doesn't need to do anything further.