Re: Answering Service - Disservice?

[Guest guest]

Great catch . Another arrow in the quiver of 24/7 access.

When I used to be in a call group with pagers and a

" service, " we did have the occasional missed call.

More often I would call a patient within five minutes of a page to hear

" I've been waiting more than an hour!!!! "

G

At 12:37 AM 10/8/2006, you wrote:

Per some recent

discussions about after hours calls and using an answering service.

I wonder if it increases risk for patients?

I suppose if ALL calls are forwarded, then it would prevent

the missed call.

Locke, MD

http://www.jabfm.org/cgi/content/full/19/5/437

Harm Resulting from Inappropriate Telephone Triage in

Primary Care

E. Hildebrandt, PhD, M. Westfall, MD, MPH, H. Fernald,

MA and D. Pace, MD

From the Department of Family Medicine, University of

Colorado Health Sciences Center at Fitzsimons, Aurora, CO

Correspondence: Corresponding author: E.

Hildebrandt, PhD, Department of Family and Community Medicine, University

of Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

(E-mail:

dhildebrandt@...

)

Purpose: Our objective was to assess and

categorize harm occurring to patients who called their

physicians’ office after-hours but did not have their call

forwarded to the physician because they stated that their call

was not an emergency.

Methods: We collected data on 4949 calls handled by our

answering service for 1 year in a family medicine residency

office in Denver, CO. Of the 2835 after-hours clinical calls,

we reviewed all 288 clinical calls that were not forwarded to

the " on-call " physician. Complete data on 119

clinical calls included reason for call, frequency of next day

appointments, Emergency Department visits, hospital admissions

and outcomes. Outcomes were reviewed and coded for harm to the

patient by experienced medical errors coders.

Results: When patient calls were not forwarded, 51% had an

appointment, 4% an Emergency Department visit, and 2% were

admitted to the hospital within 2 weeks. Analysis revealed

that 3% suffered harm, and 26% experienced discomfort due to

the delay. Although 66% required no intervention, 1% required

emergency transport and 4% a medication change.

Conclusions: Harm may occur when patients’ calls are not

forwarded to the on-call physician. Although the level of harm

is generally temporary and minimal, the potential exists for

serious harm to occur. Physicians need to re-evaluate the way

they handle after-hours calls.

[Guest guest]

RE Answering service as a "service" OR a safety net.

As a solo for the past almost 2 years, I surely need to relate that when I started this after working in groups for 16 prior years that I did have my service "hold" one call as the pt said "when the doc calls in, give him this message." When I didn't "call in" for 2 hours (the operator didn't realize I only called in when they called me!), pt called back.

Like anything else, I feel strongly about backup and communication.

So, I still use an answering service ($61.95/month) but have modified as follows:

1) Answering service calls me with EVERY CALL (usually 1-2 per week after hours despite encouragement, for a panel of about 500 pts).

2) There are "dead spots" and can also have mechanical failures of equipment; answering service is almost absolutely reliable.

I use the answering service to document pts having called (or NOT) but the phone voice mail uses caller ID, so we check that each day even if no message is left.

3) So it's a choice here. Gordon, please acknowledge that the choice of using an answering service is almost mandatory for some of us, but others don't seem to care. What I don't want is the pt that leaves a message, has a bad result, yet I check later and find a voice mail on some device and I didn't answer it.

By the way, I have the hosp ER call me direct on cell phone, yet they often still call the office despite specific directions!! We must be aware that the more complex the system, the more we must be alert for potential failures, and determine our comfort levels.

Dr Matt Levin

Solo, FP since Dec 2004

Residency graduated 1988

SOAPware user since 1997

Re: Answering Service - Disservice?

Great catch . Another arrow in the quiver of 24/7 access.When I used to be in a call group with pagers and a "service," we did have the occasional missed call. More often I would call a patient within five minutes of a page to hear "I've been waiting more than an hour!!!!"GAt 12:37 AM 10/8/2006, you wrote:

Per some recent discussions about after hours calls and using an answering service. I wonder if it increases risk for patients? I suppose if ALL calls are forwarded, then it would prevent the missed call. Locke, MD http://www.jabfm.org/cgi/content/full/19/5/437 Harm Resulting from Inappropriate Telephone Triage in Primary Care E. Hildebrandt, PhD, M. Westfall, MD, MPH, H. Fernald, MA and D. Pace, MD From the Department of Family Medicine, University of Colorado Health Sciences Center at Fitzsimons, Aurora, CO Correspondence: Corresponding author: E. Hildebrandt, PhD, Department of Family and Community Medicine, University of Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001 (E-mail: dhildebrandt@... )Purpose: Our objective was to assess and categorize harm occurring to patients who called their physicians’ office after-hours but did not have their call forwarded to the physician because they stated that their call was not an emergency. Methods: We collected data on 4949 calls handled by our answering service for 1 year in a family medicine residency office in Denver, CO. Of the 2835 after-hours clinical calls, we reviewed all 288 clinical calls that were not forwarded to the "on-call" physician. Complete data on 119 clinical calls included reason for call, frequency of next day appointments, Emergency Department visits, hospital admissions and outcomes. Outcomes were reviewed and coded for harm to the patient by experienced medical errors coders. Results: When patient calls were not forwarded, 51% had an appointment, 4% an Emergency Department visit, and 2% were admitted to the hospital within 2 weeks. Analysis revealed that 3% suffered harm, and 26% experienced discomfort due to the delay. Although 66% required no intervention, 1% required emergency transport and 4% a medication change. Conclusions: Harm may occur when patients’ calls are not forwarded to the on-call physician. Although the level of harm is generally temporary and minimal, the potential exists for serious harm to occur. Physicians need to re-evaluate the way they handle after-hours calls.

[Guest guest]

RE Answering service as a "service" OR a safety net.

As a solo for the past almost 2 years, I surely need to relate that when I started this after working in groups for 16 prior years that I did have my service "hold" one call as the pt said "when the doc calls in, give him this message." When I didn't "call in" for 2 hours (the operator didn't realize I only called in when they called me!), pt called back.

Like anything else, I feel strongly about backup and communication.

So, I still use an answering service ($61.95/month) but have modified as follows:

1) Answering service calls me with EVERY CALL (usually 1-2 per week after hours despite encouragement, for a panel of about 500 pts).

2) There are "dead spots" and can also have mechanical failures of equipment; answering service is almost absolutely reliable.

I use the answering service to document pts having called (or NOT) but the phone voice mail uses caller ID, so we check that each day even if no message is left.

3) So it's a choice here. Gordon, please acknowledge that the choice of using an answering service is almost mandatory for some of us, but others don't seem to care. What I don't want is the pt that leaves a message, has a bad result, yet I check later and find a voice mail on some device and I didn't answer it.

By the way, I have the hosp ER call me direct on cell phone, yet they often still call the office despite specific directions!! We must be aware that the more complex the system, the more we must be alert for potential failures, and determine our comfort levels.

Dr Matt Levin

Solo, FP since Dec 2004

Residency graduated 1988

SOAPware user since 1997

Re: Answering Service - Disservice?

Great catch . Another arrow in the quiver of 24/7 access.When I used to be in a call group with pagers and a "service," we did have the occasional missed call. More often I would call a patient within five minutes of a page to hear "I've been waiting more than an hour!!!!"GAt 12:37 AM 10/8/2006, you wrote:

Per some recent discussions about after hours calls and using an answering service. I wonder if it increases risk for patients? I suppose if ALL calls are forwarded, then it would prevent the missed call. Locke, MD http://www.jabfm.org/cgi/content/full/19/5/437 Harm Resulting from Inappropriate Telephone Triage in Primary Care E. Hildebrandt, PhD, M. Westfall, MD, MPH, H. Fernald, MA and D. Pace, MD From the Department of Family Medicine, University of Colorado Health Sciences Center at Fitzsimons, Aurora, CO Correspondence: Corresponding author: E. Hildebrandt, PhD, Department of Family and Community Medicine, University of Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001 (E-mail: dhildebrandt@... )Purpose: Our objective was to assess and categorize harm occurring to patients who called their physicians’ office after-hours but did not have their call forwarded to the physician because they stated that their call was not an emergency. Methods: We collected data on 4949 calls handled by our answering service for 1 year in a family medicine residency office in Denver, CO. Of the 2835 after-hours clinical calls, we reviewed all 288 clinical calls that were not forwarded to the "on-call" physician. Complete data on 119 clinical calls included reason for call, frequency of next day appointments, Emergency Department visits, hospital admissions and outcomes. Outcomes were reviewed and coded for harm to the patient by experienced medical errors coders. Results: When patient calls were not forwarded, 51% had an appointment, 4% an Emergency Department visit, and 2% were admitted to the hospital within 2 weeks. Analysis revealed that 3% suffered harm, and 26% experienced discomfort due to the delay. Although 66% required no intervention, 1% required emergency transport and 4% a medication change. Conclusions: Harm may occur when patients’ calls are not forwarded to the on-call physician. Although the level of harm is generally temporary and minimal, the potential exists for serious harm to occur. Physicians need to re-evaluate the way they handle after-hours calls.

[Guest guest]

Matt's right that there can be real advantage in having backup

communication technology, especially if you are in an area where cell

phone connections are tenuous.

But what about the option of direct access? This gets past the

" pt left a message about something dire and I didn't call in to

check and something bad happened. "

In a region with poor cell coverage, one could carry a pager and give the

number out.

I agree that increasing complexity leads to increased risk.

My solution is to remove intermediaries and push for direct

access.

My patients call the office. The machine tells them if I'm closed

for the evening " and the problem can't wait, please call me on my

cell: 764-3605 "

It is very simple and works very well. If my cell didn't work well

in my region, I'd use a pager.

Gordon

At 10:05 AM 10/8/2006, you wrote:

RE Answering service as a

" service " OR a safety net.

As a solo for the past almost 2 years, I surely need to relate that when

I started this after working in groups for 16 prior years that I did have

my service " hold " one call as the pt said " when the doc

calls in, give him this message. " When I didn't " call

in " for 2 hours (the operator didn't realize I only called in when

they called me!), pt called back.

Like anything else, I feel strongly about backup and communication.

So, I still use an answering service ($61.95/month) but have modified as

follows:

1) Answering service calls me with EVERY CALL (usually 1-2 per week after

hours despite encouragement, for a panel of about 500 pts).

2) There are " dead spots " and can also have mechanical failures

of equipment; answering service is almost absolutely reliable.

I use the answering service to document pts

having called (or NOT) but the phone voice mail uses caller ID, so we

check that each day even if no message is left.

3) So it's a choice here. Gordon, please acknowledge that the

choice of using an answering service is almost mandatory for some of us,

but others don't seem to care. What I don't want is the pt that

leaves a message, has a bad result, yet I check later and find a voice

mail on some device and I didn't answer it.

By the way, I have the hosp ER call me direct on cell phone, yet they

often still call the office despite specific directions!! We must

be aware that the more complex the system, the more we must be alert for

potential failures, and determine our comfort levels.

Dr Matt Levin

Solo, FP since Dec 2004

Residency graduated 1988

SOAPware user since 1997

Re: Answering Service -

Disservice?

Great catch . Another arrow in the quiver of 24/7

access.

When I used to be in a call group with pagers and a

" service, " we did have the occasional missed call.

More often I would call a patient within five minutes of a page to hear

" I've been waiting more than an hour!!!! "

G

At 12:37 AM 10/8/2006, you wrote:

Per some recent discussions about after hours calls and

using an answering service.

I wonder if it increases risk for patients?

I suppose if ALL calls are forwarded, then it would

prevent the missed call.

Locke, MD

http://www.jabfm.org/cgi/content/full/19/5/437

Harm Resulting from Inappropriate Telephone Triage in

Primary Care

E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

Fernald, MA and D. Pace, MD

From the Department of Family Medicine, University

of Colorado Health Sciences Center at Fitzsimons, Aurora, CO

Correspondence: Corresponding author: E.

Hildebrandt, PhD, Department of Family and Community Medicine, University

of Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

(E-mail:

dhildebrandt@...

)

Purpose: Our objective was to assess and

categorize harm occurring to patients who called their physicians’

office after-hours but did not have their call forwarded to the

physician because they stated that their call was not an

emergency.

Methods: We collected data on 4949 calls handled by our answering

service for 1 year in a family medicine residency office in

Denver, CO. Of the 2835 after-hours clinical calls, we reviewed

all 288 clinical calls that were not forwarded to the

" on-call " physician. Complete data on 119 clinical calls

included reason for call, frequency of next day appointments,

Emergency Department visits, hospital admissions and outcomes.

Outcomes were reviewed and coded for harm to the patient by

experienced medical errors coders.

Results: When patient calls were not forwarded, 51% had an

appointment, 4% an Emergency Department visit, and 2% were admitted

to the hospital within 2 weeks. Analysis revealed that 3% suffered

harm, and 26% experienced discomfort due to the delay. Although

66% required no intervention, 1% required emergency transport

and 4% a medication change.

Conclusions: Harm may occur when patients’ calls are not

forwarded to the on-call physician. Although the level of harm

is generally temporary and minimal, the potential exists for

serious harm to occur. Physicians need to re-evaluate the way

they handle after-hours calls.

[Guest guest]

Matt's right that there can be real advantage in having backup

communication technology, especially if you are in an area where cell

phone connections are tenuous.

But what about the option of direct access? This gets past the

" pt left a message about something dire and I didn't call in to

check and something bad happened. "

In a region with poor cell coverage, one could carry a pager and give the

number out.

I agree that increasing complexity leads to increased risk.

My solution is to remove intermediaries and push for direct

access.

My patients call the office. The machine tells them if I'm closed

for the evening " and the problem can't wait, please call me on my

cell: 764-3605 "

It is very simple and works very well. If my cell didn't work well

in my region, I'd use a pager.

Gordon

At 10:05 AM 10/8/2006, you wrote:

RE Answering service as a

" service " OR a safety net.

As a solo for the past almost 2 years, I surely need to relate that when

I started this after working in groups for 16 prior years that I did have

my service " hold " one call as the pt said " when the doc

calls in, give him this message. " When I didn't " call

in " for 2 hours (the operator didn't realize I only called in when

they called me!), pt called back.

Like anything else, I feel strongly about backup and communication.

So, I still use an answering service ($61.95/month) but have modified as

follows:

1) Answering service calls me with EVERY CALL (usually 1-2 per week after

hours despite encouragement, for a panel of about 500 pts).

2) There are " dead spots " and can also have mechanical failures

of equipment; answering service is almost absolutely reliable.

I use the answering service to document pts

having called (or NOT) but the phone voice mail uses caller ID, so we

check that each day even if no message is left.

3) So it's a choice here. Gordon, please acknowledge that the

choice of using an answering service is almost mandatory for some of us,

but others don't seem to care. What I don't want is the pt that

leaves a message, has a bad result, yet I check later and find a voice

mail on some device and I didn't answer it.

By the way, I have the hosp ER call me direct on cell phone, yet they

often still call the office despite specific directions!! We must

be aware that the more complex the system, the more we must be alert for

potential failures, and determine our comfort levels.

Dr Matt Levin

Solo, FP since Dec 2004

Residency graduated 1988

SOAPware user since 1997

Re: Answering Service -

Disservice?

Great catch . Another arrow in the quiver of 24/7

access.

When I used to be in a call group with pagers and a

" service, " we did have the occasional missed call.

More often I would call a patient within five minutes of a page to hear

" I've been waiting more than an hour!!!! "

G

At 12:37 AM 10/8/2006, you wrote:

Per some recent discussions about after hours calls and

using an answering service.

I wonder if it increases risk for patients?

I suppose if ALL calls are forwarded, then it would

prevent the missed call.

Locke, MD

http://www.jabfm.org/cgi/content/full/19/5/437

Harm Resulting from Inappropriate Telephone Triage in

Primary Care

E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

Fernald, MA and D. Pace, MD

From the Department of Family Medicine, University

of Colorado Health Sciences Center at Fitzsimons, Aurora, CO

Correspondence: Corresponding author: E.

Hildebrandt, PhD, Department of Family and Community Medicine, University

of Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

(E-mail:

dhildebrandt@...

)

Purpose: Our objective was to assess and

categorize harm occurring to patients who called their physicians’

office after-hours but did not have their call forwarded to the

physician because they stated that their call was not an

emergency.

Methods: We collected data on 4949 calls handled by our answering

service for 1 year in a family medicine residency office in

Denver, CO. Of the 2835 after-hours clinical calls, we reviewed

all 288 clinical calls that were not forwarded to the

" on-call " physician. Complete data on 119 clinical calls

included reason for call, frequency of next day appointments,

Emergency Department visits, hospital admissions and outcomes.

Outcomes were reviewed and coded for harm to the patient by

experienced medical errors coders.

Results: When patient calls were not forwarded, 51% had an

appointment, 4% an Emergency Department visit, and 2% were admitted

to the hospital within 2 weeks. Analysis revealed that 3% suffered

harm, and 26% experienced discomfort due to the delay. Although

66% required no intervention, 1% required emergency transport

and 4% a medication change.

Conclusions: Harm may occur when patients’ calls are not

forwarded to the on-call physician. Although the level of harm

is generally temporary and minimal, the potential exists for

serious harm to occur. Physicians need to re-evaluate the way

they handle after-hours calls.

[Guest guest]

i have not yet looked at the article, but i gather from the summary this is data for those practices where it was anticipated and expected that a physician be available for telephone calls. i wonder what the data might show for a practice where, regardless of equivalency between want and need, it was not anticipated nor expected that a physician be available for outside of office hours care, and that patients were specifically told to use their own (layman's standard) determination of when to seek care urgently and emergently. once again, does equivalency between want and need necessitate or depend on 24/7 access? let's see some data. LL "L. Gordon " wrote: Great catch . Another arrow in the quiver of 24/7 access.When I used to be in a call group with pagers and a "service," we did have the occasional missed call. More often I would call a patient within five minutes of a page to hear "I've been waiting more than an hour!!!!"GAt 12:37 AM 10/8/2006, you wrote: Per some recent discussions about after hours calls and using an answering service. I wonder if it increases risk for patients? I suppose if ALL calls are forwarded, then it would prevent the missed call. Locke,

MD http://www.jabfm.org/cgi/content/full/19/5/437 Harm Resulting from Inappropriate Telephone Triage in Primary Care E. Hildebrandt, PhD, M. Westfall, MD, MPH, H. Fernald, MA and D. Pace, MD From the Department of Family Medicine, University of Colorado Health Sciences Center at Fitzsimons, Aurora, CO Correspondence: Corresponding author: E. Hildebrandt, PhD, Department of Family and Community Medicine, University of Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001 (E-mail: dhildebrandtbresnan (DOT) net )Purpose: Our objective was to assess and categorize harm occurring to patients who called their physicians’

office after-hours but did not have their call forwarded to the physician because they stated that their call was not an emergency. Methods: We collected data on 4949 calls handled by our answering service for 1 year in a family medicine residency office in Denver, CO. Of the 2835 after-hours clinical calls, we reviewed all 288 clinical calls that were not forwarded to the "on-call" physician. Complete data on 119 clinical calls included reason for call, frequency of next day appointments, Emergency Department visits, hospital admissions and outcomes. Outcomes were reviewed and coded for harm to the patient by experienced medical errors coders. Results: When patient calls were not forwarded, 51% had an appointment, 4% an Emergency Department visit, and 2% were admitted to the

hospital within 2 weeks. Analysis revealed that 3% suffered harm, and 26% experienced discomfort due to the delay. Although 66% required no intervention, 1% required emergency transport and 4% a medication change. Conclusions: Harm may occur when patients’ calls are not forwarded to the on-call physician. Although the level of harm is generally temporary and minimal, the potential exists for serious harm to occur. Physicians need to re-evaluate the way they handle after-hours calls.

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[Guest guest]

let's say all technology fails, and the patient cannot communicate with you. what then? we're still left with what does the patient do? they are back to using their best judgement. we cannot guarantee to be the ever-present, guiding, omniscient, all-knowing and comforting parent, even if we promise 24/7 access. LL"L. Gordon " wrote: Matt's right that there can be real advantage in having backup communication technology,

especially if you are in an area where cell phone connections are tenuous.But what about the option of direct access? This gets past the "pt left a message about something dire and I didn't call in to check and something bad happened."In a region with poor cell coverage, one could carry a pager and give the number out.I agree that increasing complexity leads to increased risk.My solution is to remove intermediaries and push for direct access.My patients call the office. The machine tells them if I'm closed for the evening " and the problem can't wait, please call me on my cell: 764-3605"It is very simple and works very well. If my cell didn't work well in my region, I'd use a pager.GordonAt 10:05 AM 10/8/2006, you wrote: RE Answering service as a "service" OR a safety net. As a solo for the past almost 2 years, I surely need to relate that

when I started this after working in groups for 16 prior years that I did have my service "hold" one call as the pt said "when the doc calls in, give him this message." When I didn't "call in" for 2 hours (the operator didn't realize I only called in when they called me!), pt called back. Like anything else, I feel strongly about backup and communication. So, I still use an answering service ($61.95/month) but have modified as follows: 1) Answering service calls me with EVERY CALL (usually 1-2 per week after hours despite encouragement, for a panel of about 500 pts). 2) There are "dead spots" and can also have mechanical failures of equipment; answering service is almost absolutely reliable. I use the answering service to document pts having called (or NOT) but the phone voice mail uses caller ID, so we check that each day even if no message is left. 3) So it's a choice

here. Gordon, please acknowledge that the choice of using an answering service is almost mandatory for some of us, but others don't seem to care. What I don't want is the pt that leaves a message, has a bad result, yet I check later and find a voice mail on some device and I didn't answer it. By the way, I have the hosp ER call me direct on cell phone, yet they often still call the office despite specific directions!! We must be aware that the more complex the system, the more we must be alert for potential failures, and determine our comfort levels. Dr Matt LevinSolo, FP since Dec 2004Residency graduated 1988SOAPware user since 1997 Re: Answering Service - Disservice? Great catch . Another arrow in the quiver of 24/7 access. When I used to be in a call group with pagers and a "service," we did have the occasional missed call. More often I would call a patient within five minutes of a page to hear "I've been waiting more than an hour!!!!" G At 12:37 AM 10/8/2006, you wrote: Per some recent discussions about after hours calls and using an answering service. I wonder if it increases risk for patients? I suppose if ALL calls are forwarded, then it would prevent the missed call. Locke, MD http://www.jabfm.org/cgi/content/full/19/5/437 Harm Resulting from Inappropriate Telephone Triage in Primary Care E. Hildebrandt, PhD, M. Westfall, MD, MPH, H. Fernald, MA and D. Pace, MD From the Department of Family Medicine, University of Colorado Health Sciences Center at Fitzsimons, Aurora, CO Correspondence: Corresponding author: E. Hildebrandt, PhD, Department of Family and Community Medicine, University of Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001 (E-mail: dhildebrandtbresnan (DOT) net ) Purpose: Our objective was to assess and categorize harm occurring to patients who called their physicians’ office

after-hours but did not have their call forwarded to the physician because they stated that their call was not an emergency. Methods: We collected data on 4949 calls handled by our answering service for 1 year in a family medicine residency office in Denver, CO. Of the 2835 after-hours clinical calls, we reviewed all 288 clinical calls that were not forwarded to the "on-call" physician. Complete data on 119 clinical calls included reason for call, frequency of next day appointments, Emergency Department visits, hospital admissions and outcomes. Outcomes were reviewed and coded for harm to the patient by experienced medical errors coders. Results: When patient calls were not forwarded, 51% had an appointment, 4% an Emergency Department visit, and 2% were admitted to the hospital within 2 weeks. Analysis revealed that 3% suffered harm,

and 26% experienced discomfort due to the delay. Although 66% required no intervention, 1% required emergency transport and 4% a medication change. Conclusions: Harm may occur when patients’ calls are not forwarded to the on-call physician. Although the level of harm is generally temporary and minimal, the potential exists for serious harm to occur. Physicians need to re-evaluate the way they handle after-hours calls.

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[Guest guest]

I forward my office phone to my cell phone. When I am in the office, I

check my messages between patients and call back. The voice mail states

that if it is a medical emergency to call 911. Sometimes I take the

phone with me in the room, if I know that the patient does not mind it

and I answer during the visit. Most people are OK with that but I don't

push my luck.

> Matt's right that there can be real advantage in having backup

> communication technology, especially if you are in an area where cell

> phone connections are tenuous.

>

> But what about the option of direct access?  This gets past the " pt

> left a message about something dire and I didn't call in to check and

> something bad happened. "

> In a region with poor cell coverage, one could carry a pager and give

> the number out.

>

> I agree that increasing complexity leads to increased risk.

> My solution is to remove intermediaries and push for direct access.

>

> My patients call the office.  The machine tells them if I'm closed

> for the evening " and the problem can't wait, please call me on my

> cell:  764-3605 "

> It is very simple and works very well.  If my cell didn't work well

> in my region, I'd use a pager.

> Gordon

> At 10:05 AM 10/8/2006, you wrote:

>

>> RE Answering service as a " service " OR a safety net.

>>  

>> As a solo for the past almost 2 years, I surely need to relate that

>> when I started this after working in groups for 16 prior years that I

>> did have my service " hold " one call as the pt said " when the doc

>> calls in, give him this message. "   When I didn't " call in " for 2

>> hours (the operator didn't realize I only called in when they called

>> me!), pt called back.

>>  

>> Like anything else, I feel strongly about backup and communication.

>>  

>> So, I still use an answering service ($61.95/month) but have

>> modified as follows:

>>  

>> 1) Answering service calls me with EVERY CALL (usually 1-2 per week

>> after hours despite encouragement, for a panel of about 500 pts).

>>  

>> 2) There are " dead spots " and can also have mechanical failures of

>> equipment; answering service is almost absolutely reliable.

>>      I use the answering service to document pts having called (or

>> NOT) but the phone voice mail uses caller ID, so we check that each

>> day even if no message is left.

>>  

>> 3) So it's a choice here.  Gordon, please acknowledge that the

>> choice of using an answering service is almost mandatory for some of

>> us, but others don't seem to care.  What I don't want is the pt that

>> leaves a message, has a bad result, yet I check later and find a

>> voice mail on some device and I didn't answer it. 

>>  

>> By the way, I have the hosp ER call me direct on cell phone, yet

>> they often still call the office despite specific directions!!  We

>> must be aware that the more complex the system, the more we must be

>> alert for potential failures, and determine our comfort levels.

>>  

>> Dr Matt Levin

>> Solo, FP since Dec 2004

>> Residency graduated 1988

>> SOAPware user since 1997

>> Re: Answering Service - Disservice?

>>

>> Great catch .  Another arrow in the quiver of 24/7 access.

>> When I used to be in a call group with pagers and a " service, "   we

>> did have the occasional missed call.  More often I would call a

>> patient within five minutes of a page to hear " I've been waiting more

>> than an hour!!!! "

>>

>> G

>> At 12:37 AM 10/8/2006, you wrote:

>>

>>> Per some recent discussions about after hours calls and using an

>>> answering service.

>>>

>>>  

>>> I wonder if it increases risk for patients?

>>>

>>>  

>>> I suppose if ALL calls are forwarded, then it would prevent the

>>> missed call.

>>>

>>>  

>>> Locke, MD

>>>

>>>  

>>> http://www.jabfm.org/cgi/content/full/19/5/437

>>>

>>>  

>>> Harm Resulting from Inappropriate Telephone Triage in Primary Care

>>>

>>>  

>>> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

>>> Fernald, MA and D. Pace, MD

>>>

>>> From the Department of Family Medicine, University of Colorado

>>> Health Sciences Center at Fitzsimons, Aurora, CO

>>>

>>> Correspondence: Corresponding author: E. Hildebrandt, PhD,

>>> Department of Family and Community Medicine, University of

>>> Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

>>> (E-mail: dhildebrandt@... )

>>>

>>> Purpose: Our objective was to assess and categorize harm occurring

>>> to patients who called their physicians’ office after-hours but did

>>> not have their call forwarded to the physician because they stated

>>> that their call was not an emergency.

>>>

>>> Methods: We collected data on 4949 calls handled by our answering

>>> service for 1 year in a family medicine residency office in Denver,

>>> CO. Of the 2835 after-hours clinical calls, we reviewed all 288

>>> clinical calls that were not forwarded to the " on-call " physician.

>>> Complete data on 119 clinical calls included reason for call,

>>> frequency of next day appointments, Emergency Department visits,

>>> hospital admissions and outcomes. Outcomes were reviewed and coded

>>> for harm to the patient by experienced medical errors coders.

>>>

>>> Results: When patient calls were not forwarded, 51% had an

>>> appointment, 4% an Emergency Department visit, and 2% were admitted

>>> to the hospital within 2 weeks. Analysis revealed that 3% suffered

>>> harm, and 26% experienced discomfort due to the delay. Although 66%

>>> required no intervention, 1% required emergency transport and 4% a

>>> medication change.

>>>

>>> Conclusions: Harm may occur when patients’ calls are not forwarded

>>> to the on-call physician. Although the level of harm is generally

>>> temporary and minimal, the potential exists for serious harm to

>>> occur. Physicians need to re-evaluate the way they handle

>>> after-hours calls.

>

>

[Guest guest]

I forward my office phone to my cell phone. When I am in the office, I

check my messages between patients and call back. The voice mail states

that if it is a medical emergency to call 911. Sometimes I take the

phone with me in the room, if I know that the patient does not mind it

and I answer during the visit. Most people are OK with that but I don't

push my luck.

> Matt's right that there can be real advantage in having backup

> communication technology, especially if you are in an area where cell

> phone connections are tenuous.

>

> But what about the option of direct access?  This gets past the " pt

> left a message about something dire and I didn't call in to check and

> something bad happened. "

> In a region with poor cell coverage, one could carry a pager and give

> the number out.

>

> I agree that increasing complexity leads to increased risk.

> My solution is to remove intermediaries and push for direct access.

>

> My patients call the office.  The machine tells them if I'm closed

> for the evening " and the problem can't wait, please call me on my

> cell:  764-3605 "

> It is very simple and works very well.  If my cell didn't work well

> in my region, I'd use a pager.

> Gordon

> At 10:05 AM 10/8/2006, you wrote:

>

>> RE Answering service as a " service " OR a safety net.

>>  

>> As a solo for the past almost 2 years, I surely need to relate that

>> when I started this after working in groups for 16 prior years that I

>> did have my service " hold " one call as the pt said " when the doc

>> calls in, give him this message. "   When I didn't " call in " for 2

>> hours (the operator didn't realize I only called in when they called

>> me!), pt called back.

>>  

>> Like anything else, I feel strongly about backup and communication.

>>  

>> So, I still use an answering service ($61.95/month) but have

>> modified as follows:

>>  

>> 1) Answering service calls me with EVERY CALL (usually 1-2 per week

>> after hours despite encouragement, for a panel of about 500 pts).

>>  

>> 2) There are " dead spots " and can also have mechanical failures of

>> equipment; answering service is almost absolutely reliable.

>>      I use the answering service to document pts having called (or

>> NOT) but the phone voice mail uses caller ID, so we check that each

>> day even if no message is left.

>>  

>> 3) So it's a choice here.  Gordon, please acknowledge that the

>> choice of using an answering service is almost mandatory for some of

>> us, but others don't seem to care.  What I don't want is the pt that

>> leaves a message, has a bad result, yet I check later and find a

>> voice mail on some device and I didn't answer it. 

>>  

>> By the way, I have the hosp ER call me direct on cell phone, yet

>> they often still call the office despite specific directions!!  We

>> must be aware that the more complex the system, the more we must be

>> alert for potential failures, and determine our comfort levels.

>>  

>> Dr Matt Levin

>> Solo, FP since Dec 2004

>> Residency graduated 1988

>> SOAPware user since 1997

>> Re: Answering Service - Disservice?

>>

>> Great catch .  Another arrow in the quiver of 24/7 access.

>> When I used to be in a call group with pagers and a " service, "   we

>> did have the occasional missed call.  More often I would call a

>> patient within five minutes of a page to hear " I've been waiting more

>> than an hour!!!! "

>>

>> G

>> At 12:37 AM 10/8/2006, you wrote:

>>

>>> Per some recent discussions about after hours calls and using an

>>> answering service.

>>>

>>>  

>>> I wonder if it increases risk for patients?

>>>

>>>  

>>> I suppose if ALL calls are forwarded, then it would prevent the

>>> missed call.

>>>

>>>  

>>> Locke, MD

>>>

>>>  

>>> http://www.jabfm.org/cgi/content/full/19/5/437

>>>

>>>  

>>> Harm Resulting from Inappropriate Telephone Triage in Primary Care

>>>

>>>  

>>> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

>>> Fernald, MA and D. Pace, MD

>>>

>>> From the Department of Family Medicine, University of Colorado

>>> Health Sciences Center at Fitzsimons, Aurora, CO

>>>

>>> Correspondence: Corresponding author: E. Hildebrandt, PhD,

>>> Department of Family and Community Medicine, University of

>>> Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

>>> (E-mail: dhildebrandt@... )

>>>

>>> Purpose: Our objective was to assess and categorize harm occurring

>>> to patients who called their physicians’ office after-hours but did

>>> not have their call forwarded to the physician because they stated

>>> that their call was not an emergency.

>>>

>>> Methods: We collected data on 4949 calls handled by our answering

>>> service for 1 year in a family medicine residency office in Denver,

>>> CO. Of the 2835 after-hours clinical calls, we reviewed all 288

>>> clinical calls that were not forwarded to the " on-call " physician.

>>> Complete data on 119 clinical calls included reason for call,

>>> frequency of next day appointments, Emergency Department visits,

>>> hospital admissions and outcomes. Outcomes were reviewed and coded

>>> for harm to the patient by experienced medical errors coders.

>>>

>>> Results: When patient calls were not forwarded, 51% had an

>>> appointment, 4% an Emergency Department visit, and 2% were admitted

>>> to the hospital within 2 weeks. Analysis revealed that 3% suffered

>>> harm, and 26% experienced discomfort due to the delay. Although 66%

>>> required no intervention, 1% required emergency transport and 4% a

>>> medication change.

>>>

>>> Conclusions: Harm may occur when patients’ calls are not forwarded

>>> to the on-call physician. Although the level of harm is generally

>>> temporary and minimal, the potential exists for serious harm to

>>> occur. Physicians need to re-evaluate the way they handle

>>> after-hours calls.

>

>

[Guest guest]

RE Pager failure.

Hah!!

My pager service or ANYONE's pager service in western PA has given up the ghost!! Noone wants to support it, as everyone uses cell phones now!!

Tech moves on. At least I use a blackberry for email away from home; did cancel the phone service for it as my cell phone reliability/hardware is fairly good, although as stated before, my answering service backup is my "failsafe."

Dr Matt Levin

Re: Answering Service - Disservice?

Great catch . Another arrow in the quiver of 24/7 access.

When I used to be in a call group with pagers and a "service," we did have the occasional missed call. More often I would call a patient within five minutes of a page to hear "I've been waiting more than an hour!!!!"

G

At 12:37 AM 10/8/2006, you wrote:

Per some recent discussions about after hours calls and using an answering service.

I wonder if it increases risk for patients?

I suppose if ALL calls are forwarded, then it would prevent the missed call.

Locke, MD

http://www.jabfm.org/cgi/content/full/19/5/437

Harm Resulting from Inappropriate Telephone Triage in Primary Care

E. Hildebrandt, PhD, M. Westfall, MD, MPH, H. Fernald, MA and D. Pace, MD

From the Department of Family Medicine, University of Colorado Health Sciences Center at Fitzsimons, Aurora, CO

Correspondence: Corresponding author: E. Hildebrandt, PhD, Department of Family and Community Medicine, University of Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001 (E-mail: dhildebrandt@... )

Purpose: Our objective was to assess and categorize harm occurring to patients who called their physicians’ office after-hours but did not have their call forwarded to the physician because they stated that their call was not an emergency.

Methods: We collected data on 4949 calls handled by our answering service for 1 year in a family medicine residency office in Denver, CO. Of the 2835 after-hours clinical calls, we reviewed all 288 clinical calls that were not forwarded to the "on-call" physician. Complete data on 119 clinical calls included reason for call, frequency of next day appointments, Emergency Department visits, hospital admissions and outcomes. Outcomes were reviewed and coded for harm to the patient by experienced medical errors coders.

Results: When patient calls were not forwarded, 51% had an appointment, 4% an Emergency Department visit, and 2% were admitted to the hospital within 2 weeks. Analysis revealed that 3% suffered harm, and 26% experienced discomfort due to the delay. Although 66% required no intervention, 1% required emergency transport and 4% a medication change.

Conclusions: Harm may occur when patients’ calls are not forwarded to the on-call physician. Although the level of harm is generally temporary and minimal, the potential exists for serious harm to occur. Physicians need to re-evaluate the way they handle after-hours calls.

[Guest guest]

RE Pager failure.

Hah!!

My pager service or ANYONE's pager service in western PA has given up the ghost!! Noone wants to support it, as everyone uses cell phones now!!

Tech moves on. At least I use a blackberry for email away from home; did cancel the phone service for it as my cell phone reliability/hardware is fairly good, although as stated before, my answering service backup is my "failsafe."

Dr Matt Levin

Re: Answering Service - Disservice?

Great catch . Another arrow in the quiver of 24/7 access.

When I used to be in a call group with pagers and a "service," we did have the occasional missed call. More often I would call a patient within five minutes of a page to hear "I've been waiting more than an hour!!!!"

G

At 12:37 AM 10/8/2006, you wrote:

Per some recent discussions about after hours calls and using an answering service.

I wonder if it increases risk for patients?

I suppose if ALL calls are forwarded, then it would prevent the missed call.

Locke, MD

http://www.jabfm.org/cgi/content/full/19/5/437

Harm Resulting from Inappropriate Telephone Triage in Primary Care

E. Hildebrandt, PhD, M. Westfall, MD, MPH, H. Fernald, MA and D. Pace, MD

From the Department of Family Medicine, University of Colorado Health Sciences Center at Fitzsimons, Aurora, CO

Correspondence: Corresponding author: E. Hildebrandt, PhD, Department of Family and Community Medicine, University of Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001 (E-mail: dhildebrandt@... )

Purpose: Our objective was to assess and categorize harm occurring to patients who called their physicians’ office after-hours but did not have their call forwarded to the physician because they stated that their call was not an emergency.

Methods: We collected data on 4949 calls handled by our answering service for 1 year in a family medicine residency office in Denver, CO. Of the 2835 after-hours clinical calls, we reviewed all 288 clinical calls that were not forwarded to the "on-call" physician. Complete data on 119 clinical calls included reason for call, frequency of next day appointments, Emergency Department visits, hospital admissions and outcomes. Outcomes were reviewed and coded for harm to the patient by experienced medical errors coders.

Results: When patient calls were not forwarded, 51% had an appointment, 4% an Emergency Department visit, and 2% were admitted to the hospital within 2 weeks. Analysis revealed that 3% suffered harm, and 26% experienced discomfort due to the delay. Although 66% required no intervention, 1% required emergency transport and 4% a medication change.

Conclusions: Harm may occur when patients’ calls are not forwarded to the on-call physician. Although the level of harm is generally temporary and minimal, the potential exists for serious harm to occur. Physicians need to re-evaluate the way they handle after-hours calls.

[Guest guest]

True.

G

At 10:44 AM 10/8/2006, you wrote:

let's say all technology fails,

and the patient cannot communicate with you.

what then?

we're still left with what does the patient do?

they are back to using their best judgement.

we cannot guarantee to be the ever-present, guiding, omniscient,

all-knowing and comforting parent, even if we promise 24/7 access.

LL

" L. Gordon "

wrote:

Matt's right that there can be real advantage in having backup

communication technology, especially if you are in an area where cell

phone connections are tenuous.

But what about the option of direct access? This gets past the

" pt left a message about something dire and I didn't call in to

check and something bad happened. "

In a region with poor cell coverage, one could carry a pager and give

the number out.

I agree that increasing complexity leads to increased risk.

My solution is to remove intermediaries and push for direct

access.

My patients call the office. The machine tells them if I'm

closed for the evening " and the problem can't wait, please call me

on my cell: 764-3605 "

It is very simple and works very well. If my cell didn't work

well in my region, I'd use a pager.

Gordon

At 10:05 AM 10/8/2006, you wrote:

RE Answering service as a " service " OR a safety net.

As a solo for the past almost 2 years, I surely need to relate that

when I started this after working in groups for 16 prior years that I did

have my service " hold " one call as the pt said " when the

doc calls in, give him this message. " When I didn't " call

in " for 2 hours (the operator didn't realize I only called in when

they called me!), pt called back.

Like anything else, I feel strongly about backup and

communication.

So, I still use an answering service ($61.95/month) but have modified

as follows:

1) Answering service calls me with EVERY CALL (usually 1-2 per week

after hours despite encouragement, for a panel of about 500 pts).

2) There are " dead spots " and can also have mechanical

failures of equipment; answering service is almost absolutely

reliable.

I use the answering service to document pts

having called (or NOT) but the phone voice mail uses caller ID, so we

check that each day even if no message is left.

3) So it's a choice here. Gordon, please acknowledge that the

choice of using an answering service is almost mandatory for some of us,

but others don't seem to care. What I don't want is the pt that

leaves a message, has a bad result, yet I check later and find a voice

mail on some device and I didn't answer it.

By the way, I have the hosp ER call me direct on cell phone, yet they

often still call the office despite specific directions!! We must

be aware that the more complex the system, the more we must be alert for

potential failures, and determine our comfort levels.

Dr Matt Levin

Solo, FP since Dec 2004

Residency graduated 1988

SOAPware user since 1997

Re: Answering Service -

Disservice?

Great catch . Another arrow in the quiver of 24/7 access.

When I used to be in a call group with pagers and a

" service, " we did have the occasional missed call.

More often I would call a patient within five minutes of a page to hear

" I've been waiting more than an hour!!!! "

G

At 12:37 AM 10/8/2006, you wrote:

Per some recent discussions about after hours calls and

using an answering service.

I wonder if it increases risk for patients?

I suppose if ALL calls are forwarded, then it would

prevent the missed call.

Locke, MD

http://www.jabfm.org/cgi/content/full/19/5/437

Harm Resulting from Inappropriate Telephone Triage in

Primary Care

E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

Fernald, MA and D. Pace, MD

From the Department of Family Medicine, University of

Colorado Health Sciences Center at Fitzsimons, Aurora, CO

Correspondence: Corresponding author: E.

Hildebrandt, PhD, Department of Family and Community Medicine, University

of Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

(E-mail:

dhildebrandt@...

)

Purpose: Our objective was to assess and categorize

harm occurring to patients who called their physicians’ office

after-hours but did not have their call forwarded to the physician

because they stated that their call was not an emergency. Methods: We collected data on 4949 calls handled by our answering

service for 1 year in a family medicine residency office in Denver, CO.

Of the 2835 after-hours clinical calls, we reviewed all 288 clinical

calls that were not forwarded to the " on-call " physician.

Complete data on 119 clinical calls included reason for call, frequency

of next day appointments, Emergency Department visits, hospital

admissions and outcomes. Outcomes were reviewed and coded for harm to the

patient by experienced medical errors coders.

Results: When patient calls were not forwarded, 51% had an

appointment, 4% an Emergency Department visit, and 2% were admitted to

the hospital within 2 weeks. Analysis revealed that 3% suffered harm, and

26% experienced discomfort due to the delay. Although 66% required no

intervention, 1% required emergency transport and 4% a medication change.

Conclusions: Harm may occur when patients’ calls are not forwarded to

the on-call physician. Although the level of harm is generally temporary

and minimal, the potential exists for serious harm to occur. Physicians

need to re-evaluate the way they handle after-hours

calls.

Get your own

web address for just $1.99/1st yr. We'll help.

Yahoo! Small Business.

[Guest guest]

True.

G

At 10:44 AM 10/8/2006, you wrote:

let's say all technology fails,

and the patient cannot communicate with you.

what then?

we're still left with what does the patient do?

they are back to using their best judgement.

we cannot guarantee to be the ever-present, guiding, omniscient,

all-knowing and comforting parent, even if we promise 24/7 access.

LL

" L. Gordon "

wrote:

Matt's right that there can be real advantage in having backup

communication technology, especially if you are in an area where cell

phone connections are tenuous.

But what about the option of direct access? This gets past the

" pt left a message about something dire and I didn't call in to

check and something bad happened. "

In a region with poor cell coverage, one could carry a pager and give

the number out.

I agree that increasing complexity leads to increased risk.

My solution is to remove intermediaries and push for direct

access.

My patients call the office. The machine tells them if I'm

closed for the evening " and the problem can't wait, please call me

on my cell: 764-3605 "

It is very simple and works very well. If my cell didn't work

well in my region, I'd use a pager.

Gordon

At 10:05 AM 10/8/2006, you wrote:

RE Answering service as a " service " OR a safety net.

As a solo for the past almost 2 years, I surely need to relate that

when I started this after working in groups for 16 prior years that I did

have my service " hold " one call as the pt said " when the

doc calls in, give him this message. " When I didn't " call

in " for 2 hours (the operator didn't realize I only called in when

they called me!), pt called back.

Like anything else, I feel strongly about backup and

communication.

So, I still use an answering service ($61.95/month) but have modified

as follows:

1) Answering service calls me with EVERY CALL (usually 1-2 per week

after hours despite encouragement, for a panel of about 500 pts).

2) There are " dead spots " and can also have mechanical

failures of equipment; answering service is almost absolutely

reliable.

I use the answering service to document pts

having called (or NOT) but the phone voice mail uses caller ID, so we

check that each day even if no message is left.

3) So it's a choice here. Gordon, please acknowledge that the

choice of using an answering service is almost mandatory for some of us,

but others don't seem to care. What I don't want is the pt that

leaves a message, has a bad result, yet I check later and find a voice

mail on some device and I didn't answer it.

By the way, I have the hosp ER call me direct on cell phone, yet they

often still call the office despite specific directions!! We must

be aware that the more complex the system, the more we must be alert for

potential failures, and determine our comfort levels.

Dr Matt Levin

Solo, FP since Dec 2004

Residency graduated 1988

SOAPware user since 1997

Re: Answering Service -

Disservice?

Great catch . Another arrow in the quiver of 24/7 access.

When I used to be in a call group with pagers and a

" service, " we did have the occasional missed call.

More often I would call a patient within five minutes of a page to hear

" I've been waiting more than an hour!!!! "

G

At 12:37 AM 10/8/2006, you wrote:

Per some recent discussions about after hours calls and

using an answering service.

I wonder if it increases risk for patients?

I suppose if ALL calls are forwarded, then it would

prevent the missed call.

Locke, MD

http://www.jabfm.org/cgi/content/full/19/5/437

Harm Resulting from Inappropriate Telephone Triage in

Primary Care

E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

Fernald, MA and D. Pace, MD

From the Department of Family Medicine, University of

Colorado Health Sciences Center at Fitzsimons, Aurora, CO

Correspondence: Corresponding author: E.

Hildebrandt, PhD, Department of Family and Community Medicine, University

of Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

(E-mail:

dhildebrandt@...

)

Purpose: Our objective was to assess and categorize

harm occurring to patients who called their physicians’ office

after-hours but did not have their call forwarded to the physician

because they stated that their call was not an emergency. Methods: We collected data on 4949 calls handled by our answering

service for 1 year in a family medicine residency office in Denver, CO.

Of the 2835 after-hours clinical calls, we reviewed all 288 clinical

calls that were not forwarded to the " on-call " physician.

Complete data on 119 clinical calls included reason for call, frequency

of next day appointments, Emergency Department visits, hospital

admissions and outcomes. Outcomes were reviewed and coded for harm to the

patient by experienced medical errors coders.

Results: When patient calls were not forwarded, 51% had an

appointment, 4% an Emergency Department visit, and 2% were admitted to

the hospital within 2 weeks. Analysis revealed that 3% suffered harm, and

26% experienced discomfort due to the delay. Although 66% required no

intervention, 1% required emergency transport and 4% a medication change.

Conclusions: Harm may occur when patients’ calls are not forwarded to

the on-call physician. Although the level of harm is generally temporary

and minimal, the potential exists for serious harm to occur. Physicians

need to re-evaluate the way they handle after-hours

calls.

Get your own

web address for just $1.99/1st yr. We'll help.

Yahoo! Small Business.

[Guest guest]

Over the past few years as both a practicing neurologist doing inpatient consults, as well as being highly involved in telecommunications issues for healthcare, I have found this to be a fascinating area. One of the things to look at very closely are the " unified messaging " solutions. I am quite familiar with Onebox but there are others like Communikate, and even the more advanced aspects of Yahoo IM that is interconnecting IM with voice, with voice over IM, etc. What is important is not the specific technology but the concepts and practical issues around them. One of the really neat aspects of some such services (not all) is the fact that while they provide great solutions for online fax/voice/email management they are really all about the idea of " personal air traffic control " Practices who use this not just as backup but as a primary telephonic process are able to have a few linked accounts, each of which can have notifications, forwarding set specific to it, and can be accessed via the phone, the web, or standard mail clients.So instead of directing the caller to " if you need me call my cell " they would merely call one main number, be given a choice to make it a routine or a more urgent issue by picking a different extension. The more urgent type line is then configured by an online updatable schedule to dial through to different phone numbers at certain times, have it ring a certain number of times and then perhaps trigger into a specific voicemail. That voice mail is then set perhaps to send an urgent text message to one's cell or pager letting you know a message is waiting. It is usually best to have someone help you configure these types of things so you have things routed the way you want, but once done and implemented you cant believe you functioned without them. Some have pricing models that are very manageable.This is an area where in fact the use of an integrated telecommunications process is in fact MORE friendly to the calling customer/patient, and MORE efficient for all involved because it is truly doing what an answering service really cant, and is ultimately much less expensive when all of the inefficiencies of communication are counted in the equation.There is a consultant in the Bay Area who has done some terrific white papers on specific issues around use of technology for healthcare--remote monitoring, e prescribing, mobile communications, etc. I think what one often needs is a " personal communications workplan " of some simple sort that is just cognizant of what is out there that can be leveraged easily, at modest cost, with high benefit. The complete integration of voice/fax/email/IM actually exists now but it will be very useful for discussion boards like this as those who " take a step " can be guided by and help guide others in their thinking about this important area.Andy Barbash, MDBethesda, MDabarbash@...

Original MessageI forward my office phone to my cell phone. When I am in the office, I check my messages between patients and call back. The voice mail states that if it is a medical emergency to call 911. Sometimes I take the phone with me in the room, if I know that the patient does not mind it and I answer during the visit. Most people are OK with that but I don't push my luck.

> Matt's right that there can be real advantage in having backup > communication technology, especially if you are in an area where cell > phone connections are tenuous.>> But what about the option of direct access? This gets past the " pt > left a message about something dire and I didn't call in to check and > something bad happened. " > In a region with poor cell coverage, one could carry a pager and give > the number out.>> I agree that increasing complexity leads to increased risk.> My solution is to remove intermediaries and push for direct access.>> My patients call the office. The machine tells them if I'm closed > for the evening " and the problem can't wait, please call me on my > cell: 764-3605 " > It is very simple and works very well. If my cell didn't work well > in my region, I'd use a pager.> Gordon> At 10:05 AM 10/8/2006, you wrote:>>> RE Answering service as a " service " OR a safety net.>>  >> As a solo for the past almost 2 years, I surely need to relate that >> when I started this after working in groups for 16 prior years that I >> did have my service " hold " one call as the pt said " when the doc >> calls in, give him this message. "  When I didn't " call in " for 2 >> hours (the operator didn't realize I only called in when they called >> me!), pt called back.>>  >> Like anything else, I feel strongly about backup and communication.>>  >> So, I still use an answering service ($61.95/month) but have >> modified as follows:>>  >> 1) Answering service calls me with EVERY CALL (usually 1-2 per week >> after hours despite encouragement, for a panel of about 500 pts).>>  >> 2) There are " dead spots " and can also have mechanical failures of >> equipment; answering service is almost absolutely reliable.>>     I use the answering service to document pts having called (or >> NOT) but the phone voice mail uses caller ID, so we check that each >> day even if no message is left.>>  >> 3) So it's a choice here. Gordon, please acknowledge that the >> choice of using an answering service is almost mandatory for some of >> us, but others don't seem to care. What I don't want is the pt that >> leaves a message, has a bad result, yet I check later and find a >> voice mail on some device and I didn't answer it. >>  >> By the way, I have the hosp ER call me direct on cell phone, yet >> they often still call the office despite specific directions!! We >> must be aware that the more complex the system, the more we must be >> alert for potential failures, and determine our comfort levels.>>  >> Dr Matt Levin>> Solo, FP since Dec 2004>> Residency graduated 1988>> SOAPware user since 1997>> Re: Answering Service - Disservice?>>>> Great catch . Another arrow in the quiver of 24/7 access.>> When I used to be in a call group with pagers and a " service, "  we >> did have the occasional missed call. More often I would call a >> patient within five minutes of a page to hear " I've been waiting more >> than an hour!!!! " >>>> G>> At 12:37 AM 10/8/2006, you wrote:>>>>> Per some recent discussions about after hours calls and using an >>> answering service.>>>>>>  >>> I wonder if it increases risk for patients?>>>>>>  >>> I suppose if ALL calls are forwarded, then it would prevent the >>> missed call.>>>>>>  >>> Locke, MD>>>>>>  >>> http://www.jabfm.org/cgi/content/full/19/5/437>>>>>>  >>> Harm Resulting from Inappropriate Telephone Triage in Primary Care>>>>>>  >>> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H. >>> Fernald, MA and D. Pace, MD>>>>>> From the Department of Family Medicine, University of Colorado >>> Health Sciences Center at Fitzsimons, Aurora, CO>>>>>> Correspondence: Corresponding author: E. Hildebrandt, PhD, >>> Department of Family and Community Medicine, University of >>> Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001 >>> (E-mail: dhildebrandt@... )>>>>>> Purpose: Our objective was to assess and categorize harm occurring >>> to patients who called their physicians’ office after-hours but did >>> not have their call forwarded to the physician because they stated >>> that their call was not an emergency.>>>>>> Methods: We collected data on 4949 calls handled by our answering >>> service for 1 year in a family medicine residency office in Denver, >>> CO. Of the 2835 after-hours clinical calls, we reviewed all 288 >>> clinical calls that were not forwarded to the " on-call " physician. >>> Complete data on 119 clinical calls included reason for call, >>> frequency of next day appointments, Emergency Department visits, >>> hospital admissions and outcomes. Outcomes were reviewed and coded >>> for harm to the patient by experienced medical errors coders.>>>>>> Results: When patient calls were not forwarded, 51% had an >>> appointment, 4% an Emergency Department visit, and 2% were admitted >>> to the hospital within 2 weeks. Analysis revealed that 3% suffered >>> harm, and 26% experienced discomfort due to the delay. Although 66% >>> required no intervention, 1% required emergency transport and 4% a >>> medication change.>>>>>> Conclusions: Harm may occur when patients’ calls are not forwarded >>> to the on-call physician. Although the level of harm is generally >>> temporary and minimal, the potential exists for serious harm to >>> occur. Physicians need to re-evaluate the way they handle >>> after-hours calls.> >

[Guest guest]

Andy- do you know what the best (least painful) way for those of us that

started out with separate phone,fax and email accounts to migrate over to

one integrated service?

Just the thought of trying to notify all those pharmacies/hospitals/xray

places/insurances/consultants and labs, not to mention patients, makes me

feel mildly queasy.

Lynn Ho

>

>Reply-To:

>To:

>Subject: Re: Answering Service - Disservice?

>Date: Sun, 8 Oct 2006 11:41:18 -0400

>

>Over the past few years as both a practicing neurologist doing inpatient

>consults, as well as being highly involved in telecommunications issues for

>healthcare, I have found this to be a fascinating area. One of the things

>to look at very closely are the " unified messaging " solutions. I am quite

>familiar with Onebox but there are others like Communikate, and even the

>more advanced aspects of Yahoo IM that is interconnecting IM with voice,

>with voice over IM, etc. What is important is not the specific technology

>but the concepts and practical issues around them. One of the really neat

>aspects of some such services (not all) is the fact that while they provide

>great solutions for online fax/voice/email management they are really all

>about the idea of " personal air traffic control "

>

>Practices who use this not just as backup but as a primary telephonic

>process are able to have a few linked accounts, each of which can have

>notifications, forwarding set specific to it, and can be accessed via the

>phone, the web, or standard mail clients.

>

>So instead of directing the caller to " if you need me call my cell " they

>would merely call one main number, be given a choice to make it a routine

>or a more urgent issue by picking a different extension. The more urgent

>type line is then configured by an online updatable schedule to dial

>through to different phone numbers at certain times, have it ring a certain

>number of times and then perhaps trigger into a specific voicemail. That

>voice mail is then set perhaps to send an urgent text message to one's cell

>or pager letting you know a message is waiting. It is usually best to have

>someone help you configure these types of things so you have things routed

>the way you want, but once done and implemented you cant believe you

>functioned without them. Some have pricing models that are very

>manageable.

>

>This is an area where in fact the use of an integrated telecommunications

>process is in fact MORE friendly to the calling customer/patient, and MORE

>efficient for all involved because it is truly doing what an answering

>service really cant, and is ultimately much less expensive when all of the

>inefficiencies of communication are counted in the equation.

>

>There is a consultant in the Bay Area who has done some terrific white

>papers on specific issues around use of technology for healthcare--remote

>monitoring, e prescribing, mobile communications, etc. I think what one

>often needs is a " personal communications workplan " of some simple sort

>that is just cognizant of what is out there that can be leveraged easily,

>at modest cost, with high benefit. The complete integration of

>voice/fax/email/IM actually exists now but it will be very useful for

>discussion boards like this as those who " take a step " can be guided by and

>help guide others in their thinking about this important area.

>

>Andy Barbash, MD

>Bethesda, MD

>abarbash@...

>

>

>

>

>

>

>

>Original Message

>

>I forward my office phone to my cell phone. When I am in the office, I

>check my messages between patients and call back. The voice mail states

>that if it is a medical emergency to call 911. Sometimes I take the

>phone with me in the room, if I know that the patient does not mind it

>and I answer during the visit. Most people are OK with that but I don't

>push my luck.

>

> > Matt's right that there can be real advantage in having backup

> > communication technology, especially if you are in an area where cell

> > phone connections are tenuous.

> >

> > But what about the option of direct access? This gets past the " pt

> > left a message about something dire and I didn't call in to check and

> > something bad happened. "

> > In a region with poor cell coverage, one could carry a pager and give

> > the number out.

> >

> > I agree that increasing complexity leads to increased risk.

> > My solution is to remove intermediaries and push for direct access.

> >

> > My patients call the office. The machine tells them if I'm closed

> > for the evening " and the problem can't wait, please call me on my

> > cell:Â 764-3605 "

> > It is very simple and works very well. If my cell didn't work well

> > in my region, I'd use a pager.

> > Gordon

> > At 10:05 AM 10/8/2006, you wrote:

> >

> >> RE Answering service as a " service " OR a safety net.

> >> Â

> >> As a solo for the past almost 2 years, I surely need to relate that

> >> when I started this after working in groups for 16 prior years that I

> >> did have my service " hold " one call as the pt said " when the doc

> >> calls in, give him this message. " Â When I didn't " call in " for 2

> >> hours (the operator didn't realize I only called in when they called

> >> me!), pt called back.

> >> Â

> >> Like anything else, I feel strongly about backup and communication.

> >> Â

> >> So, I still use an answering service ($61.95/month) but have

> >> modified as follows:

> >> Â

> >> 1) Answering service calls me with EVERY CALL (usually 1-2 per week

> >> after hours despite encouragement, for a panel of about 500 pts).

> >> Â

> >> 2) There are " dead spots " and can also have mechanical failures of

> >> equipment; answering service is almost absolutely reliable.

> >> Â Â Â Â I use the answering service to document pts having called (or

> >> NOT) but the phone voice mail uses caller ID, so we check that each

> >> day even if no message is left.

> >> Â

> >> 3) So it's a choice here. Gordon, please acknowledge that the

> >> choice of using an answering service is almost mandatory for some of

> >> us, but others don't seem to care. What I don't want is the pt that

> >> leaves a message, has a bad result, yet I check later and find a

> >> voice mail on some device and I didn't answer it.Â

> >> Â

> >> By the way, I have the hosp ER call me direct on cell phone, yet

> >> they often still call the office despite specific directions!! We

> >> must be aware that the more complex the system, the more we must be

> >> alert for potential failures, and determine our comfort levels.

> >> Â

> >> Dr Matt Levin

> >> Solo, FP since Dec 2004

> >> Residency graduated 1988

> >> SOAPware user since 1997

> >> Re: Answering Service - Disservice?

> >>

> >> Great catch . Another arrow in the quiver of 24/7 access.

> >> When I used to be in a call group with pagers and a " service, " Â we

> >> did have the occasional missed call. More often I would call a

> >> patient within five minutes of a page to hear " I've been waiting more

> >> than an hour!!!! "

> >>

> >> G

> >> At 12:37 AM 10/8/2006, you wrote:

> >>

> >>> Per some recent discussions about after hours calls and using an

> >>> answering service.

> >>>

> >>> Â

> >>> I wonder if it increases risk for patients?

> >>>

> >>> Â

> >>> I suppose if ALL calls are forwarded, then it would prevent the

> >>> missed call.

> >>>

> >>> Â

> >>> Locke, MD

> >>>

> >>> Â

> >>> http://www.jabfm.org/cgi/content/full/19/5/437

> >>>

> >>> Â

> >>> Harm Resulting from Inappropriate Telephone Triage in Primary Care

> >>>

> >>> Â

> >>> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

> >>> Fernald, MA and D. Pace, MD

> >>>

> >>> From the Department of Family Medicine, University of Colorado

> >>> Health Sciences Center at Fitzsimons, Aurora, CO

> >>>

> >>> Correspondence: Corresponding author: E. Hildebrandt, PhD,

> >>> Department of Family and Community Medicine, University of

> >>> Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

> >>> (E-mail: dhildebrandt@... )

> >>>

> >>> Purpose: Our objective was to assess and categorize harm occurring

> >>> to patients who called their physicians’ office after-hours but did

> >>> not have their call forwarded to the physician because they stated

> >>> that their call was not an emergency.

> >>>

> >>> Methods: We collected data on 4949 calls handled by our answering

> >>> service for 1 year in a family medicine residency office in Denver,

> >>> CO. Of the 2835 after-hours clinical calls, we reviewed all 288

> >>> clinical calls that were not forwarded to the " on-call " physician.

> >>> Complete data on 119 clinical calls included reason for call,

> >>> frequency of next day appointments, Emergency Department visits,

> >>> hospital admissions and outcomes. Outcomes were reviewed and coded

> >>> for harm to the patient by experienced medical errors coders.

> >>>

> >>> Results: When patient calls were not forwarded, 51% had an

> >>> appointment, 4% an Emergency Department visit, and 2% were admitted

> >>> to the hospital within 2 weeks. Analysis revealed that 3% suffered

> >>> harm, and 26% experienced discomfort due to the delay. Although 66%

> >>> required no intervention, 1% required emergency transport and 4% a

> >>> medication change.

> >>>

> >>> Conclusions: Harm may occur when patients’ calls are not forwarded

> >>> to the on-call physician. Although the level of harm is generally

> >>> temporary and minimal, the potential exists for serious harm to

> >>> occur. Physicians need to re-evaluate the way they handle

> >>> after-hours calls.

> >

> >

[Guest guest]

The one problem I have with a unified system is : what happens if it

fails ? Your whole communication will fail (e-mail, fax, phone...).

Sometimes my internet is down but the phone still works. Or my office

phone does not work but my cell works... Am I wrong ? Maybe I did not

understand correctly.

> Andy- do you know what the best (least painful) way for those of us

> that

> started out with separate phone,fax and email accounts to migrate over

> to

> one integrated service?

> Just the thought of trying to notify all those

> pharmacies/hospitals/xray

> places/insurances/consultants and labs, not to mention patients, makes

> me

> feel mildly queasy.

>

> Lynn Ho

>

>

>>

>> Reply-To:

>> To:

>> Subject: Re: Answering Service - Disservice?

>> Date: Sun, 8 Oct 2006 11:41:18 -0400

>>

>> Over the past few years as both a practicing neurologist doing

>> inpatient

>> consults, as well as being highly involved in telecommunications

>> issues for

>> healthcare, I have found this to be a fascinating area. One of the

>> things

>> to look at very closely are the " unified messaging " solutions. I am

>> quite

>> familiar with Onebox but there are others like Communikate, and even

>> the

>> more advanced aspects of Yahoo IM that is interconnecting IM with

>> voice,

>> with voice over IM, etc. What is important is not the specific

>> technology

>> but the concepts and practical issues around them. One of the really

>> neat

>> aspects of some such services (not all) is the fact that while they

>> provide

>> great solutions for online fax/voice/email management they are really

>> all

>> about the idea of " personal air traffic control "

>>

>> Practices who use this not just as backup but as a primary telephonic

>> process are able to have a few linked accounts, each of which can have

>> notifications, forwarding set specific to it, and can be accessed via

>> the

>> phone, the web, or standard mail clients.

>>

>> So instead of directing the caller to " if you need me call my cell "

>> they

>> would merely call one main number, be given a choice to make it a

>> routine

>> or a more urgent issue by picking a different extension. The more

>> urgent

>> type line is then configured by an online updatable schedule to dial

>> through to different phone numbers at certain times, have it ring a

>> certain

>> number of times and then perhaps trigger into a specific voicemail.

>> That

>> voice mail is then set perhaps to send an urgent text message to

>> one's cell

>> or pager letting you know a message is waiting. It is usually best to

>> have

>> someone help you configure these types of things so you have things

>> routed

>> the way you want, but once done and implemented you cant believe you

>> functioned without them. Some have pricing models that are very

>> manageable.

>>

>> This is an area where in fact the use of an integrated

>> telecommunications

>> process is in fact MORE friendly to the calling customer/patient, and

>> MORE

>> efficient for all involved because it is truly doing what an answering

>> service really cant, and is ultimately much less expensive when all

>> of the

>> inefficiencies of communication are counted in the equation.

>>

>> There is a consultant in the Bay Area who has done some terrific white

>> papers on specific issues around use of technology for

>> healthcare--remote

>> monitoring, e prescribing, mobile communications, etc. I think what

>> one

>> often needs is a " personal communications workplan " of some simple

>> sort

>> that is just cognizant of what is out there that can be leveraged

>> easily,

>> at modest cost, with high benefit. The complete integration of

>> voice/fax/email/IM actually exists now but it will be very useful for

>> discussion boards like this as those who " take a step " can be guided

>> by and

>> help guide others in their thinking about this important area.

>>

>> Andy Barbash, MD

>> Bethesda, MD

>> abarbash@...

>>

>>

>>

>>

>>

>>

>>

>> Original Message

>>

>> I forward my office phone to my cell phone. When I am in the office, I

>> check my messages between patients and call back. The voice mail

>> states

>> that if it is a medical emergency to call 911. Sometimes I take the

>> phone with me in the room, if I know that the patient does not mind it

>> and I answer during the visit. Most people are OK with that but I

>> don't

>> push my luck.

>>

>>> Matt's right that there can be real advantage in having backup

>>> communication technology, especially if you are in an area where cell

>>> phone connections are tenuous.

>>>

>>> But what about the option of direct access? This gets past the " pt

>>> left a message about something dire and I didn't call in to check and

>>> something bad happened. "

>>> In a region with poor cell coverage, one could carry a pager and

>>> give

>>> the number out.

>>>

>>> I agree that increasing complexity leads to increased risk.

>>> My solution is to remove intermediaries and push for direct access.

>>>

>>> My patients call the office. The machine tells them if I'm closed

>>> for the evening " and the problem can't wait, please call me on my

>>> cell:Â 764-3605 "

>>> It is very simple and works very well. If my cell didn't work well

>>> in my region, I'd use a pager.

>>> Gordon

>>> At 10:05 AM 10/8/2006, you wrote:

>>>

>>>> RE Answering service as a " service " OR a safety net.

>>>> Â

>>>> As a solo for the past almost 2 years, I surely need to relate that

>>>> when I started this after working in groups for 16 prior years that

>>>> I

>>>> did have my service " hold " one call as the pt said " when the doc

>>>> calls in, give him this message. " Â When I didn't " call in " for 2

>>>> hours (the operator didn't realize I only called in when they called

>>>> me!), pt called back.

>>>> Â

>>>> Like anything else, I feel strongly about backup and communication.

>>>> Â

>>>> So, I still use an answering service ($61.95/month) but have

>>>> modified as follows:

>>>> Â

>>>> 1) Answering service calls me with EVERY CALL (usually 1-2 per week

>>>> after hours despite encouragement, for a panel of about 500 pts).

>>>> Â

>>>> 2) There are " dead spots " and can also have mechanical failures of

>>>> equipment; answering service is almost absolutely reliable.

>>>> Â Â Â Â I use the answering service to document pts having called

>>>> (or

>>>> NOT) but the phone voice mail uses caller ID, so we check that each

>>>> day even if no message is left.

>>>> Â

>>>> 3) So it's a choice here. Gordon, please acknowledge that the

>>>> choice of using an answering service is almost mandatory for some of

>>>> us, but others don't seem to care. What I don't want is the pt

>>>> that

>>>> leaves a message, has a bad result, yet I check later and find a

>>>> voice mail on some device and I didn't answer it.Â

>>>> Â

>>>> By the way, I have the hosp ER call me direct on cell phone, yet

>>>> they often still call the office despite specific directions!! We

>>>> must be aware that the more complex the system, the more we must be

>>>> alert for potential failures, and determine our comfort levels.

>>>> Â

>>>> Dr Matt Levin

>>>> Solo, FP since Dec 2004

>>>> Residency graduated 1988

>>>> SOAPware user since 1997

>>>> Re: Answering Service - Disservice?

>>>>

>>>> Great catch . Another arrow in the quiver of 24/7 access.

>>>> When I used to be in a call group with pagers and a " service, " Â we

>>>> did have the occasional missed call. More often I would call a

>>>> patient within five minutes of a page to hear " I've been waiting

>>>> more

>>>> than an hour!!!! "

>>>>

>>>> G

>>>> At 12:37 AM 10/8/2006, you wrote:

>>>>

>>>>> Per some recent discussions about after hours calls and using an

>>>>> answering service.

>>>>>

>>>>> Â

>>>>> I wonder if it increases risk for patients?

>>>>>

>>>>> Â

>>>>> I suppose if ALL calls are forwarded, then it would prevent the

>>>>> missed call.

>>>>>

>>>>> Â

>>>>> Locke, MD

>>>>>

>>>>> Â

>>>>> http://www.jabfm.org/cgi/content/full/19/5/437

>>>>>

>>>>> Â

>>>>> Harm Resulting from Inappropriate Telephone Triage in Primary Care

>>>>>

>>>>> Â

>>>>> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

>>>>> Fernald, MA and D. Pace, MD

>>>>>

>>>>> From the Department of Family Medicine, University of Colorado

>>>>> Health Sciences Center at Fitzsimons, Aurora, CO

>>>>>

>>>>> Correspondence: Corresponding author: E. Hildebrandt, PhD,

>>>>> Department of Family and Community Medicine, University of

>>>>> Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

>>>>> (E-mail: dhildebrandt@... )

>>>>>

>>>>> Purpose: Our objective was to assess and categorize harm occurring

>>>>> to patients who called their physicians’ office after-hours but

>>>>> did

>>>>> not have their call forwarded to the physician because they stated

>>>>> that their call was not an emergency.

>>>>>

>>>>> Methods: We collected data on 4949 calls handled by our answering

>>>>> service for 1 year in a family medicine residency office in Denver,

>>>>> CO. Of the 2835 after-hours clinical calls, we reviewed all 288

>>>>> clinical calls that were not forwarded to the " on-call " physician.

>>>>> Complete data on 119 clinical calls included reason for call,

>>>>> frequency of next day appointments, Emergency Department visits,

>>>>> hospital admissions and outcomes. Outcomes were reviewed and coded

>>>>> for harm to the patient by experienced medical errors coders.

>>>>>

>>>>> Results: When patient calls were not forwarded, 51% had an

>>>>> appointment, 4% an Emergency Department visit, and 2% were admitted

>>>>> to the hospital within 2 weeks. Analysis revealed that 3% suffered

>>>>> harm, and 26% experienced discomfort due to the delay. Although 66%

>>>>> required no intervention, 1% required emergency transport and 4% a

>>>>> medication change.

>>>>>

>>>>> Conclusions: Harm may occur when patients’ calls are not

>>>>> forwarded

>>>>> to the on-call physician. Although the level of harm is generally

>>>>> temporary and minimal, the potential exists for serious harm to

>>>>> occur. Physicians need to re-evaluate the way they handle

>>>>> after-hours calls.

>>>

>>>

>

>

>

>

>

>

[Guest guest]

The one problem I have with a unified system is : what happens if it

fails ? Your whole communication will fail (e-mail, fax, phone...).

Sometimes my internet is down but the phone still works. Or my office

phone does not work but my cell works... Am I wrong ? Maybe I did not

understand correctly.

> Andy- do you know what the best (least painful) way for those of us

> that

> started out with separate phone,fax and email accounts to migrate over

> to

> one integrated service?

> Just the thought of trying to notify all those

> pharmacies/hospitals/xray

> places/insurances/consultants and labs, not to mention patients, makes

> me

> feel mildly queasy.

>

> Lynn Ho

>

>

>>

>> Reply-To:

>> To:

>> Subject: Re: Answering Service - Disservice?

>> Date: Sun, 8 Oct 2006 11:41:18 -0400

>>

>> Over the past few years as both a practicing neurologist doing

>> inpatient

>> consults, as well as being highly involved in telecommunications

>> issues for

>> healthcare, I have found this to be a fascinating area. One of the

>> things

>> to look at very closely are the " unified messaging " solutions. I am

>> quite

>> familiar with Onebox but there are others like Communikate, and even

>> the

>> more advanced aspects of Yahoo IM that is interconnecting IM with

>> voice,

>> with voice over IM, etc. What is important is not the specific

>> technology

>> but the concepts and practical issues around them. One of the really

>> neat

>> aspects of some such services (not all) is the fact that while they

>> provide

>> great solutions for online fax/voice/email management they are really

>> all

>> about the idea of " personal air traffic control "

>>

>> Practices who use this not just as backup but as a primary telephonic

>> process are able to have a few linked accounts, each of which can have

>> notifications, forwarding set specific to it, and can be accessed via

>> the

>> phone, the web, or standard mail clients.

>>

>> So instead of directing the caller to " if you need me call my cell "

>> they

>> would merely call one main number, be given a choice to make it a

>> routine

>> or a more urgent issue by picking a different extension. The more

>> urgent

>> type line is then configured by an online updatable schedule to dial

>> through to different phone numbers at certain times, have it ring a

>> certain

>> number of times and then perhaps trigger into a specific voicemail.

>> That

>> voice mail is then set perhaps to send an urgent text message to

>> one's cell

>> or pager letting you know a message is waiting. It is usually best to

>> have

>> someone help you configure these types of things so you have things

>> routed

>> the way you want, but once done and implemented you cant believe you

>> functioned without them. Some have pricing models that are very

>> manageable.

>>

>> This is an area where in fact the use of an integrated

>> telecommunications

>> process is in fact MORE friendly to the calling customer/patient, and

>> MORE

>> efficient for all involved because it is truly doing what an answering

>> service really cant, and is ultimately much less expensive when all

>> of the

>> inefficiencies of communication are counted in the equation.

>>

>> There is a consultant in the Bay Area who has done some terrific white

>> papers on specific issues around use of technology for

>> healthcare--remote

>> monitoring, e prescribing, mobile communications, etc. I think what

>> one

>> often needs is a " personal communications workplan " of some simple

>> sort

>> that is just cognizant of what is out there that can be leveraged

>> easily,

>> at modest cost, with high benefit. The complete integration of

>> voice/fax/email/IM actually exists now but it will be very useful for

>> discussion boards like this as those who " take a step " can be guided

>> by and

>> help guide others in their thinking about this important area.

>>

>> Andy Barbash, MD

>> Bethesda, MD

>> abarbash@...

>>

>>

>>

>>

>>

>>

>>

>> Original Message

>>

>> I forward my office phone to my cell phone. When I am in the office, I

>> check my messages between patients and call back. The voice mail

>> states

>> that if it is a medical emergency to call 911. Sometimes I take the

>> phone with me in the room, if I know that the patient does not mind it

>> and I answer during the visit. Most people are OK with that but I

>> don't

>> push my luck.

>>

>>> Matt's right that there can be real advantage in having backup

>>> communication technology, especially if you are in an area where cell

>>> phone connections are tenuous.

>>>

>>> But what about the option of direct access? This gets past the " pt

>>> left a message about something dire and I didn't call in to check and

>>> something bad happened. "

>>> In a region with poor cell coverage, one could carry a pager and

>>> give

>>> the number out.

>>>

>>> I agree that increasing complexity leads to increased risk.

>>> My solution is to remove intermediaries and push for direct access.

>>>

>>> My patients call the office. The machine tells them if I'm closed

>>> for the evening " and the problem can't wait, please call me on my

>>> cell:Â 764-3605 "

>>> It is very simple and works very well. If my cell didn't work well

>>> in my region, I'd use a pager.

>>> Gordon

>>> At 10:05 AM 10/8/2006, you wrote:

>>>

>>>> RE Answering service as a " service " OR a safety net.

>>>> Â

>>>> As a solo for the past almost 2 years, I surely need to relate that

>>>> when I started this after working in groups for 16 prior years that

>>>> I

>>>> did have my service " hold " one call as the pt said " when the doc

>>>> calls in, give him this message. " Â When I didn't " call in " for 2

>>>> hours (the operator didn't realize I only called in when they called

>>>> me!), pt called back.

>>>> Â

>>>> Like anything else, I feel strongly about backup and communication.

>>>> Â

>>>> So, I still use an answering service ($61.95/month) but have

>>>> modified as follows:

>>>> Â

>>>> 1) Answering service calls me with EVERY CALL (usually 1-2 per week

>>>> after hours despite encouragement, for a panel of about 500 pts).

>>>> Â

>>>> 2) There are " dead spots " and can also have mechanical failures of

>>>> equipment; answering service is almost absolutely reliable.

>>>> Â Â Â Â I use the answering service to document pts having called

>>>> (or

>>>> NOT) but the phone voice mail uses caller ID, so we check that each

>>>> day even if no message is left.

>>>> Â

>>>> 3) So it's a choice here. Gordon, please acknowledge that the

>>>> choice of using an answering service is almost mandatory for some of

>>>> us, but others don't seem to care. What I don't want is the pt

>>>> that

>>>> leaves a message, has a bad result, yet I check later and find a

>>>> voice mail on some device and I didn't answer it.Â

>>>> Â

>>>> By the way, I have the hosp ER call me direct on cell phone, yet

>>>> they often still call the office despite specific directions!! We

>>>> must be aware that the more complex the system, the more we must be

>>>> alert for potential failures, and determine our comfort levels.

>>>> Â

>>>> Dr Matt Levin

>>>> Solo, FP since Dec 2004

>>>> Residency graduated 1988

>>>> SOAPware user since 1997

>>>> Re: Answering Service - Disservice?

>>>>

>>>> Great catch . Another arrow in the quiver of 24/7 access.

>>>> When I used to be in a call group with pagers and a " service, " Â we

>>>> did have the occasional missed call. More often I would call a

>>>> patient within five minutes of a page to hear " I've been waiting

>>>> more

>>>> than an hour!!!! "

>>>>

>>>> G

>>>> At 12:37 AM 10/8/2006, you wrote:

>>>>

>>>>> Per some recent discussions about after hours calls and using an

>>>>> answering service.

>>>>>

>>>>> Â

>>>>> I wonder if it increases risk for patients?

>>>>>

>>>>> Â

>>>>> I suppose if ALL calls are forwarded, then it would prevent the

>>>>> missed call.

>>>>>

>>>>> Â

>>>>> Locke, MD

>>>>>

>>>>> Â

>>>>> http://www.jabfm.org/cgi/content/full/19/5/437

>>>>>

>>>>> Â

>>>>> Harm Resulting from Inappropriate Telephone Triage in Primary Care

>>>>>

>>>>> Â

>>>>> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

>>>>> Fernald, MA and D. Pace, MD

>>>>>

>>>>> From the Department of Family Medicine, University of Colorado

>>>>> Health Sciences Center at Fitzsimons, Aurora, CO

>>>>>

>>>>> Correspondence: Corresponding author: E. Hildebrandt, PhD,

>>>>> Department of Family and Community Medicine, University of

>>>>> Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

>>>>> (E-mail: dhildebrandt@... )

>>>>>

>>>>> Purpose: Our objective was to assess and categorize harm occurring

>>>>> to patients who called their physicians’ office after-hours but

>>>>> did

>>>>> not have their call forwarded to the physician because they stated

>>>>> that their call was not an emergency.

>>>>>

>>>>> Methods: We collected data on 4949 calls handled by our answering

>>>>> service for 1 year in a family medicine residency office in Denver,

>>>>> CO. Of the 2835 after-hours clinical calls, we reviewed all 288

>>>>> clinical calls that were not forwarded to the " on-call " physician.

>>>>> Complete data on 119 clinical calls included reason for call,

>>>>> frequency of next day appointments, Emergency Department visits,

>>>>> hospital admissions and outcomes. Outcomes were reviewed and coded

>>>>> for harm to the patient by experienced medical errors coders.

>>>>>

>>>>> Results: When patient calls were not forwarded, 51% had an

>>>>> appointment, 4% an Emergency Department visit, and 2% were admitted

>>>>> to the hospital within 2 weeks. Analysis revealed that 3% suffered

>>>>> harm, and 26% experienced discomfort due to the delay. Although 66%

>>>>> required no intervention, 1% required emergency transport and 4% a

>>>>> medication change.

>>>>>

>>>>> Conclusions: Harm may occur when patients’ calls are not

>>>>> forwarded

>>>>> to the on-call physician. Although the level of harm is generally

>>>>> temporary and minimal, the potential exists for serious harm to

>>>>> occur. Physicians need to re-evaluate the way they handle

>>>>> after-hours calls.

>>>

>>>

>

>

>

>

>

>

[Guest guest]

That's exactly what happened when I had my earlier Treo(300 I think). The phone part kept acting up and I had to keep resetting. I went through 3 treo's that year then gave up and vowed never to have another integrated system. Anemaria Lutas wrote: The one problem I have with a unified system is : what happens if it fails ? Your whole communication will fail (e-mail, fax, phone...). Sometimes my internet is down but the phone still works. Or my office phone does

not work but my cell works... Am I wrong ? Maybe I did not understand correctly.> Andy- do you know what the best (least painful) way for those of us > that> started out with separate phone,fax and email accounts to migrate over > to> one integrated service?> Just the thought of trying to notify all those > pharmacies/hospitals/xray> places/insurances/consultants and labs, not to mention patients, makes > me> feel mildly queasy.>> Lynn Ho>>>> From: "abarbashonebox" <abarbashonebox>>> Reply-To: >> To: >> Subject: Re: Answering Service - Disservice?>> Date: Sun, 8 Oct 2006 11:41:18 -0400>>>> Over the past few years as both a practicing neurologist doing >> inpatient>> consults, as well as being highly involved in telecommunications >> issues for>> healthcare, I have found this to be a fascinating area. One of the >> things>> to look at very closely are the "unified messaging" solutions. I am >> quite>> familiar with Onebox but there are others like Communikate, and even >> the>> more advanced aspects of Yahoo IM that is interconnecting IM with >> voice,>> with voice over IM, etc. What is important is not the specific >> technology>> but the concepts and practical

issues around them. One of the really >> neat>> aspects of some such services (not all) is the fact that while they >> provide>> great solutions for online fax/voice/email management they are really >> all>> about the idea of "personal air traffic control">>>> Practices who use this not just as backup but as a primary telephonic>> process are able to have a few linked accounts, each of which can have>> notifications, forwarding set specific to it, and can be accessed via >> the>> phone, the web, or standard mail clients.>>>> So instead of directing the caller to "if you need me call my cell" >> they>> would merely call one main number, be given a choice to make it a >> routine>> or a more urgent issue by picking a different extension. The more >> urgent>> type line is then

configured by an online updatable schedule to dial>> through to different phone numbers at certain times, have it ring a >> certain>> number of times and then perhaps trigger into a specific voicemail. >> That>> voice mail is then set perhaps to send an urgent text message to >> one's cell>> or pager letting you know a message is waiting. It is usually best to >> have>> someone help you configure these types of things so you have things >> routed>> the way you want, but once done and implemented you cant believe you>> functioned without them. Some have pricing models that are very>> manageable.>>>> This is an area where in fact the use of an integrated >> telecommunications>> process is in fact MORE friendly to the calling customer/patient, and >> MORE>> efficient for all involved

because it is truly doing what an answering>> service really cant, and is ultimately much less expensive when all >> of the>> inefficiencies of communication are counted in the equation.>>>> There is a consultant in the Bay Area who has done some terrific white>> papers on specific issues around use of technology for >> healthcare--remote>> monitoring, e prescribing, mobile communications, etc. I think what >> one>> often needs is a "personal communications workplan" of some simple >> sort>> that is just cognizant of what is out there that can be leveraged >> easily,>> at modest cost, with high benefit. The complete integration of>> voice/fax/email/IM actually exists now but it will be very useful for>> discussion boards like this as those who "take a step" can be guided >> by and>>

help guide others in their thinking about this important area.>>>> Andy Barbash, MD>> Bethesda, MD>> abarbashonebox>>>>>>>>>>>>>>>> Original Message>>>> I forward my office phone to my cell phone. When I am in the office, I>> check my messages between patients and call back. The voice mail >> states>> that if it is a medical emergency to call 911. Sometimes I take the>> phone with me in the room, if I know that the patient does not mind it>> and I answer during the visit. Most people are OK with that but I >> don't>> push my luck.>> >>> Matt's right that there can be real advantage in having backup>>> communication technology,

especially if you are in an area where cell>>> phone connections are tenuous.>>>>>> But what about the option of direct access? This gets past the "pt>>> left a message about something dire and I didn't call in to check and>>> something bad happened.">>> In a region with poor cell coverage, one could carry a pager and >>> give>>> the number out.>>>>>> I agree that increasing complexity leads to increased risk.>>> My solution is to remove intermediaries and push for direct access.>>>>>> My patients call the office. The machine tells them if I'm closed>>> for the evening " and the problem can't wait, please call me on my>>> cell: 764-3605">>> It is very simple and works very well. If my cell didn't work well>>> in my region, I'd use a

pager.>>> Gordon>>> At 10:05 AM 10/8/2006, you wrote:>>>>>>> RE Answering service as a "service" OR a safety net.>>>> Â>>>> As a solo for the past almost 2 years, I surely need to relate that>>>> when I started this after working in groups for 16 prior years that >>>> I>>>> did have my service "hold" one call as the pt said "when the doc>>>> calls in, give him this message."Â When I didn't "call in" for 2>>>> hours (the operator didn't realize I only called in when they called>>>> me!), pt called back.>>>> Â>>>> Like anything else, I feel strongly about backup and communication.>>>> Â>>>> So, I still use an answering service ($61.95/month) but have>>>> modified as follows:>>>> Â>>>>

1) Answering service calls me with EVERY CALL (usually 1-2 per week>>>> after hours despite encouragement, for a panel of about 500 pts).>>>> Â>>>> 2) There are "dead spots" and can also have mechanical failures of>>>> equipment; answering service is almost absolutely reliable.>>>>     I use the answering service to document pts having called >>>> (or>>>> NOT) but the phone voice mail uses caller ID, so we check that each>>>> day even if no message is left.>>>> Â>>>> 3) So it's a choice here. Gordon, please acknowledge that the>>>> choice of using an answering service is almost mandatory for some of>>>> us, but others don't seem to care. What I don't want is the pt >>>> that>>>> leaves a message, has a bad result, yet I check later and find

a>>>> voice mail on some device and I didn't answer it.Â>>>> Â>>>> By the way, I have the hosp ER call me direct on cell phone, yet>>>> they often still call the office despite specific directions!! We>>>> must be aware that the more complex the system, the more we must be>>>> alert for potential failures, and determine our comfort levels.>>>> Â>>>> Dr Matt Levin>>>> Solo, FP since Dec 2004>>>> Residency graduated 1988>>>> SOAPware user since 1997>>>> Re: Answering

Service - Disservice?>>>>>>>> Great catch . Another arrow in the quiver of 24/7 access.>>>> When I used to be in a call group with pagers and a "service," we>>>> did have the occasional missed call. More often I would call a>>>> patient within five minutes of a page to hear "I've been waiting >>>> more>>>> than an hour!!!!">>>>>>>> G>>>> At 12:37 AM 10/8/2006, you wrote:>>>>>>>>> Per some recent discussions about after hours calls and using an>>>>> answering service.>>>>>>>>>> Â>>>>> I wonder if it increases risk for patients?>>>>>>>>>> Â>>>>> I suppose if ALL calls are forwarded, then it would prevent the>>>>> missed

call.>>>>>>>>>> Â>>>>> Locke, MD>>>>>>>>>> Â>>>>> http://www.jabfm.org/cgi/content/full/19/5/437>>>>>>>>>> Â>>>>> Harm Resulting from Inappropriate Telephone Triage in Primary Care>>>>>>>>>> Â>>>>> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.>>>>> Fernald, MA and D. Pace, MD>>>>>>>>>> From the Department of Family Medicine, University of Colorado>>>>> Health Sciences Center at Fitzsimons, Aurora, CO>>>>>>>>>> Correspondence: Corresponding author: E. Hildebrandt, PhD,>>>>> Department of Family and Community

Medicine, University of>>>>> Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001>>>>> (E-mail: dhildebrandtbresnan (DOT) net )>>>>>>>>>> Purpose: Our objective was to assess and categorize harm occurring>>>>> to patients who called their physicians’ office after-hours but >>>>> did>>>>> not have their call forwarded to the physician because they stated>>>>> that their call was not an emergency.>>>>>>>>>> Methods: We collected data on 4949 calls handled by our answering>>>>> service for 1 year in a family medicine residency office in Denver,>>>>> CO. Of the 2835 after-hours clinical calls, we reviewed all 288>>>>> clinical calls that were not forwarded to the "on-call"

physician.>>>>> Complete data on 119 clinical calls included reason for call,>>>>> frequency of next day appointments, Emergency Department visits,>>>>> hospital admissions and outcomes. Outcomes were reviewed and coded>>>>> for harm to the patient by experienced medical errors coders.>>>>>>>>>> Results: When patient calls were not forwarded, 51% had an>>>>> appointment, 4% an Emergency Department visit, and 2% were admitted>>>>> to the hospital within 2 weeks. Analysis revealed that 3% suffered>>>>> harm, and 26% experienced discomfort due to the delay. Although 66%>>>>> required no intervention, 1% required emergency transport and 4% a>>>>> medication change.>>>>>>>>>> Conclusions: Harm may occur when patients’ calls are not

>>>>> forwarded>>>>> to the on-call physician. Although the level of harm is generally>>>>> temporary and minimal, the potential exists for serious harm to>>>>> occur. Physicians need to re-evaluate the way they handle>>>>> after-hours calls.>>>>>>>>>>>>

[Guest guest]

That's exactly what happened when I had my earlier Treo(300 I think). The phone part kept acting up and I had to keep resetting. I went through 3 treo's that year then gave up and vowed never to have another integrated system. Anemaria Lutas wrote: The one problem I have with a unified system is : what happens if it fails ? Your whole communication will fail (e-mail, fax, phone...). Sometimes my internet is down but the phone still works. Or my office phone does

not work but my cell works... Am I wrong ? Maybe I did not understand correctly.> Andy- do you know what the best (least painful) way for those of us > that> started out with separate phone,fax and email accounts to migrate over > to> one integrated service?> Just the thought of trying to notify all those > pharmacies/hospitals/xray> places/insurances/consultants and labs, not to mention patients, makes > me> feel mildly queasy.>> Lynn Ho>>>> From: "abarbashonebox" <abarbashonebox>>> Reply-To: >> To: >> Subject: Re: Answering Service - Disservice?>> Date: Sun, 8 Oct 2006 11:41:18 -0400>>>> Over the past few years as both a practicing neurologist doing >> inpatient>> consults, as well as being highly involved in telecommunications >> issues for>> healthcare, I have found this to be a fascinating area. One of the >> things>> to look at very closely are the "unified messaging" solutions. I am >> quite>> familiar with Onebox but there are others like Communikate, and even >> the>> more advanced aspects of Yahoo IM that is interconnecting IM with >> voice,>> with voice over IM, etc. What is important is not the specific >> technology>> but the concepts and practical

issues around them. One of the really >> neat>> aspects of some such services (not all) is the fact that while they >> provide>> great solutions for online fax/voice/email management they are really >> all>> about the idea of "personal air traffic control">>>> Practices who use this not just as backup but as a primary telephonic>> process are able to have a few linked accounts, each of which can have>> notifications, forwarding set specific to it, and can be accessed via >> the>> phone, the web, or standard mail clients.>>>> So instead of directing the caller to "if you need me call my cell" >> they>> would merely call one main number, be given a choice to make it a >> routine>> or a more urgent issue by picking a different extension. The more >> urgent>> type line is then

configured by an online updatable schedule to dial>> through to different phone numbers at certain times, have it ring a >> certain>> number of times and then perhaps trigger into a specific voicemail. >> That>> voice mail is then set perhaps to send an urgent text message to >> one's cell>> or pager letting you know a message is waiting. It is usually best to >> have>> someone help you configure these types of things so you have things >> routed>> the way you want, but once done and implemented you cant believe you>> functioned without them. Some have pricing models that are very>> manageable.>>>> This is an area where in fact the use of an integrated >> telecommunications>> process is in fact MORE friendly to the calling customer/patient, and >> MORE>> efficient for all involved

because it is truly doing what an answering>> service really cant, and is ultimately much less expensive when all >> of the>> inefficiencies of communication are counted in the equation.>>>> There is a consultant in the Bay Area who has done some terrific white>> papers on specific issues around use of technology for >> healthcare--remote>> monitoring, e prescribing, mobile communications, etc. I think what >> one>> often needs is a "personal communications workplan" of some simple >> sort>> that is just cognizant of what is out there that can be leveraged >> easily,>> at modest cost, with high benefit. The complete integration of>> voice/fax/email/IM actually exists now but it will be very useful for>> discussion boards like this as those who "take a step" can be guided >> by and>>

help guide others in their thinking about this important area.>>>> Andy Barbash, MD>> Bethesda, MD>> abarbashonebox>>>>>>>>>>>>>>>> Original Message>>>> I forward my office phone to my cell phone. When I am in the office, I>> check my messages between patients and call back. The voice mail >> states>> that if it is a medical emergency to call 911. Sometimes I take the>> phone with me in the room, if I know that the patient does not mind it>> and I answer during the visit. Most people are OK with that but I >> don't>> push my luck.>> >>> Matt's right that there can be real advantage in having backup>>> communication technology,

especially if you are in an area where cell>>> phone connections are tenuous.>>>>>> But what about the option of direct access? This gets past the "pt>>> left a message about something dire and I didn't call in to check and>>> something bad happened.">>> In a region with poor cell coverage, one could carry a pager and >>> give>>> the number out.>>>>>> I agree that increasing complexity leads to increased risk.>>> My solution is to remove intermediaries and push for direct access.>>>>>> My patients call the office. The machine tells them if I'm closed>>> for the evening " and the problem can't wait, please call me on my>>> cell: 764-3605">>> It is very simple and works very well. If my cell didn't work well>>> in my region, I'd use a

pager.>>> Gordon>>> At 10:05 AM 10/8/2006, you wrote:>>>>>>> RE Answering service as a "service" OR a safety net.>>>> Â>>>> As a solo for the past almost 2 years, I surely need to relate that>>>> when I started this after working in groups for 16 prior years that >>>> I>>>> did have my service "hold" one call as the pt said "when the doc>>>> calls in, give him this message."Â When I didn't "call in" for 2>>>> hours (the operator didn't realize I only called in when they called>>>> me!), pt called back.>>>> Â>>>> Like anything else, I feel strongly about backup and communication.>>>> Â>>>> So, I still use an answering service ($61.95/month) but have>>>> modified as follows:>>>> Â>>>>

1) Answering service calls me with EVERY CALL (usually 1-2 per week>>>> after hours despite encouragement, for a panel of about 500 pts).>>>> Â>>>> 2) There are "dead spots" and can also have mechanical failures of>>>> equipment; answering service is almost absolutely reliable.>>>>     I use the answering service to document pts having called >>>> (or>>>> NOT) but the phone voice mail uses caller ID, so we check that each>>>> day even if no message is left.>>>> Â>>>> 3) So it's a choice here. Gordon, please acknowledge that the>>>> choice of using an answering service is almost mandatory for some of>>>> us, but others don't seem to care. What I don't want is the pt >>>> that>>>> leaves a message, has a bad result, yet I check later and find

a>>>> voice mail on some device and I didn't answer it.Â>>>> Â>>>> By the way, I have the hosp ER call me direct on cell phone, yet>>>> they often still call the office despite specific directions!! We>>>> must be aware that the more complex the system, the more we must be>>>> alert for potential failures, and determine our comfort levels.>>>> Â>>>> Dr Matt Levin>>>> Solo, FP since Dec 2004>>>> Residency graduated 1988>>>> SOAPware user since 1997>>>> Re: Answering

Service - Disservice?>>>>>>>> Great catch . Another arrow in the quiver of 24/7 access.>>>> When I used to be in a call group with pagers and a "service," we>>>> did have the occasional missed call. More often I would call a>>>> patient within five minutes of a page to hear "I've been waiting >>>> more>>>> than an hour!!!!">>>>>>>> G>>>> At 12:37 AM 10/8/2006, you wrote:>>>>>>>>> Per some recent discussions about after hours calls and using an>>>>> answering service.>>>>>>>>>> Â>>>>> I wonder if it increases risk for patients?>>>>>>>>>> Â>>>>> I suppose if ALL calls are forwarded, then it would prevent the>>>>> missed

call.>>>>>>>>>> Â>>>>> Locke, MD>>>>>>>>>> Â>>>>> http://www.jabfm.org/cgi/content/full/19/5/437>>>>>>>>>> Â>>>>> Harm Resulting from Inappropriate Telephone Triage in Primary Care>>>>>>>>>> Â>>>>> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.>>>>> Fernald, MA and D. Pace, MD>>>>>>>>>> From the Department of Family Medicine, University of Colorado>>>>> Health Sciences Center at Fitzsimons, Aurora, CO>>>>>>>>>> Correspondence: Corresponding author: E. Hildebrandt, PhD,>>>>> Department of Family and Community

Medicine, University of>>>>> Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001>>>>> (E-mail: dhildebrandtbresnan (DOT) net )>>>>>>>>>> Purpose: Our objective was to assess and categorize harm occurring>>>>> to patients who called their physicians’ office after-hours but >>>>> did>>>>> not have their call forwarded to the physician because they stated>>>>> that their call was not an emergency.>>>>>>>>>> Methods: We collected data on 4949 calls handled by our answering>>>>> service for 1 year in a family medicine residency office in Denver,>>>>> CO. Of the 2835 after-hours clinical calls, we reviewed all 288>>>>> clinical calls that were not forwarded to the "on-call"

physician.>>>>> Complete data on 119 clinical calls included reason for call,>>>>> frequency of next day appointments, Emergency Department visits,>>>>> hospital admissions and outcomes. Outcomes were reviewed and coded>>>>> for harm to the patient by experienced medical errors coders.>>>>>>>>>> Results: When patient calls were not forwarded, 51% had an>>>>> appointment, 4% an Emergency Department visit, and 2% were admitted>>>>> to the hospital within 2 weeks. Analysis revealed that 3% suffered>>>>> harm, and 26% experienced discomfort due to the delay. Although 66%>>>>> required no intervention, 1% required emergency transport and 4% a>>>>> medication change.>>>>>>>>>> Conclusions: Harm may occur when patients’ calls are not

>>>>> forwarded>>>>> to the on-call physician. Although the level of harm is generally>>>>> temporary and minimal, the potential exists for serious harm to>>>>> occur. Physicians need to re-evaluate the way they handle>>>>> after-hours calls.>>>>>>>>>>>>

[Guest guest]

What about all the walkin clinics run by nurse practioners, do they

worry about call?

Brent

>

>

> Per some recent discussions about after hours calls and using an

answering service.

>

>

>

> I wonder if it increases risk for patients?

>

>

>

> I suppose if ALL calls are forwarded, then it would prevent the

missed call.

>

>

>

> Locke, MD

>

>

>

> http://www.jabfm.org/cgi/content/full/19/5/437

>

>

>

> Harm Resulting from Inappropriate Telephone Triage in Primary

Care

>

>

>

> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

Fernald, MA and D. Pace, MD

>

>

> From the Department of Family Medicine, University of Colorado

Health Sciences Center at Fitzsimons, Aurora, CO

>

>

> Correspondence: Corresponding author: E. Hildebrandt, PhD,

Department of Family and Community Medicine, University of Minnesota,

101 Luther King Jr. Drive, Mankato, MN 56001 (E-mail:

dhildebrandt@... )

>

>

> Purpose: Our objective was to assess and categorize harm

occurring to patients who called their physicians' office after-hours

but did not have their call forwarded to the physician because they

stated that their call was not an emergency.

>

>

> Methods: We collected data on 4949 calls handled by our

answering service for 1 year in a family medicine residency office in

Denver, CO. Of the 2835 after-hours clinical calls, we reviewed all

288 clinical calls that were not forwarded to the " on-call "

physician. Complete data on 119 clinical calls included reason for

call, frequency of next day appointments, Emergency Department

visits, hospital admissions and outcomes. Outcomes were reviewed and

coded for harm to the patient by experienced medical errors coders.

>

>

> Results: When patient calls were not forwarded, 51% had an

appointment, 4% an Emergency Department visit, and 2% were admitted

to the hospital within 2 weeks. Analysis revealed that 3% suffered

harm, and 26% experienced discomfort due to the delay. Although 66%

required no intervention, 1% required emergency transport and 4% a

medication change.

>

>

> Conclusions: Harm may occur when patients' calls are not

forwarded to the on-call physician. Although the level of harm is

generally temporary and minimal, the potential exists for serious

harm to occur. Physicians need to re-evaluate the way they handle

after-hours calls.

>

>

>

>

>

> ---------------------------------

> Get your own web address for just $1.99/1st yr. We'll help. Yahoo!

Small Business.

>

[Guest guest]

On the Vonage (internet phone) I have at home - if the internet is down locally,

it automatically forwards the message to my cell phone.

Some fax systems actually allow the fax to be converted to pdf and forwarded to

your e-mail.

I'm hoping Vonage will do this soon. There are some other internet phone

companies that already have this feature.

Anyway, the system would only be " down " if the Vonage side is down.

If my side is down, it will forward the phone call.

And when the fax to e-mail is up and running in the future, it will just hold

the e-mail/fax until I am back on-line.

But generally, I agree...the more complex the system, the more it is likely to

break down.

That's why I plan to go to a system with my Vonage that allows me to just

forward calls to the 1 business line to my home or cell phone. That way the

patient just calls the one # and gets me directly.

Currently, our system requires the patient to call the business line. They get a

phone message (that must be changed every few days for the new doctor on call)

that says Doctor X is on call. To reach him, hang up and call his pager at

blahblahblah.

Problem is...even the paging system in the valley is quirky. If I don't get the

page, I never see it as a missed call.

At least on the cell phone I see I missed a call.

I like the idea of having 2 options on the phone for the patient -- to leave a

message for the morning, punch 1. For urgent questions, punch 2.

Locke, MD

Re: Answering Service - Disservice?

>> Date: Sun, 8 Oct 2006 11:41:18 -0400

>>

>> Over the past few years as both a practicing neurologist doing

>> inpatient

>> consults, as well as being highly involved in telecommunications

>> issues for

>> healthcare, I have found this to be a fascinating area. One of the

>> things

>> to look at very closely are the " unified messaging " solutions. I am

>> quite

>> familiar with Onebox but there are others like Communikate, and even

>> the

>> more advanced aspects of Yahoo IM that is interconnecting IM with

>> voice,

>> with voice over IM, etc. What is important is not the specific

>> technology

>> but the concepts and practical issues around them. One of the really

>> neat

>> aspects of some such services (not all) is the fact that while they

>> provide

>> great solutions for online fax/voice/email management they are really

>> all

>> about the idea of " personal air traffic control "

>>

>> Practices who use this not just as backup but as a primary telephonic

>> process are able to have a few linked accounts, each of which can have

>> notifications, forwarding set specific to it, and can be accessed via

>> the

>> phone, the web, or standard mail clients.

>>

>> So instead of directing the caller to " if you need me call my cell "

>> they

>> would merely call one main number, be given a choice to make it a

>> routine

>> or a more urgent issue by picking a different extension. The more

>> urgent

>> type line is then configured by an online updatable schedule to dial

>> through to different phone numbers at certain times, have it ring a

>> certain

>> number of times and then perhaps trigger into a specific voicemail.

>> That

>> voice mail is then set perhaps to send an urgent text message to

>> one's cell

>> or pager letting you know a message is waiting. It is usually best to

>> have

>> someone help you configure these types of things so you have things

>> routed

>> the way you want, but once done and implemented you cant believe you

>> functioned without them. Some have pricing models that are very

>> manageable.

>>

>> This is an area where in fact the use of an integrated

>> telecommunications

>> process is in fact MORE friendly to the calling customer/patient, and

>> MORE

>> efficient for all involved because it is truly doing what an answering

>> service really cant, and is ultimately much less expensive when all

>> of the

>> inefficiencies of communication are counted in the equation.

>>

>> There is a consultant in the Bay Area who has done some terrific white

>> papers on specific issues around use of technology for

>> healthcare--remote

>> monitoring, e prescribing, mobile communications, etc. I think what

>> one

>> often needs is a " personal communications workplan " of some simple

>> sort

>> that is just cognizant of what is out there that can be leveraged

>> easily,

>> at modest cost, with high benefit. The complete integration of

>> voice/fax/email/IM actually exists now but it will be very useful for

>> discussion boards like this as those who " take a step " can be guided

>> by and

>> help guide others in their thinking about this important area.

>>

>> Andy Barbash, MD

>> Bethesda, MD

>> abarbash@...

>>

>>

>>

>>

>>

>>

>>

>> Original Message

>>

>> I forward my office phone to my cell phone. When I am in the office, I

>> check my messages between patients and call back. The voice mail

>> states

>> that if it is a medical emergency to call 911. Sometimes I take the

>> phone with me in the room, if I know that the patient does not mind it

>> and I answer during the visit. Most people are OK with that but I

>> don't

>> push my luck.

>>

>>> Matt's right that there can be real advantage in having backup

>>> communication technology, especially if you are in an area where cell

>>> phone connections are tenuous.

>>>

>>> But what about the option of direct access? This gets past the " pt

>>> left a message about something dire and I didn't call in to check and

>>> something bad happened. "

>>> In a region with poor cell coverage, one could carry a pager and

>>> give

>>> the number out.

>>>

>>> I agree that increasing complexity leads to increased risk.

>>> My solution is to remove intermediaries and push for direct access.

>>>

>>> My patients call the office. The machine tells them if I'm closed

>>> for the evening " and the problem can't wait, please call me on my

>>> cell:Â 764-3605 "

>>> It is very simple and works very well. If my cell didn't work well

>>> in my region, I'd use a pager.

>>> Gordon

>>> At 10:05 AM 10/8/2006, you wrote:

>>>

>>>> RE Answering service as a " service " OR a safety net.

>>>> Â

>>>> As a solo for the past almost 2 years, I surely need to relate that

>>>> when I started this after working in groups for 16 prior years that

>>>> I

>>>> did have my service " hold " one call as the pt said " when the doc

>>>> calls in, give him this message. " Â When I didn't " call in " for 2

>>>> hours (the operator didn't realize I only called in when they called

>>>> me!), pt called back.

>>>> Â

>>>> Like anything else, I feel strongly about backup and communication.

>>>> Â

>>>> So, I still use an answering service ($61.95/month) but have

>>>> modified as follows:

>>>> Â

>>>> 1) Answering service calls me with EVERY CALL (usually 1-2 per week

>>>> after hours despite encouragement, for a panel of about 500 pts).

>>>> Â

>>>> 2) There are " dead spots " and can also have mechanical failures of

>>>> equipment; answering service is almost absolutely reliable.

>>>> Â Â Â Â I use the answering service to document pts having called

>>>> (or

>>>> NOT) but the phone voice mail uses caller ID, so we check that each

>>>> day even if no message is left.

>>>> Â

>>>> 3) So it's a choice here. Gordon, please acknowledge that the

>>>> choice of using an answering service is almost mandatory for some of

>>>> us, but others don't seem to care. What I don't want is the pt

>>>> that

>>>> leaves a message, has a bad result, yet I check later and find a

>>>> voice mail on some device and I didn't answer it.Â

>>>> Â

>>>> By the way, I have the hosp ER call me direct on cell phone, yet

>>>> they often still call the office despite specific directions!! We

>>>> must be aware that the more complex the system, the more we must be

>>>> alert for potential failures, and determine our comfort levels.

>>>> Â

>>>> Dr Matt Levin

>>>> Solo, FP since Dec 2004

>>>> Residency graduated 1988

>>>> SOAPware user since 1997

>>>> Re: Answering Service - Disservice?

>>>>

>>>> Great catch . Another arrow in the quiver of 24/7 access.

>>>> When I used to be in a call group with pagers and a " service, " Â we

>>>> did have the occasional missed call. More often I would call a

>>>> patient within five minutes of a page to hear " I've been waiting

>>>> more

>>>> than an hour!!!! "

>>>>

>>>> G

>>>> At 12:37 AM 10/8/2006, you wrote:

>>>>

>>>>> Per some recent discussions about after hours calls and using an

>>>>> answering service.

>>>>>

>>>>> Â

>>>>> I wonder if it increases risk for patients?

>>>>>

>>>>> Â

>>>>> I suppose if ALL calls are forwarded, then it would prevent the

>>>>> missed call.

>>>>>

>>>>> Â

>>>>> Locke, MD

>>>>>

>>>>> Â

>>>>> http://www.jabfm.org/cgi/content/full/19/5/437

>>>>>

>>>>> Â

>>>>> Harm Resulting from Inappropriate Telephone Triage in Primary Care

>>>>>

>>>>> Â

>>>>> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

>>>>> Fernald, MA and D. Pace, MD

>>>>>

>>>>> From the Department of Family Medicine, University of Colorado

>>>>> Health Sciences Center at Fitzsimons, Aurora, CO

>>>>>

>>>>> Correspondence: Corresponding author: E. Hildebrandt, PhD,

>>>>> Department of Family and Community Medicine, University of

>>>>> Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

>>>>> (E-mail: dhildebrandt@... )

>>>>>

>>>>> Purpose: Our objective was to assess and categorize harm occurring

>>>>> to patients who called their physicians’ office after-hours but

>>>>> did

>>>>> not have their call forwarded to the physician because they stated

>>>>> that their call was not an emergency.

>>>>>

>>>>> Methods: We collected data on 4949 calls handled by our answering

>>>>> service for 1 year in a family medicine residency office in Denver,

>>>>> CO. Of the 2835 after-hours clinical calls, we reviewed all 288

>>>>> clinical calls that were not forwarded to the " on-call " physician.

>>>>> Complete data on 119 clinical calls included reason for call,

>>>>> frequency of next day appointments, Emergency Department visits,

>>>>> hospital admissions and outcomes. Outcomes were reviewed and coded

>>>>> for harm to the patient by experienced medical errors coders.

>>>>>

>>>>> Results: When patient calls were not forwarded, 51% had an

>>>>> appointment, 4% an Emergency Department visit, and 2% were admitted

>>>>> to the hospital within 2 weeks. Analysis revealed that 3% suffered

>>>>> harm, and 26% experienced discomfort due to the delay. Although 66%

>>>>> required no intervention, 1% required emergency transport and 4% a

>>>>> medication change.

>>>>>

>>>>> Conclusions: Harm may occur when patients’ calls are not

>>>>> forwarded

>>>>> to the on-call physician. Although the level of harm is generally

>>>>> temporary and minimal, the potential exists for serious harm to

>>>>> occur. Physicians need to re-evaluate the way they handle

>>>>> after-hours calls.

>>>

>>>

>

>

>

>

>

>

[Guest guest]

On the Vonage (internet phone) I have at home - if the internet is down locally,

it automatically forwards the message to my cell phone.

Some fax systems actually allow the fax to be converted to pdf and forwarded to

your e-mail.

I'm hoping Vonage will do this soon. There are some other internet phone

companies that already have this feature.

Anyway, the system would only be " down " if the Vonage side is down.

If my side is down, it will forward the phone call.

And when the fax to e-mail is up and running in the future, it will just hold

the e-mail/fax until I am back on-line.

But generally, I agree...the more complex the system, the more it is likely to

break down.

That's why I plan to go to a system with my Vonage that allows me to just

forward calls to the 1 business line to my home or cell phone. That way the

patient just calls the one # and gets me directly.

Currently, our system requires the patient to call the business line. They get a

phone message (that must be changed every few days for the new doctor on call)

that says Doctor X is on call. To reach him, hang up and call his pager at

blahblahblah.

Problem is...even the paging system in the valley is quirky. If I don't get the

page, I never see it as a missed call.

At least on the cell phone I see I missed a call.

I like the idea of having 2 options on the phone for the patient -- to leave a

message for the morning, punch 1. For urgent questions, punch 2.

Locke, MD

Re: Answering Service - Disservice?

>> Date: Sun, 8 Oct 2006 11:41:18 -0400

>>

>> Over the past few years as both a practicing neurologist doing

>> inpatient

>> consults, as well as being highly involved in telecommunications

>> issues for

>> healthcare, I have found this to be a fascinating area. One of the

>> things

>> to look at very closely are the " unified messaging " solutions. I am

>> quite

>> familiar with Onebox but there are others like Communikate, and even

>> the

>> more advanced aspects of Yahoo IM that is interconnecting IM with

>> voice,

>> with voice over IM, etc. What is important is not the specific

>> technology

>> but the concepts and practical issues around them. One of the really

>> neat

>> aspects of some such services (not all) is the fact that while they

>> provide

>> great solutions for online fax/voice/email management they are really

>> all

>> about the idea of " personal air traffic control "

>>

>> Practices who use this not just as backup but as a primary telephonic

>> process are able to have a few linked accounts, each of which can have

>> notifications, forwarding set specific to it, and can be accessed via

>> the

>> phone, the web, or standard mail clients.

>>

>> So instead of directing the caller to " if you need me call my cell "

>> they

>> would merely call one main number, be given a choice to make it a

>> routine

>> or a more urgent issue by picking a different extension. The more

>> urgent

>> type line is then configured by an online updatable schedule to dial

>> through to different phone numbers at certain times, have it ring a

>> certain

>> number of times and then perhaps trigger into a specific voicemail.

>> That

>> voice mail is then set perhaps to send an urgent text message to

>> one's cell

>> or pager letting you know a message is waiting. It is usually best to

>> have

>> someone help you configure these types of things so you have things

>> routed

>> the way you want, but once done and implemented you cant believe you

>> functioned without them. Some have pricing models that are very

>> manageable.

>>

>> This is an area where in fact the use of an integrated

>> telecommunications

>> process is in fact MORE friendly to the calling customer/patient, and

>> MORE

>> efficient for all involved because it is truly doing what an answering

>> service really cant, and is ultimately much less expensive when all

>> of the

>> inefficiencies of communication are counted in the equation.

>>

>> There is a consultant in the Bay Area who has done some terrific white

>> papers on specific issues around use of technology for

>> healthcare--remote

>> monitoring, e prescribing, mobile communications, etc. I think what

>> one

>> often needs is a " personal communications workplan " of some simple

>> sort

>> that is just cognizant of what is out there that can be leveraged

>> easily,

>> at modest cost, with high benefit. The complete integration of

>> voice/fax/email/IM actually exists now but it will be very useful for

>> discussion boards like this as those who " take a step " can be guided

>> by and

>> help guide others in their thinking about this important area.

>>

>> Andy Barbash, MD

>> Bethesda, MD

>> abarbash@...

>>

>>

>>

>>

>>

>>

>>

>> Original Message

>>

>> I forward my office phone to my cell phone. When I am in the office, I

>> check my messages between patients and call back. The voice mail

>> states

>> that if it is a medical emergency to call 911. Sometimes I take the

>> phone with me in the room, if I know that the patient does not mind it

>> and I answer during the visit. Most people are OK with that but I

>> don't

>> push my luck.

>>

>>> Matt's right that there can be real advantage in having backup

>>> communication technology, especially if you are in an area where cell

>>> phone connections are tenuous.

>>>

>>> But what about the option of direct access? This gets past the " pt

>>> left a message about something dire and I didn't call in to check and

>>> something bad happened. "

>>> In a region with poor cell coverage, one could carry a pager and

>>> give

>>> the number out.

>>>

>>> I agree that increasing complexity leads to increased risk.

>>> My solution is to remove intermediaries and push for direct access.

>>>

>>> My patients call the office. The machine tells them if I'm closed

>>> for the evening " and the problem can't wait, please call me on my

>>> cell:Â 764-3605 "

>>> It is very simple and works very well. If my cell didn't work well

>>> in my region, I'd use a pager.

>>> Gordon

>>> At 10:05 AM 10/8/2006, you wrote:

>>>

>>>> RE Answering service as a " service " OR a safety net.

>>>> Â

>>>> As a solo for the past almost 2 years, I surely need to relate that

>>>> when I started this after working in groups for 16 prior years that

>>>> I

>>>> did have my service " hold " one call as the pt said " when the doc

>>>> calls in, give him this message. " Â When I didn't " call in " for 2

>>>> hours (the operator didn't realize I only called in when they called

>>>> me!), pt called back.

>>>> Â

>>>> Like anything else, I feel strongly about backup and communication.

>>>> Â

>>>> So, I still use an answering service ($61.95/month) but have

>>>> modified as follows:

>>>> Â

>>>> 1) Answering service calls me with EVERY CALL (usually 1-2 per week

>>>> after hours despite encouragement, for a panel of about 500 pts).

>>>> Â

>>>> 2) There are " dead spots " and can also have mechanical failures of

>>>> equipment; answering service is almost absolutely reliable.

>>>> Â Â Â Â I use the answering service to document pts having called

>>>> (or

>>>> NOT) but the phone voice mail uses caller ID, so we check that each

>>>> day even if no message is left.

>>>> Â

>>>> 3) So it's a choice here. Gordon, please acknowledge that the

>>>> choice of using an answering service is almost mandatory for some of

>>>> us, but others don't seem to care. What I don't want is the pt

>>>> that

>>>> leaves a message, has a bad result, yet I check later and find a

>>>> voice mail on some device and I didn't answer it.Â

>>>> Â

>>>> By the way, I have the hosp ER call me direct on cell phone, yet

>>>> they often still call the office despite specific directions!! We

>>>> must be aware that the more complex the system, the more we must be

>>>> alert for potential failures, and determine our comfort levels.

>>>> Â

>>>> Dr Matt Levin

>>>> Solo, FP since Dec 2004

>>>> Residency graduated 1988

>>>> SOAPware user since 1997

>>>> Re: Answering Service - Disservice?

>>>>

>>>> Great catch . Another arrow in the quiver of 24/7 access.

>>>> When I used to be in a call group with pagers and a " service, " Â we

>>>> did have the occasional missed call. More often I would call a

>>>> patient within five minutes of a page to hear " I've been waiting

>>>> more

>>>> than an hour!!!! "

>>>>

>>>> G

>>>> At 12:37 AM 10/8/2006, you wrote:

>>>>

>>>>> Per some recent discussions about after hours calls and using an

>>>>> answering service.

>>>>>

>>>>> Â

>>>>> I wonder if it increases risk for patients?

>>>>>

>>>>> Â

>>>>> I suppose if ALL calls are forwarded, then it would prevent the

>>>>> missed call.

>>>>>

>>>>> Â

>>>>> Locke, MD

>>>>>

>>>>> Â

>>>>> http://www.jabfm.org/cgi/content/full/19/5/437

>>>>>

>>>>> Â

>>>>> Harm Resulting from Inappropriate Telephone Triage in Primary Care

>>>>>

>>>>> Â

>>>>> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H.

>>>>> Fernald, MA and D. Pace, MD

>>>>>

>>>>> From the Department of Family Medicine, University of Colorado

>>>>> Health Sciences Center at Fitzsimons, Aurora, CO

>>>>>

>>>>> Correspondence: Corresponding author: E. Hildebrandt, PhD,

>>>>> Department of Family and Community Medicine, University of

>>>>> Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001

>>>>> (E-mail: dhildebrandt@... )

>>>>>

>>>>> Purpose: Our objective was to assess and categorize harm occurring

>>>>> to patients who called their physicians’ office after-hours but

>>>>> did

>>>>> not have their call forwarded to the physician because they stated

>>>>> that their call was not an emergency.

>>>>>

>>>>> Methods: We collected data on 4949 calls handled by our answering

>>>>> service for 1 year in a family medicine residency office in Denver,

>>>>> CO. Of the 2835 after-hours clinical calls, we reviewed all 288

>>>>> clinical calls that were not forwarded to the " on-call " physician.

>>>>> Complete data on 119 clinical calls included reason for call,

>>>>> frequency of next day appointments, Emergency Department visits,

>>>>> hospital admissions and outcomes. Outcomes were reviewed and coded

>>>>> for harm to the patient by experienced medical errors coders.

>>>>>

>>>>> Results: When patient calls were not forwarded, 51% had an

>>>>> appointment, 4% an Emergency Department visit, and 2% were admitted

>>>>> to the hospital within 2 weeks. Analysis revealed that 3% suffered

>>>>> harm, and 26% experienced discomfort due to the delay. Although 66%

>>>>> required no intervention, 1% required emergency transport and 4% a

>>>>> medication change.

>>>>>

>>>>> Conclusions: Harm may occur when patients’ calls are not

>>>>> forwarded

>>>>> to the on-call physician. Although the level of harm is generally

>>>>> temporary and minimal, the potential exists for serious harm to

>>>>> occur. Physicians need to re-evaluate the way they handle

>>>>> after-hours calls.

>>>

>>>

>

>

>

>

>

>

[Guest guest]

ANDY, Major problems with your patch, it has messed up my system. I can not do anything on the system other than read mail, can not save to chart or email you through it. Help.

To:

Sent: Sunday, October 08, 2006 11:41 AM

Subject: Re: Answering Service - Disservice?

Over the past few years as both a practicing neurologist doing inpatient consults, as well as being highly involved in telecommunications issues for healthcare, I have found this to be a fascinating area. One of the things to look at very closely are the "unified messaging" solutions. I am quite familiar with Onebox but there are others like Communikate, and even the more advanced aspects of Yahoo IM that is interconnecting IM with voice, with voice over IM, etc. What is important is not the specific technology but the concepts and practical issues around them. One of the really neat aspects of some such services (not all) is the fact that while they provide great solutions for online fax/voice/email management they are really all about the idea of "personal air traffic control"Practices who use this not just as backup but as a primary telephonic process are able to have a few linked accounts, each of which can have notifications, forwarding set specific to it, and can be accessed via the phone, the web, or standard mail clients.So instead of directing the caller to "if you need me call my cell" they would merely call one main number, be given a choice to make it a routine or a more urgent issue by picking a different extension. The more urgent type line is then configured by an online updatable schedule to dial through to different phone numbers at certain times, have it ring a certain number of times and then perhaps trigger into a specific voicemail. That voice mail is then set perhaps to send an urgent text message to one's cell or pager letting you know a message is waiting. It is usually best to have someone help you configure these types of things so you have things routed the way you want, but once done and implemented you cant believe you functioned without them. Some have pricing models that are very manageable.This is an area where in fact the use of an integrated telecommunications process is in fact MORE friendly to the calling customer/patient, and MORE efficient for all involved because it is truly doing what an answering service really cant, and is ultimately much less expensive when all of the inefficiencies of communication are counted in the equation.There is a consultant in the Bay Area who has done some terrific white papers on specific issues around use of technology for healthcare--remote monitoring, e prescribing, mobile communications, etc. I think what one often needs is a "personal communications workplan" of some simple sort that is just cognizant of what is out there that can be leveraged easily, at modest cost, with high benefit. The complete integration of voice/fax/email/IM actually exists now but it will be very useful for discussion boards like this as those who "take a step" can be guided by and help guide others in their thinking about this important area.Andy Barbash, MDBethesda, MDabarbashonebox

Original MessageI forward my office phone to my cell phone. When I am in the office, I check my messages between patients and call back. The voice mail states that if it is a medical emergency to call 911. Sometimes I take the phone with me in the room, if I know that the patient does not mind it and I answer during the visit. Most people are OK with that but I don't push my luck.

> Matt's right that there can be real advantage in having backup > communication technology, especially if you are in an area where cell > phone connections are tenuous.>> But what about the option of direct access? This gets past the "pt > left a message about something dire and I didn't call in to check and > something bad happened."> In a region with poor cell coverage, one could carry a pager and give > the number out.>> I agree that increasing complexity leads to increased risk.> My solution is to remove intermediaries and push for direct access.>> My patients call the office. The machine tells them if I'm closed > for the evening " and the problem can't wait, please call me on my > cell: 764-3605"> It is very simple and works very well. If my cell didn't work well > in my region, I'd use a pager.> Gordon> At 10:05 AM 10/8/2006, you wrote:>>> RE Answering service as a "service" OR a safety net.>>  >> As a solo for the past almost 2 years, I surely need to relate that >> when I started this after working in groups for 16 prior years that I >> did have my service "hold" one call as the pt said "when the doc >> calls in, give him this message." When I didn't "call in" for 2 >> hours (the operator didn't realize I only called in when they called >> me!), pt called back.>>  >> Like anything else, I feel strongly about backup and communication.>>  >> So, I still use an answering service ($61.95/month) but have >> modified as follows:>>  >> 1) Answering service calls me with EVERY CALL (usually 1-2 per week >> after hours despite encouragement, for a panel of about 500 pts).>>  >> 2) There are "dead spots" and can also have mechanical failures of >> equipment; answering service is almost absolutely reliable.>>     I use the answering service to document pts having called (or >> NOT) but the phone voice mail uses caller ID, so we check that each >> day even if no message is left.>>  >> 3) So it's a choice here. Gordon, please acknowledge that the >> choice of using an answering service is almost mandatory for some of >> us, but others don't seem to care. What I don't want is the pt that >> leaves a message, has a bad result, yet I check later and find a >> voice mail on some device and I didn't answer it. >>  >> By the way, I have the hosp ER call me direct on cell phone, yet >> they often still call the office despite specific directions!! We >> must be aware that the more complex the system, the more we must be >> alert for potential failures, and determine our comfort levels.>>  >> Dr Matt Levin>> Solo, FP since Dec 2004>> Residency graduated 1988>> SOAPware user since 1997>> Re: Answering Service - Disservice?>>>> Great catch . Another arrow in the quiver of 24/7 access.>> When I used to be in a call group with pagers and a "service," we >> did have the occasional missed call. More often I would call a >> patient within five minutes of a page to hear "I've been waiting more >> than an hour!!!!">>>> G>> At 12:37 AM 10/8/2006, you wrote:>>>>> Per some recent discussions about after hours calls and using an >>> answering service.>>>>>>  >>> I wonder if it increases risk for patients?>>>>>>  >>> I suppose if ALL calls are forwarded, then it would prevent the >>> missed call.>>>>>>  >>> Locke, MD>>>>>>  >>> http://www.jabfm.org/cgi/content/full/19/5/437>>>>>>  >>> Harm Resulting from Inappropriate Telephone Triage in Primary Care>>>>>>  >>> E. Hildebrandt, PhD, M. Westfall, MD, MPH, H. >>> Fernald, MA and D. Pace, MD>>>>>> From the Department of Family Medicine, University of Colorado >>> Health Sciences Center at Fitzsimons, Aurora, CO>>>>>> Correspondence: Corresponding author: E. Hildebrandt, PhD, >>> Department of Family and Community Medicine, University of >>> Minnesota, 101 Luther King Jr. Drive, Mankato, MN 56001 >>> (E-mail: dhildebrandtbresnan (DOT) net )>>>>>> Purpose: Our objective was to assess and categorize harm occurring >>> to patients who called their physicians’ office after-hours but did >>> not have their call forwarded to the physician because they stated >>> that their call was not an emergency.>>>>>> Methods: We collected data on 4949 calls handled by our answering >>> service for 1 year in a family medicine residency office in Denver, >>> CO. Of the 2835 after-hours clinical calls, we reviewed all 288 >>> clinical calls that were not forwarded to the "on-call" physician. >>> Complete data on 119 clinical calls included reason for call, >>> frequency of next day appointments, Emergency Department visits, >>> hospital admissions and outcomes. Outcomes were reviewed and coded >>> for harm to the patient by experienced medical errors coders.>>>>>> Results: When patient calls were not forwarded, 51% had an >>> appointment, 4% an Emergency Department visit, and 2% were admitted >>> to the hospital within 2 weeks. Analysis revealed that 3% suffered >>> harm, and 26% experienced discomfort due to the delay. Although 66% >>> required no intervention, 1% required emergency transport and 4% a >>> medication change.>>>>>> Conclusions: Harm may occur when patients’ calls are not forwarded >>> to the on-call physician. Although the level of harm is generally >>> temporary and minimal, the potential exists for serious harm to >>> occur. Physicians need to re-evaluate the way they handle >>> after-hours calls.> >