Risk Management

Ten Steps to Ensure that On-Call Coverage Doesn’t Put Your Patient on Hold

By B. Thomas Hutchinson, MD

Argus, September 1997

Medical call coverage, the transference of patient care responsibility from the “attending/treating” physician to a “covering” physician, is a necessary and integral part of contemporary ophthalmic practice. However, when patient care responsibility is transferred, there is greater risk exposure because of real or perceived undue delays in addressing the medical problem and lack of an established relationship between the patient and covering physician. If not carefully planned, effected and monitored, call coverage may be detrimental to the patient and result in a malpractice lawsuit, not only pitting patient against physician but, at times, physician against physician.

Establishing guidelines for coverage that ensures quality care for the patient will satisfy the risk management aspects of shared responsibility and enhance the image of the practice with patients. The following concepts are important to consider when evaluating existing or new call coverage.

Although most state licenses allow a physician to practice medicine and surgery in the broadest sense, a prudent course is to arrange coverage with an ophthalmologist who has similar training and experience, whenever possible. Practice patterns in call coverage must meet the standard of the community, which may vary between geographic areas of concentrated subspecialty care and areas of sparse medical coverage. In areas of concentrated subspecialty care, sharing coverage between different ophthalmic subspecialists and between comprehensive ophthalmologists and subspecialists may be appropriate only if each has maintained skills and practice patterns commensurate with the spectrum of care in the medical call coverage. Optometric and ophthalmological cross-coverage and that of different disciplines of medicine is an inappropriate policy and opens one to substantial legal risk.

Both the treating/attending and covering ophthalmologist should acknowledge the time the coverage starts and ends. The treating/attending ophthalmologist should advise the hospital, office and answering service of the name and telephone numbers of the covering physician. The covering ophthalmologist should advise the hospital, office and answering service of his/her availability and how to be reached.

The treating/attending ophthalmologist should provide covering physicians with information on patients with acute or anticipated problems; this should be documented in the patient’s medical record. The treating/attending ophthalmologist also should give these patients the covering ophthalmologist’s phone numbers and arrange for scheduled visits if the interval of coverage warrants it.

Instructions to the patient from the answering service or other facility must be clear and complete. If possible, an alternative referral source should be provided in case the ophthalmologist on call is unexpectedly unavailable. Access to the physician on call or the responsible facility must be given on the initial inquiry of the patient.

The medical records of the practice being covered should be available if needed.

Documentation

Recording the name, telephone number, identifying address, time of call, reason for call, disposition of the inquiry and follow-up arrangements is absolutely necessary. When returning the call coverage to the treating/attending ophthalmologist, the record of calls and care given will provide continuity of the patient’s care and establish for the written record the events of the on-call care provided.

If a patient’s concerns are not completely addressed during a telephone inquiry, the patient should be seen by the covering ophthalmologist, even if the patient is known to the covering ophthalmologist.

The treating/attending ophthalmologist should partner only with fellow ophthalmologists who share his/her own philosophy regarding prompt, high quality and ethical service to the patient.

Follow-up communication with both patients and any covering ophthalmologist should be a priority when the treating/attending ophthalmologist returns to cover the practice.

Although coverage arrangements are especially important for solo practitioners, it is also important for ophthalmologists in group practices to have clear policies defining coverage arrangements with their associates.

A timely response to a real or perceived emergency benefits not only the patient, but also the practice of both the attending and covering ophthalmologist. In summary, an effective, medically correct and responsive call coverage program is a necessity for every practicing ophthalmologist.