Continuity of Care Issues

Patient continuity issues are a main component of a clinical dermatology practice.  It is essential that residents be exposed to and understand how to handle these issues in order to provide optimal patient care.  To ensure that residents participate in all aspects of patient care, including continuity of care issues as discussed in the ACGME residency program requirements, the residents will be responsible for various patient care issues.  The residents are also encouraged, as part of their clinical practice management training, to assist in improving and streamlining processes related to patient care and safety issues.

Coordination of patient phone calls requiring medical-decision making are the responsibility of the encounter provider.  The medical assistants, nurses, secretaries, and schedulers in the office receive phone calls and faxes during the day.  The staff member then creates a telephone or refill encounter in EPIC which is routed to the appropriate provider’s In Basket.  The nature of the calls is usually regarding biopsy results, laboratory results, medications refills, or disease not controlled by current medications.  The provider is responsible for addressing the problem and triaging or returning the patient’s call.  Depending on the nature of the patient’s call and the learning opportunities involved, attending physicians may handle the situation him/herself, may ask a medical assistant, nurse, or physician assistant to perform the task (See Appendix B for nurse/MA appropriate call-backs) or may forward the message to the resident’s In Basket with a specific request.  If a message is sent to a resident’s In Basket, a response must be made on the day the message is received with documentation placed in EPIC.  If a resident is out of the office, arrangements must be made ahead of time for other residents to cover his/her In Basket.  Repeat attempts to reach the patient should be made on a daily basis with those calls noted in EPIC.  Documentation is made in the patient’s electronic chart and the message can be “doned” or forwarded to the attending physician if appropriate.  Appropriate laboratory results are to be reviewed prior to refilling certain medications.  Patients not seen in clinic for a year or greater will need to schedule an appointment prior to any medication refills unless otherwise approved by the attending physician.  Phone callbacks are not to be done during other clinic responsibilities.  It is recognized that making the calls during normal business hours is more effective and should be attempted before or right after clinics or during lunch.  If the assistance of an office staff member or attending in regard to any continuity of care issue is needed, please communicate this with the appropriate individual or the Chief Resident(s).

All patient care coordination issues for patients seen in Resident Continuity Clinics will be addressed by the resident handling the patient’s dermatologic care (the encounter provider).