Clinical Tasking and On Call Physicians

Understand reasons we task messages to clinical staff

Learn how to task messages

Understand the process for medication refills

Understand when to contact an on callphysician

Learn how to contact an on call physician

As we do with Medical Records and Referrals, messages are tasked to the clinical staff (physicians, medical assistants) task groups using EHR

All messages tasked are sent to groups, not to individuals

Messages can only be taken for established patients of the practice

Messages for clinical staff can be for many different reasons, including but not limited to:◦ Medication Refills

◦ Prescription clarification/change

◦ Medical questions regarding health or treatment

◦ Discuss results

◦ Doctor to Doctor Calls

◦ Forms (Plan of Care)

◦ Laboratory- Stat Results

◦ Pre-op Clearance

◦ Hospital Discharge

Medication refills are only accepted from the patient or the patient’s representative. We can not accept refill requests from a pharmacy*

For callers requesting a refill, the patient must have been seen by the doctor within the last three months, except for Covenant Village patients of Bloom, Shook, or Guida (these patients can request refills if they’ve been seen within 1 year.)

The prescription must have originated from an NSU physician.

If the medication has never been prescribed at NSU, patient will need an appointment to request a refill.

*Exception: Park Shore Pharmacy for United

Cerebral Palsy Group Home Center patients

When a patient calls in for a refill we need to confirm that the medication was prescribed by the doctor here at NSU. When you see the medication list in the template the last column says RX Elsewhere. If a Y is in this box than that means it was prescribed by another doctor.

If a medication was not prescribed here, then the patient needs to be advised that they need an appointment for refill. Please do not request a refill via a message for a patient if the meds were not prescribed at NSU. Below is an example of the RX Elsewhere box.

The Student Medical Center does not prescribe any controlled substances.

Truvada refills need an office visit appointment every 3 months for bloodwork

If a patient is requesting a change to a medication they need to be scheduled for an appointment.

Student Medical will not prescribe any medications via message. If the patient needs a new medication, a refill to a med not prescribed at NSU, a change to a medication, etc. they MUST schedule an appointment. The doctors do not want messages tasked for these matters. Please inform patients they must schedule an appointment, there is no exceptions to this.

Medication refills are tasked using the Medication Management tab in the contact log of EHR.

When you click into the medication grid a list of current medications will show to choose from.

You must ensure that the name and dosage information for the medication listed exactly

matches what the patient is requesting

When the information does not match with the system or the medication is not listed on the list at all, do not put the message in the medication management template. Instead, put this information in a “Medical Question” message to the doctor.

This message must state that there is a discrepancy between what is listed in the medication management list and what the patient has stated that they need refilled or that the medication is not listed on the active meds list.

You must also include all information that the patient stated about the medication, who prescribed the medication, and that the patient needs a call back to further clarify the

medication that needs to be refilled.

If a patient is calling for a refill and they have not been seen in the last 3 months, the patient should be asked to make an appointment to follow up with a physician and request refills.

If the patient can not wait for an appointment, a request can be placed and approval is at the doctor’s discretion.

Approvals are usually made for one month until appointment can be made and are for urgent medications; such as blood pressure or diabetic medication.

Dr. Shook, Bloom and Guida are requesting that we task any Rx refill requests for Covenant Village Care Center patients that have been seen at NSU within the last 12 months. They will refill medications without seeing the patient as long asthe patient has been seen within the last 12 months.

Controlled substance refills do require an office visit.

Ask who prescribed this medicine to confirm it was an NSU physician

For all patients except Covenant Village patients, determine if patient has been seen by an NSU Physician within 3 months, if not, offer an appointment

Ask for the name(s) of medication(s) and strength information

Verify the pharmacy on file or gather new pharmacy information

How much is left in the patient’s prescription? Is the patient completely out of the medication?

Has the patient contacted the pharmacy to make sure there are no refills left on the Rx.

Requests patient's contact telephone number

Inform caller timeframe for messages of 1-2 business days

If a patient needs to add a new pharmacy to their chart, follow the directions below to add the pharmacy:

When in EPM click on look up to open the update patient information tab

Pharmacy is located on the left hand side second from the bottom

Click on yellow folder to add or delete pharmacy

Clear old pharmacy if they are not using it any longer and add new pharmacy

Send an email to Lead and Supervisor with the following information: o Pharmacy Name

o Mailing Address

o State/Province

o Zip Code + four digits

o Pharmacy Phone

o Pharmacy Fax

o Store Number

If a pharmacy calls for a refill you will inform them that we only accept refill requests from the patient.

If they are calling for a prescription clarification or change to a prescription we can take that information.

You will collect all details as to why the change is requested or what the clarification is and task a message in the medical question template.

Pharmacies or patients can call regarding prior authorization for medication.

This is when an insurance company requires approval to pay for a medication.

The pharmacy normally faxes the information to the physician.

Physician will fill out a form from the insurance company about the medication and fax for approval.

When approval or denial is received it will be sent back to the pharmacy

If the pharmacy did not send the form, you can just place a message to the physician to check on the status of the prior auth. The physicians have the forms to send to pt’s insurance as needed.

Medical questions regarding health or treatment are another reason for tasking a message to a physician.

These messages can be anything that is being asked about the clinical care of the patient.

A few examples are:

Side effects from medication

Patient recently seen for illness, still not well

Concern/clarification regarding a condition they have already been seen for

If a patient has not been seen in the Student Medical Center in the last 12 months and they call to leave a message for a physician, they need to schedule an appointment (if they are still a student).

If they are no longer a student they need to establish care with a PCP for further care.

If they insist on leaving a message, please inform the patient that since it has been over 12 months since their last visit, if a message is forwarded to one of our doctors that it will most likely be forwarded to the front desk for an appointment, they will not get a call from a physician. Please include that the patient was advised of this in the message tasked.

When patients are calling to discuss results you utilize the Test Results template in EHR.

You must collect the following information for the message after locating the patients record:

◦ Name of test

◦ When it was performed

◦ Where it was performed

◦ Contact number for patient to receive callback

Advise patient of callback timeframe of 1-2 business days

If a patient calls for test results, you need to check if the results came in by checking if there is a provider test action on the chart.

Review the doctors note for information on the provider test action.

◦ If the doctor left a note that they called patient asking the patient to call back, then you can leave a message that they are returning the call.

◦ If the doctor notes that there are no abnormal findings then you can advise the patient of such, and if they place a note that they need an appointment, please schedule the appointment.

◦ If the results are normal, but pt still has questions for a physician, they must make an appt to follow up to review results.

If there is no provider test action, please advise that we have not received the results, unless it has been more than 1 week since the test was done. In this case, you can place a message with details about where and when the test was performed and the office will attempt to obtain those results for the pt.

The Student Medical Center does not want messages tasked regarding lab results, unless the note from the doctor indicates they want to speak to the patient.

Use the notes in the Provider Test Action to advise patients of what message was left for them regarding their results.

The SMC staff calls patients with their lab results as a courtesy. If the call has been made to the patient and a voicemail message was left there should be no other messages sent back to the doctors asking to discuss anything further unless the original message asks for the patient to call the doctor back.

The patient needs to be instructed to make a follow up appointment to review anything further and/or they are welcome to go to medical records directly to pick up a copy of their results.

When a doctor is calling to speak to our physicians regarding a mutual patient you will ask for:

◦ Patient name and DOB

◦ Name of the doctor calling

◦ Type of specialty

◦ Urgent Matter or not

◦ Phone number for callback

If matter is urgent we contact clinic front desk for the specific department to attempt to get a doctor on the line immediately

If matter is not urgent, you can simply place a message for a physician.

Insurance plans or companies calling on behalf of insurance companies will call to do what is called a “Peer to Peer” before they authorize a referral that our physician requested.

In these cases, you do not send the message to a physician group, instead the message would go to the Referrals group for a callback or for forwarding to a physician, since it is referral-related.

Patients, home health companies, funeral homes and other medical companies or patient representatives can call regarding forms that need to be completed or signed by the doctor.

These forms include:◦ Plan of care

◦ Death Certificates

◦ Disability forms, other medical related forms

◦ Physical or Immunization forms (Peds or SHC)

When someone is calling regarding a form you will need to determine the following:

◦ What type of form

◦ Was it sent to us via fax, mail or dropping off in clinic

◦ Confirm it was sent to the correct fax number, if faxed

◦ When it needs to be completed by

◦ Method of returning form (fax, mail, pick up)

◦ What doctor needs to complete form

◦ Name and phone number of caller

Task message with details to above questions and any other information caller provides

If a laboratory is calling with Stat/Critical/Urgent test results you will gather the following information:

Patient Name and DOB

Name of Laboratory

Name and phone number of contact person

Reference number

DO NOT PLACE CALLER ON HOLD UNTIL YOU HAVE GATHERED ALL INFORMATION LISTED ABOVE.

If during regular working hours, please contact the MA line for the respective department for assistance. If no response contact the front desk, and then if still no response, contact the Nurse Intake team. If you are unable to reach an MA, the the front desk, or the Nurse Intake team, please contact Marisol Suarez.

If it is lunch, you should still attempt to contact these people in the clinic, or use the back lines listed for the doctors. If you still can’t get anyone to answer during lunch, please leave a message and then call the clinic when they return from lunch to ensure they got the message.

If the clinic is closed when you receive the call you need to contact the on call physician for the department in which thepatient is seen.

Do not call the on call during clinic hours (this includes lunch time).

It is extremely important to actually get a doctor on the line to speak to the facility regarding the stat results. Please do not simply leave a message, even if a MA or staff member tells you to do so. Please ask for assistance from your lead or supervisor if you can’t get anyone on the line for this matter.

All messages for status of clearance must include:

◦ Name of the surgeon

◦ Name of the hospital

◦ What type of surgery

◦ Date of the surgery

◦ Name of the contact person at the office

◦ Office number and fax

Messages with the information above are tasked to the MA task group of the department in which the person is seen.

If surgery is in 1 business day or less call MA line of department in which the patient is seen for assistance. If no response contact the front desk and then Nurse Intake team.

Any and all questions or concerns (except appointments) about an established Dr. Nousari patient should be provided the below number for assistance. Please do not task messages in EHR, as his resident’s will not receive these messages.

Dermatology Resident Phone Number: 305-912-3376

Messages going to the Covenant Village, Geriatrics or Internal Med teams must start with the name of the doctor they last saw and the date of their last appointment.

Dr. Shook – last seen 2/12/18. Pt requests a call back to discuss…

ANY messages for Dr. Guida patients need to be sent to the Covenant Physicians Group and NOT Geriatrics regardless of where the patient is seen.

Patient Type Task Group for pre-opclearance

Task Group for all other messages

Davie Family Medicine Davie FM MA Davie FM Team

NMB Family Medicine NMB FM MA NMB FM Team

Internal Medicine Internal/Geriatrics MA Internal Med Team

Geriatrics Internal/Geriatrics MA Geriatrics Med Team

OBGYN OB MA OB Team

Dr. Nousari No messages – give out phone number for residents

No messages – give out phone number for residents

Endocrinology N/A Geriatrics Med Team

Davie Pediatrics Pediatrics MA Pediatrics Med Team

NMB Pediatrics NMB FM MA NMB Pediatrics

Employee Health EHW Physician Group EHW Physician Grp

Student Health Student Health MA Student Health Med Team

Covenant Village Covenant Village MA Covenant Physician

Physicians are called when a call comes in from Broward Health Medical Center (formerly Broward General) for the on-call doctor.

The Geriatric physician on-call is called for all nursing home patients.

On-call Contact List

On-call Calendars

DEPARTMENT Cell Phone or Instruction Notes/Who to Contact if No Response

Hospital - Broward General Only 954-875-8783 Check Calendar for instructions

Hospital - Broward General - Pediatrics Pt's Only Check Amion.com Call Dr. Peters at 816.674.1584

Internal Medicine (After Hours Only)

Check Amion.com -

contact doctor listed

under Int Med

After two (3) attempts, call Dr. Hafizulla at 954-295-2050

Covenant Village Clinic (Shook, Guida, Bloom patients

only - when there is not a Dr. In the office) - After

Hours Only

Check Calendar

Davie Pediatrics (After Hours Only) 954.770.4419Check Amion and call Dr. Listed for Peds, if no response call Dr.

Peters at 816.674.1584

OBGYN (After Hours Only) Check Amion.com

Student Health (After Hours Only) 954.232.9819

Davie Family Medicine (After Hours Only) 954.770.4419

After two (2) attempts, Check On Call Broward Health/Davie

Family Medicine Back Up Calendar. If no response after one (1)

attempt, call Dr. Arcos 954.260.9026Check Amion.com & call

resident on callAfter two (2) attempts, call Dr. CohenNMB Family Medicine & Pediatrics (After Hours Only)

After one (1) attempt, call Dr. Pandya at 954.873.2692

This guide is used for the following:

- When Broward Health Medical Center (Broward General) calls to reach the On Call Physician for the hospital

- On any day when the CV clinic doctors (Shook, Guida, Bloom only) are not in the office

If you receive a call during lunch hours for a clinic patient, this is considered business hours. Do not call an on call physician unless the patient is a

Geriatrics patient. Contact the clinical numbers and if no answer task a message in the system. Then call back between 1-1:15pm and advise of the

tasked message.

Geriatrics (including hospital consults at Broward

Health Medical Center, consults at Aventura Hospital,

and Nursing Home Calls - Alexander Nininger VA

Nursing Home, Avante at Boca Rehab, Covenant

Village Nursing Home)

954-816-8461

- Nursing Home Calls (Alexander Nininger VA, Avante at Boca Rehab, Covenant Village Nursing Home)

Our physicians are on call for Broward General hospital. The calendar of who is on call is listed on the intranet.

We contact the resident on call and if they do not answer we then call the attending.

We always contact the on call physician, even if they are asking for a different doctor than the one that is on call for the hospital.

The Geriatric Physician group sees patients at the following Nursing Home Facilities:

◦ VA Nursing Home a.k.a. Alexander Nininger Nursing Home

◦ Covenant Village Assisted Living Facility

◦ Avante at Boca Rehabilitation

If one of these facilities calls you ask if they have already contacted the on call cell.

If not provide cell number

If it is a patient or family member, do not provide the number. You will take all appropriate information and call the on call yourself to relay message.

You can call the Geriatrics office immediately for urgent matters for Geriatric patients. If there is no doctor in the office, please call the Geriatrics on call cell phone for assistance.

Anytime you have an urgent matter, especially for a Geriatric patient you need to contact the clinic for assistance and not simply task a message. The critical symptoms guide is listed on the intranet, but can also include other urgent matters, such as loss of consciousness, or stat results. If you aren’t sure if something is urgent or not, ask to be safe. When messages are tasked, they are not always seen immediately, and this can cause an issue with the patient receiving assistance in a timely manner for an urgent issue.

Urgent matters include the following:

1. Fever more than 99°F

2. Blood pressure less than 90/60 or higher than 170/100

3. Tachycardia heart rate greater than 100

4. Stroke like symptoms

5. Chest pain

6. Shortness of breath

7. Critical labs such as: Hypoglycemia, Hyperglycemia, Hyperkalemia

Hypoglycemia - Low blood sugar equal to or less than 70

Hyperglycemia - High blood sugar higher than 400

Hyperkalemia - High potassium rate of 5.9

Hypokalemia - Low potassium rate of 2.7

8. Oxygen saturation of less than 90%

9. Altered mental status – confusion more than normal

10. Abnormal bleeding

11. Ongoing dizziness

12. Death

Please collect the following information from callers that you need to contact the on call physician for:

Patient’s name and date of birth the call is regarding

Department/Name of Doctor the patient sees at NSU

The name of person calling (if not the patient)

Detailed reason for call

If call is for a prescription refill: Must get the name of the medication, the strength/dosage information, and the name and phone number of the pharmacy

Phone number where doctor can call back (include direct extensions)

Inform caller that doctor will be contacted immediately, but they should allow 45 minutes for callback

Inform caller of message response time if the message will require a response.

Always confirm the patient or caller’s phone number and place in message in case a response is required.

Name of doctor last seen and date of last appointment

Name of person calling (if caller is not the patient) and relation

Detailed reason for the call

Pt or caller’s contact telephone number, or phone number of contact person for message response