 |
e-Solutions
Risk Management News
June 2005
PHYSICIANS AND VACATION
COVERAGE TIPS
Now that we’re into summer
and dreams of vacation are being realized, pre-vacation
arrangements for practice coverage are vital to assure
trouble-free continuation of optimal medical care for
your patients in your absence. This article will review
risk recommendations for physician practices and encourages
hospital risk managers to share these recommendations
with members of their medical staff and hospital-owned
practices. Coverage plans that are complete and well
thought out should be coupled with good communication
between you, the covering physician, the facilities you
practice at, and your patients. This will help to guarantee
that patients’ needs are being adequately met.
When selecting a physician to cover your practice, try to find a physician in
your specialty whose treatment philosophies are compatible with your own. A long-time
patient will be comfortable with your methods and treatment style. Any radical
departure or change from this by a covering physician may be met with resistance
and noncompliance on the part of your patient. It is important for the physician
covering your practice to be aware of all aspects of coverage prior to your departure.
The covering physician should know your expectations, your needs and those of
your patients, “on-call” duties, emergency coverage, answering service
information, in-hospital patient requirements, etc. Additionally, confirm that
the physician providing your vacation coverage has professional liability insurance
coverage applicable for this type of activity and privileges at the same hospital(s).
It is also important to determine if services provided by a covering physician
will be acceptable under your patients’ insurance plans.
Claims may arise because of flaws in a physician’s vacation coverage, especially
with regard to in-hospital practice. It is recommended that elective surgical
procedures not be scheduled immediately before your vacation but be postponed
until your return rather than using a covering physician to step in during the
immediate post-operative period. If this is not possible, it is recommended that
you inform the patient of your vacation plans so that your patient knows you
will not be available for the entire post-operative course before making a decision
regarding the date of elective surgery. If you have patients in the hospital
at the time you begin your leave, relaying information on the care of these patients
is especially important. You should provide the covering physician with information
on patients with anticipated problems and this should be documented in the patient’s
medical record. For example, make sure the covering physician is aware of your
patients’ needs including dressings, drains, physical therapy, suture removal,
allergies, etc.
If you receive a consult request prior to your departure, it is recommended that
you make sure someone will follow-up in your absence, especially for surgical
consults. Malpractice claims have arisen out of communication breakdowns in the
consultation process. For example: you are called in as a surgical consultant
on a patient with acute abdominal pain; you decide that the patient is not a
candidate for surgery at that time; note your findings and impressions to that
effect in the patient’s chart; and then leave for vacation. Prior to leaving,
as the consultant, you must be sure the attending physician who requested the
consult is aware of the results, is aware that you are going on vacation, and
is aware of who will be covering your practice in your absence. Additionally,
it is important that the covering physician be made aware of the consult in order
to follow-up should the patient’s condition worsen and require re-evaluation.
Effective communication between all parties is paramount to the success of any
consultation.
Give your patients advanced notice of who will be taking care of them in your
absence. When possible, introduce your replacement to your patients and express
confidence in his or her competence and ability to meet their medical needs while
you are away.
Provide advanced notice of your plans to be away to the facilities where you
have privileges and your answering service. They should be advised of the dates
of absence and/or unavailability and the name and telephone numbers of the covering
physician.
It is recommended that your answering service receive complete instructions regarding
your absence and your coverage arrangements. Patients who call should be informed
of your absence, who is covering your practice, and how to reach your replacement
easily. It is recommended that the answering service keep a written log of all
patient calls as this becomes helpful to you for post-vacation follow-up.
Upon your return, it is recommended that the covering physician advise you about
the patient’s course of treatment during the coverage and this should be
documented. Additionally, try to get feedback from your patients regarding their
experiences with your replacement. If there were any problems or patient dissatisfaction,
these should be discussed with the patients and the covering physician immediately.
Finally, make sure that the coverage arrangement contains an understanding as
to which physician bills for treatment. The patient should be informed of this
by the treating/attending physician. It is important to determine prior to
treatment from a covering physician if the patient’s insurance provides
coverage for the treatment.
Taking the time to work out practice coverage details in advance of your departure
will help make your vacation less traumatic for you, your patients, your covering
physician, your colleagues, your staff, the facilities in which you have privileges,
and will help ensure the continued delivery of optimal patient care.
For additional information please contact Judy L. Klein, Risk Management Specialist
at OHA Insurance Solutions, Inc. at 614-255-4836 or jklein@ohainsurance.com. |
|
|
 |
|
|
