Summary: A practice’s after-hours protocols largely determine how well calls are triaged. As a medical answering service, we help our clients create, maintain, and modify effective protocols that ensure operational safety and efficiency.
Sunset is rarely the end of the workday for medical practice managers. Instead, it marks the beginning of a critical operational shift. When the lights go out and the practice doors are locked, patients are transitioned from the controlled environment to the external environment of the medical answering service. It is in this environment that after-hours communication becomes so critical.
After hours, the difference between a minor inquiry and a life-saving intervention can boil down to the strength of a practice’s triage protocols. A robust and highly professional after-hours system is the foundation. It does more than just manage incoming calls. It acts as an extension of the practice itself, ensuring operational safety and protecting physician well-being. It also serves patients by maintaining the continuity of care they expect.
The Anatomy of Call Escalation
Anyone can answer calls and take messages. As a medical answering service, we go further by providing effective triage. The foundation of this triage is standards that create a crystal-clear distinction between clinical urgency and genuine medical emergencies. Without standards in place, operators are left to guess. This only creates delays and potential liability.
Our triage training for after-hours operators is rooted in a three-tiered hierarchy:
- Emergent – Emergent calls require immediate action. They represent life-threatening situations in which seconds count. Protocols mandate an immediate transfer to 911 or, when possible, a trip to the emergency department. Symptoms of a stroke and chest pain are two prime examples.
- Urgent – Urgent calls require prompt action within a few hours. They are not immediately life-threatening but could turn in that direction under the right circumstances. Examples include bone fractures, high fevers, and acute post-operative pain. Urgent calls are escalated to the on-call physician based on practice policies.
- Routine – Routine calls are just as their name suggests. They tend to involve non-clinical inquiries about things like prescription refills and scheduling appointments. A medical answering service can handle these inquiries or hold them for the staff to deal with in the morning.
Determining the type of call an operator is dealing with is all about training. Medical answering services should not depend on operators who merely read scripts but do not understand why certain questions are being asked. Operational safety demands training that includes red flag identification.
For the record, red flag identification essentially zeros in on a list of keywords and symptoms that mandate immediate escalation. Standardizing the definitions of each keyword and symptom allows practice managers to reduce the number of gray areas that could lead to clinical errors.
Customizing Call-Flow Protocols
Triage hierarchy is just the start. Moving beyond it, a medical answering service must be cognizant of the fact that no two practices are identical in their operations. For example, an orthopedic surgical center has quite different after-hours needs compared to a pediatric office. There is no one-size-fits-all service for both.
We help clients design customized call-flow protocols. This ensures that the right information reaches the correct provider at exactly the right time. When designing such protocols, we consider:
- The Decision Tree – A decision tree is essentially a logic map. The operator follows the map through each step until the correct resolution is achieved.
- Provider Preferences – Clinicians have their preferences in terms of notification. Customizing operator responses based on these preferences reduces friction and ensures that messages are received as efficiently as possible.
- Software Integration – Protocols must be dynamic, which is to say they must be capable of real-time integration with a practice’s scheduling software. Operators should never attempt to contact clinicians who are off duty.
Customized call-flow protocols minimize friction, frustration, and clinical errors. By contrast, attempting to utilize a one-size-fits-all protocol creates many of the problems practices are hoping to avoid by using a medical answering service.
Filtering Calls to Prevent Burnout
Even when call-flow protocols are customized, clinicians can fall victim to burnout. The truth is that after-hours fatigue is one of the leading causes of this problem. Think of it in this way: when a doctor is woken up in the middle of the night to address an inquiry that could have waited until normal office hours, the answering service has failed in its duty to filter routine calls.
We see the medical answering service as a gateway of sorts. So we prioritize empowered filtering backed by operator training. We also value patient education that helps patients understand after-hours calls and what constitutes a genuine emergency. They hopefully refrain from making non-urgent calls in the future.
To improve filtering, practice managers should review call logs on a regular basis. If too many routine calls are reaching the on-call clinician, it is time to modify the filters to tighten things up.
Dealing With High Volume Surges
Operational safety is a priority for the medical answering service. It is easy for a practice to maintain when volume is low. But when volume surges, whether it’s because of a natural disaster or a sudden spike in the flu, a practice’s protocols are put to the test.
Triage should be instantly scalable to account for high-volume surges. Scalability revolves around three things:
- Redundancy – Redundancies built into the system keep operations on track in the event primary systems are knocked out.
- Flu Season – Flu season is a known entity. Practices know they will experience a surge in calls during that time. Protocols should be in place to handle the higher volume.
- System Outages – EMR systems go down. Both office staff and operators need to know who is on call even without the system. They need to know how to maintain hard copies or cloud-based backups of all critical data.
The thing that ties all of this together is quality assurance. We encourage creating a feedback loop that includes post-incident reviews, relevant metrics, and the ability for everyone involved to offer ideas and criticisms. A continuous feedback loop encourages triage strategies and policies that continually evolve with the landscape. That’s the way it should be. Triage protocols should never be a ‘set it and forget it’ endeavor.
FAQs
What is the difference between taking messages and triaging calls?
Triage is rooted in a clinical assessment with the goal of determining the priority of an incoming call. Taking messages is a simple exercise in writing down the caller’s name, phone number, and inquiry details.
What is the difference between an emergent and urgent call?
Emergent calls represent life-threatening circumstances. They require immediate action. Urgent calls represent genuine medical problems that, while not life-threatening, still need attention.
What are the red flags in a medical call script?
Red flags are specific words and symptoms that signify immediate escalation. A good example is ‘uncontrolled bleeding’. If a caller mentions it when discussing a patient’s condition, the call is immediately escalated.
In medical triage, what is a warm transfer?
A warm transfer is a scenario in which an operator stays on the phone with the caller while an emergency dispatcher or the on-call physician is contacted. Keeping the operator on the line ensures that critical information is not lost in the transfer.
