Risk Management Tip: Management and Documentation of After-hours Telephone Calls from Patients

MLMIC Risk Management Tip #8 addresses medical professional liability risks related to “Management and Documentation of After-hours Telephone Calls from Patients.”

The Risk

The failure to properly handle and document after-hours telephone calls can adversely affect patient care and lead to potential liability exposure for the physician. Should an undocumented telephone conversation become an issue in a lawsuit, the jury is less likely to believe the recollection of the physician, who receives a large number of calls on a daily basis.

Recommendations

1. Establish a system to help ensure that all after-hours calls are responded to in a reasonable time frame and are documented in the patient’s medical record.
2. Medical record documentation of after-hours calls should include the following:
   • Patient’s name
   • Name of the caller, if different than the patient, and the individual’s relationship to the patient
   • Date and time of the call
   • Reason or nature of the call, including a description of the patient’s symptoms or complaint
   • Medical advice or information that was provided, including any medications that were prescribed
3. If the patient’s condition warrants the prescription of medications, it is important to inquire about and document any medication allergies, as well any other medications the patient is currently taking.
4. If you use an answering service, it should be periodically evaluated for courtesy, efficiency, accuracy, and proper recordkeeping.
5. The use of answering machines or voicemail systems for after-hours calls is not recommended for the following reasons:
   • There are no safeguards in the event of a malfunction.
   • Patients do not always understand that no one will call back, even if this is stated in the message.
   • If, as a last resort, an answering machine or voicemail must be used, the message should be brief, simple, and include: (The office is now closed. If you believe you are experiencing a medical emergency, please disconnect and call 911.)
6. When after-hours coverage is provided by another physician’s practice, a process should be in place to ensure that documented telephone conversations are promptly forwarded to your office.

This MLMIC Risk Management Tip is available here as a PDF: “Management and Documentation of After-hours Telephone Calls from Patients.”