By Pamela Miller, OD, JD
Your front desk staff can be an essential bridge between you and your patients–or they can put you at risk of a lawsuit. Training these employees well will improve patient care and limit your liability.
The people who staff your front desk need to be trained in more than how to properly greet a patient and how to schedule appointments. They must be able to recognize emergency situations in which patients need to be seen right away, rather than a few days or a week later. Creating a protocol for front-line staff to assess such needs can lessen the chances of an urgent eye issue getting shrugged off.
Train Staff to Ask Appropriate Questions
Let’s say a person calls your office and tells the front desk staffer who answers the phone that she is not seeing out of one of her eyes. After your employee
Urgent Vs. Emergency
It is important that you define “urgent” and “emergency” for your staff.
Someone who can be seen tomorrow or the day after.
Someone who needs to be seen in minutes to hours from the present time.–ROB Editors
looks at your schedule for the rest of the day and then the rest of the week, he breezily tells the person calling that the doctor can see her in a week. The person hangs up with the staffer and a week later shows up at your office with a retinal detachment. By the time you see the patient, irreversible damage may already may have been done. In addition to your first concern–the negative impact to the eye health of your patient–the staffer who spoke with that patient may have inadvertently set a malpractice lawsuit in motion.
Back-Up Plan for When Doctor is Out of Office
Front-line staff need to be left written instructions on their desk as to what to do if a potential emergency call comes in and the doctor is not in the office.
In addition to your own mobile phone or pager number, leave phone numbers for other ODs or ophthalmologists in the area.
Do NOT instruct front-line staff to refer callers with potential emergencies to the hospital emergency room or to their primary care doctor. Chances are, they will not get the care they need from those sources, and may suffer permanent damage to their eye health.
Create a Protocol for Incoming Calls
To ensure staffers always properly assess the urgency of each call that comes in, I train staff to ask the necessary questions and to put in writing what each patient tells them. Employees record the person’s name, the reason for the call, whether the affected eye was the person’s right or left, how long the patient has been having the problem, whether they have lost vision, when they last saw the doctor, and whether the person has any pre-existing eye conditions that they are being treated for. The reason the staffer is instructed to ask that last question is if the person calling says she has lost part of her vision but has cataracts, and has had this same problem for over a year, it PROBABLY isn’t an emergency.
After the right questions have been asked and the caller’s responses documented, the employee has to know to follow-up. That means taking an action of some kind on behalf of the patient such as consulting you or another doctor in the practice as to whether the patient needs to be seen right away or, upon instructions from you, checking back with the patient the next day to ask if the problem has been resolved. To prompt staffers to follow up and document their conversation with patients, I created a “cheat sheet” that records the patient’s name, the time they called, whether the call was classified as an emergency, which doctor (if any) was consulted, instructions to the patient and whether the patient ultimately came into the office for a visit. The staffer signs each of these documents so if the practice’s actions regarding any patient is questioned, we have a signed record of all of the person’s interactions with our office. The doctor always needs to see the patient’s records and any notations prior to the records being filed away.
What to Do After an Emergency Falls Through Cracks
You also need a protocol for if the worst happens, your front-line staff fails to ask the right questions and follow-up and you see a patient after what may be permanent damage has been done. In that case, never say, “Why didn’t I see you earlier about this?” or “I should have seen you last week!” Those kinds of “oh my gosh!” comments will not benefit your patient and will give the patient material for a malpractice lawsuit.
Without backtracking about what should and should not have been done by your staff, assess whether you can repair the damage done. If you cannot fix what occurred due to the negligence of your staff, it is time to refer the patient to someone with specialized expertise such as a retinal or corneal specialist. Calmly say to the patient: “You know, it looks like we need some additional follow-up care, so I want to refer you to a specialist.” This may help to mitigate any ongoing or future damage to the patient’s vision.
Training staff to thoroughly assess the urgency of each call and consistently follow-up will improve the chances that your patients’ eyes stay healthy and that your practice avoids malpractice lawsuits.
Click here to download a copy of the standard form Dr. Miller gives to front-line staff to document phone calls with patients.
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Pamela Miller, OD, FAAO, JD, DPNAP,has a solo optometric practice in Highland, Calif. She is an attorney at law, holds a therapeutic license, is California State Board-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy, and low vision services. To contact her: firstname.lastname@example.org