Management and Documentation of After-Hours Telephone Calls from Patients

The failure to properly handle and document after-hours telephone calls can adversely affect patient care and lead to potential liability exposure for the healthcare provider. Patient communication that is not documented may increase a healthcare providers liability exposure.

It is recommended that:

1. A system should be established in order to 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; and • Medical advice or information that was provided, including any medications that were prescribed.

3. If the patient's condition necessitates the need for a prescription, it is important to inquire about and document any medication allergies, as well any other medications the patient is currently taking.

4. If a healthcare provider utilizes an answering service, the service 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 generally recommended.

6. When after-hours coverage is provided by another healthcare provider’s practice, a process should be in place to ensure that documented telephone conversations are promptly forwarded to your office.

Every healthcare provider should have a policy and procedures in place in order to manage and document all after-hours telephone calls from patients.