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After Hours


 After Hours Options 

Each pediatric practice must evaluate how best to manage after-hours calls. In most cases, the choices will include a traditional telephone answering service and a professional after-hours call center.

Professional After-hours Call Centers

In areas where professional after-hours call centers are available, their advantages are clear: They are dedicated specifically to medical (and often pediatrics-only) callers; calls are screened with a high level of medical competence; and screening personnel are professionals who utilize carefully prepared protocols for triage and advice. In addition, standardized documentation of telephoned contacts is more likely to be useful for both continuity of medical care and for medical-legal purposes. These services have been well accepted by patients and can significantly decrease telephone time with patients for on-call physicians.

Traditional Telephone Answering Services 

Despite these obvious advantages, the majority of practicing pediatricians continue to rely on traditional telephone answering services to screen after-hours patient calls: Triage services are not available in all geographic areas; some physicians dislike delegating after-hours telephone responsibility to others; call centers may not be cost-effective for all practices; and some pediatricians believe that their patients may perceive a call center as impersonal or inconsistent with their practice style.

Important Factors 

Whether a professional after-hours call center or a traditional telephone answering service is chosen to screen calls, the pediatric practice should obtain basic information about them before a specific service is chosen.

Reputation is important. A list of recommended providers can often be obtained from a local professional society or affiliate hospital and augmented with recommendations from colleagues.

Before contacting a prospective call center or telephone service, prepare a set of written policies that list your practice office hours and location, the usual sign-in and sign-out times of covering doctors, backup telephone numbers for each covering doctor, the usual procedure for retrieving non-urgent messages (e.g. calling-in every 90 minutes), the practice's preferred hospital for emergencies, and procedures to follow if a covering physician cannot be reached. This list should be used to discuss specific practice concerns and how they will be managed by that service. It can also be left on file for reference if that service is chosen.

It is preferred that a service or center will fax or transmit a copy of each telephone encounter to the office when it opens the following morning. This list should be reviewed promptly to determine whether follow-up calls are needed. The log can then be maintained for office use and pertinent data can be entered into a patient's chart.

The chosen service or center must be HIPAA compliant and agree to sign an appropriate agreement of confidentiality. Other topics for discussion should include the number of call-screeners available; the usual waiting time before calls are answered; and contingency plans in the event of computer or telephone failure. Projected monthly charges based on the usual practice call volume should be reviewed at the time of this discussion.