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  • 1.  Staff RN Coverage of Provider/Physician In-Baskets during Vacations

    Posted 07-15-2024 15:55

    Does anyone have a policy or guideline for oversight for team-based in-basket management that involves full delegation of in-basket oversight to the practice RN while providers are out of the office such as on a vacation or leave of absence?  I have been asked to approve the delegation of the Physician in-basket to the office RN for the RN to to scan the in-basket for concerning results or messages to be routed to the Physician who is in the the office. I am concerned that what will be routed to the Physician will depend on the RN's years of experience and experience in the specialty and that the result may be a risk to patient safety or nursing practice.

    As organizations focus on reducing provider burnout by optimizing provider in-baskets in the EMR, a team-based approach to in-basket management has been one solution in many of the provider journals and thus it has come up as a solution in my organization. These articles discuss the importance of clear guidelines that delineate the role and scope of the MA, RN, and provider (Physician, NP, PA) who are all attached to the provider's in-basket, and are managing normal results, staff messages, prior authorization requests, and patient messages, etc., while following standard workflows. These articles do not discuss delegation of the in-basket for cross-coverage when providers are out of the office such as for a vacation, leave of absence, or day off.   

    Thank you 



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    Keri Grande MSN, RN, AMB-BC, NE-BC, CPHQ
    Director of Ambulatory Specialty Nursing
    Elliot Medical Group
    Elliot Hospital
    Manchester, NH
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  • 2.  RE: Staff RN Coverage of Provider/Physician In-Baskets during Vacations

    Posted 07-16-2024 10:01

    Hi: 

    ThiI have some thoughts after reading this - I don't have a policy or guideline - but experience i can share from a previous role.  For me it was understanding the nomenclature - as this is not really 'managing an in-basket (which the physicians and the software people call it) but a respository of calls and results that require triaging. The triaging requires the scope and expertise of the appropriate clinician.  When it is called 'managing an inbox' - it lends itself to a clerical task - but the incoming messages as you have identified, are not all clerical.  In my previous role, the physicians were required to assign a 'buddy' to manage their inbox - it was a hard sell as the docs said it was a clerical job... until it wasn't.  We worked hard to keep that model - but it was not easy.  it may be helpful to do some data collecting on the amount of inbasket tasks/ messages that are clinical vs non clinical - or have clinical issues diverted into a different stream.  Unfortunately, this is work that takes time and is challenging to do 'before a doc goes on vacation on Monday" LOL.  As well, you are quite correct, with the focus on decreasing burnout in physicians, much of the work is being re-assigned to nurses... Sending support as you manage this issue.  



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    Barbara-Anne Maier BSCN, RN, CON(C)
    Director, Quality
    Carepath Digital Health , CareChart Digital Health
    Guelph ON
    437-324-7482
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  • 3.  RE: Staff RN Coverage of Provider/Physician In-Baskets during Vacations

    Posted 07-18-2024 11:32

    HI Keri,

    We have worked on this pretty intensely this last year. The hardest part was getting all clinics to adopt a provider of the day.  This provider is given a  blocked time to review urgent messages for the provider that is out. That was a culture change.  Some of the larger clinics do more of a buddy system.

    I don't have a particular document ready to share at his time but what we ended up doing was first putting all the types of inbasket messages into an Excel sheet by discipline: provider, RN, MA all the way to the front desk staff. Then we assigned urgency by stating what had to be done within a certain amount of time and what could wait.  So far it's going better.  



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    Rebekah Sherman
    Director of Nursing
    La Clinica de Valle
    Medford OR
    (541)221-3040
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  • 4.  RE: Staff RN Coverage of Provider/Physician In-Baskets during Vacations

    Posted 07-19-2024 10:27

    This is also something that we have been working on.  Initially we came up with a a different plan for when a provider had one day off vs multiple days but we recently found that the providers didn't know how long the person they were covering was out.  Here are a few statements out of the policy we developed.

    PCP In Basket Coverage
    Provider leads are responsible for maintaining their own clinic-specific PCP In Basket coverage policy when PCP are on paid time off (PTO) or a scheduled day off, at the guidance of the Medical Director of Primary Care. Provider leads are responsible for ensuring adequate coverage and communicating this coverage plan to their Clinic Manager. Clinic Managers will in turn notify the Director of Primary Care Operations who will relay the plan to the Contact Center and Nursing Departments.

    Adequate sign out of pending items and critical patients is the responsibility of the PCP and should be communicated adequately to any and all covering providers. PCPs are responsible for leaving a clean In Basket for their covering colleagues; failure to do so may compromise patient care. Provider leads are expected to coach PCPs with repeated difficulties in In Basket management. Repeated offenses and needs for coaching may be subject to progressive disciplinary action, up to and including termination of contract.

    A. MINIMAL Coverage (aka Urgent Only, aka Provider of the Day (POD), aka Coverage) – applies if the PCP is not scheduled to work and has not taken PTO (example: provider works 4-10's schedule). A covering provider is NOT attached to the In Basket. The covering provider is expected to handle any issues that have been identified by clinical staff as needing to be handled by the end of the business day. The PCP is encouraged to sign out to a covering provider if there are urgent issues requiring follow up. 

    C. HEAVY Coverage - If PCP is away for 3-5 business days, coverage expectations are as follows:
    i. Refill requests, telephone calls, MyChart encounters are handled by the covering provider the same business day. Any FMLA/disability paperwork/patient letter requests should be handled by the PCP on their return. Patient should be given notice of PCP absence and delay of return of these items by the PCP directly, or a delegated member of the patient's care team.

    ii. Urgent results (including urgent outside results in Outside Events) are addressed by the covering provider within 1 business day.
    iii. Non urgent results shall be communicated back to patient by covering provider on the PCP's behalf within 2-3 business days.
    iv. Referral Messages are addressed by covering provider within 1 business day.
    v. All other folders (Outside Events, Scanned Documents, CC'd results, Staff Messages) are left for the PCP to review, upon their return.
    D. FULL Coverage - If PCP is away for more than 5 business days, the In Basket shall be addressed in its entirety by the covering PCP provider(s).
    E. Buddy Coverage – If PCP is away for more than 2 weeks, one provider is designated to cover for that entire time. If the covering provider is out, a "secondary covering provider" should cover both by the provider lead at that clinic site. The In Basket shall be addressed in its entirety by the covering PCP provider. 

    I hope this is helpful,

    Angela



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    Angela Hall MN RN
    Director of Nursing and Clinical Services
    Neighborhood Health Center
    Portland OR
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    Original Message


  • 5.  RE: Staff RN Coverage of Provider/Physician In-Baskets during Vacations

    Posted 07-21-2024 20:44

    Hi 

    This is a relatively new process for my ambulatory  care clinic and it is frought with issues 

    There are various in boxes , the medical director gave the directive that all reports , requests ect are routed to the staff first, the staff then route to the various  physicians . 

    Could someone please tell me does anything go to your physicians first ? 

    Our RN OB coordinator has delegation rights to manage the obstetricians boxes , enter orders ect.When the OB is in clinic they clear out their box and they are also reviewing when not in the department. 

    I am interested in the articles you reviewed , currently I am trying to decide what is appropriate for then Nurse v MA 



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    Janette Morgan, MSN,RN,AMB-BC,HN-BC
    Director Community Care,
    The Valley Hospital,
    Ridgewood, New Jersey,
    973 427 7676
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