PCG Protocols and Policies

  • PCG Resident General Standard Work for Physicians
    • During their +2 weeks on outpatient, resident will generally have between 3-4 clinics per week. Every resident is assigned to Firm A, B, C (of note, med-peds has separate clinics)
    • Since residents will have periods of time when they will be gone from the clinic for 4 weeks at a time, we have developed a Trio system.
    • One trio includes a resident from Firm A, B, and C (your trio assignment can be found here)
    • The expectation is that residents will cover their OWN EPIC refills, phone notes, staff messages at all times unless on vacation or a rotation when they are not available to respond within 48hours
  • Firm trio coverage
    • Each resident has “trio partners” who are in different firms, and therefore on different +2 blocks
    • Each trio will complete a firm trio coverage plan which will be emailed after everyone’s first ambo block (typically the +2 resident will cover the paperwork for the trio, while it is expected that you cover your own EPIC inbasket and refills while on inpatient services)
  • Resident documentation
    • EPIC notes should be completed within 24 hours and routed to the attending you staffed with
    • Maximum allotted time: 48 hours to be routed to the attending for co-sign/addend and close encounter.
    • Residents should not close clinic encounters.
    • If clinic note is started and patient does not show up or leaves before being seen, resident should use ERR smart set to close the encounter
    • Residents can use EPIC phone notes or EPIC result notes for documentation between clinics
    • Residents requiring >1 reminder to complete notes > 48 hours, will receive reminders from APD and this will count towards professionalism
  • Resident lab follow up
    • You are expected to notify the patient within 1 week of the results
      • If abnormal, call the patient and document in EPIC phone note
      • If normal, can use MyChart portal or create a letter communication and forward to careteam to send
    • Electronic orders
      • You may initiate requests for referrals, procedures, and tests using telephone or order only encounter in EPIC.
      • Make sure you send a message to “AMB_PCG_orders” so they can follow up to help schedule primary care tests (mammograms, colonoscopies, etc).
      • Referrals to subspecialties in EPIC will prompt that specialty to call the patient, but it’s always best to give the patient the hospital phone number (888-824-0200) and the operator can forward them to the correct department to schedule an appointment
      • PCGOrders@uchospitals.edu  email for emergency only
  • Refills
    • STANDARD REFILLS (nurse has already checked allergies, DOB, PCP, appropriate med, last appt., dose, can be done electronically, 90 days for 3 refills, correct pharmacy, etc.)
      • Use approve button thru in basket
    • COMPLICATED REFILLS (nurse has a question)
      • Open the encounter, look at clinical information and nurse comments then either:
        • Approve refills electronically
        • Route back to Firm nurse with instructions
    • MEDS REQUIRING NURSE PHONE IN (rare)
      • Open encounter, looks at clinical information
      • MD to change refill to “Phone In”
      • Approve refill electronically
      • Route to RN with instructions to phone in
    • MEDS REQUIRING PRINTED SCRIPT (i.e. rare Pt request)
      • Open the encounter, reviews clinical information
      • Look at last controlled med refill or appt.
      • Check appropriate time frame (not requested 3-4 wks. before supply finished)
      • Change refill to “Print”
      • When in clinic PCP will print, sign script, and give to nurse
      • If not in PCG, you can do this as a communication or letter and route to RN
    • MEDS REQUIRING e-sign SCRIPT (i.e. controlled meds)
      • Open the encounter, reviews clinical information
      • Look at last controlled med refill or appt.
      • Check appropriate time frame (not requested 3-4 wks. before supply finished) and ILPMP if needed
      • Use DUO to electronically sign
  • PCG Precepting
    • Preceptors are expected to arrive on time and stay until all patients are seen and discussed
    • Preceptors are expected to be available to residents outside of clinic hours by page or email to answer questions about clinic patients.
    • Preceptors should sign all residents clinic notes within 48 hours and work with the Ambulatory Associate Program Director to monitor residents clinic note responsibilities
    • Preceptors should verify that residents have reviewed/addressed major test results ordered in clinic ( i.e. if a CXR show a chest mass the attending needs to make sure the residents arranges appropriate follow up or do so themselves.)
    • Preceptors should be available for RN to answer questions/refills, when resident is not responding
  • Firm Faculty Coaching
    • You are assigned a Firm Faulty Coach (listed here) who will precept you during your ambo block.
    • There is time blocked off dedicated to teaching Firm Faculty Coaching topics (coaching time listed next to attending name)
    • There are dedicated topics for each PGY year
  • APN support
    • APNs will see patients independently with certain medical conditions (T2DM, HTN, depression, COPD, high cholesterol, MSK concerns, etc). They will be scheduled with patients when PCP’s are not on +2 and trio partners are full
    • All workup and results will be routed to the APN and PCP; you should coordinate with the APN to determine the most appropriate follow up plan
  • Clinical staff responsibilities
    • RN: The RN is responsible for providing nursing support to all housestaff and their respective patients.  Their primary responsibilities include telephone triage (including delivering medical advice, normal lab results and walk-in triage), insertion of IV’s, administering IV medications, initiating blood transfusions and facilitating patient admissions to the hospital. The RN is also responsible for providing assistance with patient referrals.
    • LPN: The LPN support staff are primarily responsible for medication refills thorough EPIC and managing clinic paperwork. LPN support staff will interact with patients to let them know that paperwork has been completed, monitor paperwork and refills that have not been completed and refer questions to Firm clinic attendings.
    • MA: rooming patients, obtaining vitals and POC checks documented in huddle column, administering immunizations and injections, and stocking exam rooms
    • Patient Service Representation (PSR): Patient check-in and check-out
      • If your patient arrives more than 10 minutes late, PSR will send you a page
      • It is the policy of PCG that all patients must be seen. You may tell PSR to let the patient know that they may be the last patient you see or you may conduct an abbreviated visit to ensure there are no urgent health issues
  • Before going on vacation, make sure to do the following:
    • Sign your pager out to 6631 (ATG)
    • Place out of office message in EPIC
    • Send message to RN with dates you will be away and who is covering your inbasket
    • Establish MD coverage for paperwork folder (trio partner)
    • Place out of office for email with coverage instructions

 

Important Resources

Other PCG providers and services

  • Pharmacy: PCG pharmacist Amy Wainwright
    • Remember to use “PHARM7” consult order for cost of meds, assess if prior auth is needed
  • Social Work: Daviel Thomas
    • Can also place consult to Social Work in EPIC
  • Behavioral Medicine (BMED): Fabiana Araujo
    • Place consult in EPIC
  • Collaborative Care: Neda Laiteerapong (MD), Tanya Washington, Samantha Allen, Asthante White, Carly Lusk
    • Social worker who can provide brief therapeutic interventions (bi-weekly virtual visits)
  • Scheduling Line: x20240
  • DCAM 3B Fax #: 773-702-2230