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
  • 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
  • Late patient policy:
    • <15 min late – PSR will check in and room (if last appt of session, if > 20 min late reschedule)
    • 15-45 min late – PSR will page provider for guidance- if no response w/in 10 min, patient will be roomed
    • PSR staff will automatically schedule a patient for an open slot later in session with same provider if available
    • > 45 min- PSR will reschedule unless provider notes otherwise by adding note to scheduling notes or calling front desk
    • Attending preceptor should be paged if resident patient is > 15 min late – attending will review resident progress and determine if pt can be seen
    • Providers must carry pager/phone into patient rooms to be able to respond to pages. MAs cannot find provider to inform of late patients

 

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 Service: Neda Laiteerapong, Nicole Schlinske, Samantha Allen, Asthante White, Carly Lusk
    • Social worker who can provide diagnostic consultation, care management, consultative psychiatry, and brief therapeutic interventions (bi-weekly virtual visits for approximately 3 months)
    • Place order in Epic
  • Scheduling Line: x20240
  • DCAM 3B Fax #: 773-702-2230