Ensure your practice has the capacity to accommodate urgent appointments within 48 hours or semi-urgent patient appointments within 7 days of the request.

This is a key component to managing access and capacity for patients who were discharged from either an inpatient stay or the ED and referred to your practice for follow-up care.

There may also be cases where new patients with specific conditions need to be seen by a specialist within an urgent or semi-urgent time frame. These scheduling protocols will vary by specialty and should be reviewed and approved by clinical leadership in the practice.

Building urgent access capacity and slots into your templates will ensure patients receive the care they need in a clinically appropriate time frame while minimizing the negative impact on practice operations associated with overbooking, unnecessary churn to “move up” appointments or no-shows due to the patient’s seeking care elsewhere.

Practices should also have a detailed patient communication plan for follow-up care and test results.

Standards

• Adopt and implement the MGH/MGPO standard definitions of urgent access (appointment needed within 48 hours) and semi-urgent access (appointment needed within 7 business days).

• Answer phones live. Optimally, an option should exist for patients to speak with a clinician, if needed, to help assess clinical urgency for non-scheduling issues.

• Establish written triage protocols for urgent or semi-urgent patient scheduling needs that are available to all scheduling staff. These protocols should include urgent/semi-urgent scheduling pathways for the following scenarios:
  • Patients recently discharged from the ED who need to be seen in follow-up
  • Patients recently discharged from an inpatient stay who need to be seen in follow-up
  • Patient known to your practice (established) with an urgent clinical issue or symptom
  • Patient unknown to your practice (new) with an urgent clinical issue or symptom
    • Note: In cases where the patient issue requires immediate clinical attention, the protocol should clearly indicate triage to either
      1. a walk-in visit/appointment to your practice,
      2. a visit to the nearest urgent care center (preference for Mass General Brigham Urgent Care), or
      3. the nearest Emergency Room, if applicable, and in extreme cases,
      4. have patient call 911 for emergency assistance.

• Review referral workqueues several times each day and process urgent referrals (those requiring an appointment within 3 days) immediately.

• Review patient In Basket message pools several times each day for triage of urgent needs. Address any urgent scheduling need immediately.

• For children, the clinician who evaluated that child should speak to the clinician on call for the clinic to determine appropriate next steps. The process must involve the parent or guardian.

“Urgent” and/or “Semi-Urgent” In Basket Management

Use In Basket for communications and arrange coverage for all clinicians who are not scheduled to work on any given day. See Epic In Basket and Communication.

Time Release Blocks and Scheduling

Use standard time release blocks to add urgent care or same-day appointments into schedules. You can choose a visit type that would auto-release if not filled in a time frame.

Urgent care blocks build out additional capacity in your clinic. These are added to your departments centrally as of February 20, 2019. Any new Epic departments created after February 20, 2019 will need to put in a Cadence Help Desk ticket for this.

As of February 20, 2019, urgent care visit types were added centrally to your Epic department. Any new Epic departments created after this date will need a Cadence Help Desk ticket for this, as well.

Clinical Triage and Personnel

• Have a triage system in place that leverages clinical hierarchy to assist patients that require clinical intervention.

• Have a “Doc of the Day” available for urgent patients and/or urgent requests that come through the practices. Clinicians should be reachable by pager and/or by mobile phone and be available onsite to see your patients. Use residents, fellows or nurses on staff to meet the needs of emergent/urgent patients to determine if patients need a higher level of care than a regularly scheduled appointment.

• Be in communication with the ED to understand what types of patients are being referred to your area, which patients require regular follow-up care and which ones require an emergent appointment.

• If interpreters are required, follow up with Interpreter Services to request an interpreter immediately. Practices can use phone interpreter services or, if available, VPOP, when an interpreter is needed immediately.

• Block off approximately one to two hours per week to accommodate urgent patient appointments.

• Check the Insurance and Authorizations chapter for more guidelines on patients with non-contracted insurance products. See also the Mass General Brigham Payer Information site.

Pre-visit Appointment Activities

• Understand what processes and procedures are in place in your practice, including referrals and insurance eligibility, prior to the patient being seen. A referral should be placed in Epic if the patient is being referred to another department. If the patient requires an urgent appointment, the referring clinician must enter a referral in Epic and follow up with the department to communicate that the appointment is urgent.

• Understand your scheduling utilization and room availability. The capacity to see more patients on a moment’s notice should be understood and anticipated. See also Creating and Managing Capacity and Pre-Appointment Activities.

• Some patients may require the acute levels of care offered in the ED. For patients being referred to the ED, call ahead to ED to let them know about the patient and the situation.

• Clinicians will focus on the urgent medical issue necessitating an urgent appointment. Set expectations with patients that urgent appointments are focused visits. If an exam or consultation is needed, book the patient as needed. If a patient is looking for a consultation or second opinion, these appointments are booked as regular appointments on a clinician’s schedule unless indicated otherwise.

• If a patient requires immediate medication, follow your standard practice procedures for medication requests.

• Schedule patients using the same Walk-in schedule patient activity in Epic.

• Put standard template blocks into place.

Tools and Resources