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Delegating Work While Absent (101.055)

Delegating Work While Absent (101.055) - Policies, Administrative, UWMF, UWMF-wide, Clinic Operations, Health Link

101.055

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: DELEGATING WORK WHILE ABSENT

Effective Date: September, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: See Author

Reviewed September
2012

January, 2011

PURPOSE: To provide guidelines for UWMF physicians, nurse practitioners, physicians’
assistants and applicable clinical staff to delegate patient care-related work to others when they
are out of the clinic. The purpose of these guidelines is to ensure follow-through on timely
patient care issues.

POLICY: UWMF physicians, nurse practitioners, physicians’ assistants and applicable clinical
staff will utilize the following guidelines to delegate patient care-related work to partners or
peers when they will be out of the clinic. This policy will undergo annual review by 12/31 each
calendar year, via a checklist completed by each Manager in coordination with the Lead
Physician, with their current site plan attached.

PHYSICIANS, NURSE PRACTITIONERS AND PHYSICIANS’ ASSISTANTS
1. Providers are responsible for ensuring that timely patient care-related communication,
oversight and management of care are delegated to physician or mid-level partners
while out of the clinic for any amount of time (for meetings, ½ days off or
vacation/absences).
2. Arrangements need to be made so that a covering physician or another member of the
care team can become informed of the pertinent patient and medical record
information for patients with expected care needs (via hard copy or electronic
messaging).
3. Documentation in the medical record should be current, clear and thorough so
covering providers can determine best course of action as needed.
4. Lab, diagnostic test, procedure or imaging results of a timely or sensitive nature
should be managed efficiently by covering members of the care team. Delegation of
EpicCare InBasket to covering providers is required, in addition to the results that are
received via hard copy routing. Providers may choose to utilize “Covering Groups”
in Health Link (EpicCare) that allow the InBasket work to be viewed by several
providers (and may include the Manager as well), as long as the accountable covering
provider has been identified. Providers at each practice location should discuss and
identify which of their co-sign folders (Chart Co-Sign, Cosign-Meds and Cosign-
Orders) they are comfortable allowing others to sign, and incorporate that into their
site workplan.
5. Clinic processes should be in place to accommodate coverage efficiently and
accurately (i.e. call schedule development, site agreements about coverage
arrangements and adherence to expectation that coverage is not less than 50% during

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clinic hours). Managers will work with the physician leaders at their sites to ensure
that the Delegation of Work Site Plans for their sites are documented and followed.
(See attached format for Delegation of Work Site Plan)


CLINIC SUPPORT STAFF
1. Applicable clinic staff will ensure that timely patient care-related communication
occurs when they are out of the clinic (includes time off, days off, time not
scheduled). This can be accomplished via electronic (Health Link “Covering
Groups”), verbal, or written hand-offs to appropriate clinic staff.
2. Clinic arrangements should be in place to accommodate efficient and accurate
communication to patients.

WRITTEN BY: EpicCare Policies & Procedures Committee

REFERENCES: Ambulatory Care Guidelines, 2004
Ambulatory Service Standards, 2010

REVIEWED BY: Joint Health Link Clinic Operations Workgroup
COG-40 (Integrated UW Clinic Operations Group)
Richard Welnick, MD UW Health Ambulatory Care Medical Director

AUTHORIZATION:

Medical Director Date

EXAMPLE Site Plan For Delegation of Work:
Area of Patient Care: TO: How:
Acute patients Partners in clinic Appt schedulers will book pt appointments as outlined in
department scheduling guidelines. Pts with symptoms will be
handled by clinical staff and booked appropriately.
Lab, Imaging, Test
Results
On-Call doctor Providers will delegate InBasket to all providers. On-Call
doctor will handle absent provider’s InBasket based on call
schedule.
Hospital patients Hospitalist Providers will notify hospital of plan for hospitalist to
follow/attend inpatients
Prescription renewals,
Telephone Calls (Refill
encounters)
On-Call doctor Providers will delegate InBasket to all providers. On-Call
doctor will handle absent provider’s InBasket based on call
schedule.
Correspondence from
other providers
On-Call doctor Providers will delegate InBasket to all providers. On-Call
doctor will handle absent provider’s InBasket based on call
schedule.
Approval to sign?
1. Chart Cosign
2. Cosign-Meds
3. Cosign-Orders
On-Call doctor OK to sign each others’ cosign IB messages, or Dr. X gives
approval, Dr. Y prefers that others not sign these messages
Other

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