by Timothy Gieseke, MD, CMD

As a senior clinician and Medical Director, I’ve observed quite a bit of confusion on the part of my facility teams when I have vacationed.   I initially attempted to minimize the confusion by sending out vacation announcements by email, but found that announcements sent to DONs and Administrators stayed with them and didn’t consistently reach frontline nurses or the rest of the team.  I have continued emailing management, but in recent years have been faxing announcements to each nursing station.  This has improved frontline nurse awareness, but I still receive calls from an uninformed nurse on my cell (if I’m not off the grid).  Other team members who may not be reached by these emails or faxes include:  the rehab team, medical records, admission office, & pharmacy providers.  This has rarely resulted in an admission not being seen until the facility discovers I’m not available and reassigns the patient.  

Besides these communication issues, the staff needs to know how faxes will (or won’t) be processed and who will provide attending physician/NP services for assistance with changes of condition and for processing C-II requests, discharge requests, and abnormal lab reports.  At facilities where I’m a Medical Director, management needs to know who will provide Medical Direction.

I am fortunate that my nurse practitioner is usually available to cover most of the above services with backup from the PA/LTC colleagues in my on-call group.  Prior to vacations, I email my potential coverage team to make sure they are willing and available to provide weekday coverage, since after hours coverage is already set.  I then build and distribute an announcement that lets my teams know the duration of my vacation and identifies who will help them address the above potential new clinical issues.

As noted above it’s not a perfect system, but it is an attempt to support the team, while taking a breather.

This is an area of “Care Coordination” that I’ve not seen addressed in a public way.  I hope that others will share their ideas with the WAVE on how they insure their patients attain appropriate care while they “recreate”.