The following guidelines are intended to help you to handle situations that come up frequently while taking clinic call. While we hope that these will make it easy to handle the majority of calls you get, it is inevitable that situations will arise which are not covered here. Please consult with your backup attending when this is the case and notify Jill Watanabe Watanabe (watanabe@u.washington.edu) so that the guidelines can be updated.

Requests for Narcotics
It is clinic policy not to prescribe narcotics after hours or on weekends. If the patient is experiencing severe pain, s/he should be advised to go to the Emergency Room for an evaluation. In the rare instance when you feel that it would be appropriate for you to prescribe a narcotic over the phone, no more than a three day supply should be ordered. Please notify the patient's primary care provider on the next working day regarding the patient's request and the disposition of the request.

Requests for Refills
Patients requesting refills for non-narcotic medications should be informed that after hours call is for emergencies only and that in the future s/he should plan to get medications refilled during working hours. In this instance you may want to provide him/her with medication so medical care is not compromised; however, no more than a one week supply should be authorized. This amount should give the patient an adequate supply to get through the weekend, contact the pharmacy or their PCP, and come to Harborview to pick up a larger supply.

Notification of Abnormal Lab Results
You may be called with abnormal lab results after hours. Ask the lab for the patient's name, Harborview patient number, name of the physician who ordered the test, and patient's home phone number. Much of this information can also be accessed via Mindscape or ORCA. Patients should be contacted by phone and asked to come into the Emergency Room/Urgent Care Center as appropriate for evaluation. If you are unable to reach a patient by phone, contact your back-up attending to discuss whether the issue can wait until morning or whether additional action should be taken to contact the patient that night.

Requests to Authorize Service for Managed Care Patients
If you are contacted to approve service (Emergency Room evaluation or hospital admission) for one or our managed care patients, please instruct the caller to contact the Community Careline (731-2500). Authorization paperwork will be faxed to the outside hospital or transport to Harborview will be arranged.

Non-English Speaking Patients
If you need to talk to a patient who is non-English speaking and has no English speaking family member, you can ask the Harborview operator to connect you with the phone translator service.

Patients who are Suicidal
In addition to getting the patient's name, number and address, ask the patient if s/he has a case-worker and, if so, what the case worker's name and telephone number are. If you are concerned that the patient is suicidal, refer them to the Emergency Room. If the situation is questionable, contact the patient's case-worker as s/he may be able to intervene or to provide you with useful information (e.g. care plan). If the patient refuses to come to the Emergency Room and you feel s/he is in danger, contact the King County Crisis Clinic at 461-3222 or 1-800-244-5767 and ask for the County Mental Health Professional. This individual can go to the patient's home to make an assessment. The Crisis Clinic also keeps records on patients and can often give you information regarding case managers and care plans. In addition to the resources mentioned above, the Emergency Room social worker is always available to consult with you regarding potentially suicidal patients.

Pioneer Square Clinic Calls
From time to time, you may get called about Pioneer Square Clinic (PSQ) patients. Usually, the call will come from the lab and the issue will be a critical value. All PSQ patients are registered through Harborview so phone numbers should be on file. Contact information should be in Mindscape or ORCA demographics, but also check the provider's note since occasionally additional contact information can be found there. When no number is available, usually the patient is homeless or in a shelter. In this case, ask for the patient's address to see if you can identify which shelter:

• St. Martin's, 1516 Alaskan Way South, 323-6341
• DESC, 517 Third Avenue, 464-1570
• Union Gospel Mission, 318 2nd Avenue, 622-5177
• Compass Center, 77 South Washington, 357-3100
• Angeline's (Opportunity Place), 2030 3rd Ave, 436-8650

If you are able to contact the patient by phone, advise them to come into the Emergency Room for evaluation as indicated. If you are unable to contact the patient, call Nancy Sugg, Pioneer Square Director, 680-7591 (pager) or at home through the Harborview paging operator, to discuss what steps to take. If unable to reach Dr. Sugg, call your back-up attending. If information needs to be passed on regarding the disposition of the call, leave a message on the Pioneer Square Clinic answering machine 206-521-1750.

Family Medicine
If you receive calls for Family Medicine, inform the operator that Family Practice call is handled by the on-call Family Medicine Resident based at the University of Washington and ask for the call to be redirected.

CHARTING ON CLINIC CALLS
We encourage you to enter a brief telephone note into ORCA with a cc to the primary care provider for any call that led to a therapeutic intervention or that yielded information that would impact or aid future care planning for the patient.