Easing After-Hours Burden on Primary Care Clinicians
As a primary care physician, Helen Ireland, MD, experienced the time-consuming demands of after-hours on-call coverage. Weekends would become an extension of the busy workweek, leaving little time for a needed break and contributing to clinician burnout.
Ireland took the lead in developing a solution, helping to coordinate the launch of the After Hours Call Program eight years ago. The program initially provided after-hours coverage for primary care clinicians affiliated with Salem Hospital and Newton-Wellesley Hospital but has since expanded to provide coverage for over 1,000 primary care clinicians across Mass General Brigham. With the addition of Nantucket Cottage Medical Group earlier this spring, the program is now in place systemwide.
“We had the dual goal of supporting clinician wellness by reducing after-hours work and standardizing and improving the care and experience of our patients,” said Ireland, senior medical director of Enterprise Ambulatory Operations for Mass General Brigham. “The addition of our colleagues on Nantucket marks an important milestone, ensuring primary care clinicians and patients across Mass General Brigham benefit from a well-established, proven program.”
Answering the after-hours call
Patients who call their primary care practice after hours are routed to an answering service that facilitates a call back from a Mass General Brigham nurse or advanced practice provider (APP). The patient then speaks with one of the 53 clinicians on the After Hours team about their concerns.
“This interaction is meant to ensure any simple questions are answered and, if the patient has symptoms, that they’re accessing the right level of care in the appropriate timeframe, depending on the urgency that might be involved,” said Ashlee Goulette, CNP, clinical manager of the After Hours Call Program.
During the COVID-19 pandemic, the program added immediate virtual visits, an offering that continues today based on high patient satisfaction. These visits enable clinicians to conduct a virtual evaluation, refill a prescription or help address whatever a patient’s needs are. The visits are documented so that a patient’s primary care clinician is kept aware of their patient’s status and treatment.
To improve clinician experience and address issues impacting them, the After Hours Call Program operates in parallel with Mass General Brigham Medical Group’s Virtual Clinical Support, an initiative that alleviates demands on primary care clinicians by delegating select tasks to a dedicated, remote team of APPs, reducing the strain of Epic In Basket management. The program is also part of Mass General Brigham’s coordinated, systemwide work to expand access to primary care, which has been bolstered by the recent launch of 24/7 Virtual Primary Care, a service that enables patients to schedule same-day appointments with Mass General Brigham providers.
“Our after-hours model has been shown to improve clinician well-being, which is reflected in the feedback we receive in clinician satisfaction surveys, while also delivering timely access to high-quality care that our patients value,” Ireland said.
After hours on the island
The After Hours Call Program launched April 29 on Nantucket.
“Our providers were very excited about it and it’s a win for our patients as well,” said James Scheurell, vice president of Support Services at Nantucket Cottage Hospital. “It demonstrates the value of being part of a unified system with the resources to support a program that will alleviate the after-hours burden on our providers while enhancing access for our patients.”
The program is helping to connect patients on the island with the diverse range of services across Mass General Brigham. “The benefit of working with a systemwide team is that they know the full spectrum of everything that is available, whether it’s virtual or in-person, to support the care of our patients,” said Sarah Jean Desnoyers, practice manager for the Nantucket Cottage Medical Group.
The After Hours team is also fluent in the specialty care available on Nantucket. “When we’re recommending that a patient be seen in person, we want to tailor our advice in a way that considers the patients’ location and best serves them,” Goulette said.