A few years back, at 5:00am Saturday during the coldest February Northern Minnesota had seen in decades, a longtime home care patient’s oxygen concentrator failed. The patient’s wife retrieved an E cylinder that was for back up from the guest bedroom and proceeded to try to open the gauge. Her husband—the patient—tried as well but neither could get the tank to open. The couple was a little panicky because the patient had been using oxygen continuously for over a year with only a few moments here and there off oxygen. Regular delivery for portable cylinders was Monday, and they were down to two small portable cylinders with a total of about one hour of oxygen combined.
Desperate and alarmed, the wife asked her husband if they should call an ambulance or try to drive to the hospital. “I hate to bother him, but try Joe at ABC OXYGEN (names changed!) before we do that,” he said. The wife placed a call to the number on the oxygen concentrator at 5:20am. The on-call service answered and assured her she’d be called back shortly. Joe himself –it’s a small company—responded at 5:27am.
Joe asked her how much oxygen they had and when she told him less than an hour’s worth, he said his home was not far, he had oxygen on the delivery van in his driveway, and would be there in less than 30 minutes. At 5:50am, less than an hour after the unit alarmed, Joe pulled into their driveway with a replacement concentrator and several E cylinders to leave as back up.
The patient and his wife thanked Joe profusely and apologized for waking him up and having him come out on a cold, winter, weekend morning. Joe laughed it off with them, reviewed how to open the gauge (turns out there was still oxygen in the tank; they hadn’t opened it enough), and was back home before 7am. He updated the care plan with a progress note about the issue, so other staff would be aware.
Joe did everything absolutely correctly and according to company policy. While his “can do” attitude was certainly kind and full of empathy for his patient/customer, what he did was the expectation. The company’s on call policy was that a staff member would have a stocked vehicle at their home with them after hours and would return phone calls within ten minutes. Further, the policy stated that the company would only accept oxygen patients who they could reach in an emergency within two hours.
Contrast that scenario with companies that don’t respond to after-hours calls on a timely basis or that take on either too many patient/customers or patient/customers that live too far away. Not only is it inconsiderate to leave the person who calls in with an afterhours emergency hanging, it is also fraught with liability issues. A DME organization that provides life sustaining equipment and supplies needs to be readily available for their customer base at all times. Furthermore, the DME should be sure that they are following their own internal policies and procedures and doing all necessary documentation concerning the afterhours calls they receive.
HQAA standard PS 5 states that the organization “provides the client with information regarding after-hours access and emergency coverage.” It further requires that a DME is available 24/7 to customers receiving life sustaining equipment services (think: oxygen, ventilators, etc.). HQAA specifies that at an absolute minimum, calls will be returned within 60 minutes; less if state law or regulation stipulates some time frame less than 60 minutes. It’s important to emphasize that this 60-minute time frame is a minimum. The marketplace, your referral sources, or even the demands of your customer base may dictate that you need to respond in less time.
Also note that the standard says the DME needs to “provide the client with information regarding after-hours access” without stipulating that it only applies to oxygen and other life sustaining equipment services. In other words, regardless of the type of equipment and services you provide, you should inform the patient/customer of your policy. If you are available absolutely round the clock, let them know. If the phone calls roll over to a voicemail after business hours, and you don’t respond till the next day, you need to inform the patient/customer what to expect. Thus, a retail DME that provides shower chairs, walkers, and aids to daily living is not required to be available round the clock; however, they are required to inform their customer base of that policy.
Document after hours calls regardless of the outcome. Pertinent information that you should capture includes when the call came in, when it was returned, the nature or reason for the call, and the resolution. Complaints that come in via the after-hours process should be documented in the complaint log as well as the after-hours call log. By the way, the “call log” can be a notebook or file folder, or it can be electronic.
Tracking the number of after-hours calls, staff response time to the calls, and the nature of the calls can yield useful information for a quality improvement program. Many companies glean helpful information about staff and patient/customer learning needs, the quality and reliability of various brands of equipment, and customer satisfaction with service issues through the careful and thoughtful tracking of these calls.
An after-hours call log says a lot about a company. Surveyors tend to review the log looking for areas of strength and also areas that need improvement. Your company should do the same.
