Inpatients calling after discharge for med changes and such

[northernpsy]

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This isn't something I dealt with in residency since I rotated off-service every few weeks in residency, but now that I am working my first post-graduation job in an inpatient psych hospital, I keep getting calls from patients I discharged weeks ago telling me they need a medication change or other sorts of requests.

How do those of you who work in inpatient handle these types of situations if you don't have any means to get the people in for an outpatient appointment? I'm a hospitalist so I have no way of getting these people in for an evaluation unless they are doing badly enough that they need to be readmitted (and obviously that's not the issue here). On one hand, it can take months for them to see a new outpatient psychiatrist (IF they actually GO to the appointment - I've had more than one situation where I can see in Epic that the person just chose not to go to their follow up appointments, but yet they're calling me for med refills, paperwork for reduced bus fare/disability benefits/worker's comp, etc. that IMO should be the domain of their follow up provider)

On the other hand, I feel like it is kind of a risky situation to try to manage these patients over the phone when I haven't seen them since their discharge from inpatient. I also feel like in some cases it would probably be good for some of these people to have an incentive to GO TO THEIR OUTPATIENT FOLLOWUP. Yet I also worry about what happens if I don't do anything about their requests and something bad happens.
What do you guys do? Thanks for any thoughts.

 

[nexus73]

In very limited circumstances I will refill medications after discharge (e.g. Homeless patient had 2 week supply of cymbalta stolen one night in the shelter). I would never fill out forms or write letters unless I agreed to do it while they were in the hospital. I wouldn't change a medication without seeing the patient. People can get refills at an urgent care, primary care, or ED, they don't need you to do this generally.

The patients need to follow up with the outpatient Doctor, or if they are doing really bad they need to got to the ED.

You should have a unit secretary taking these calls and diverting most of them for you. I hope they're not calling you on a direct line.

Start demanding closer follow up appointments so patients don't have to wait 2 months to be seen.

 

[Doctor Bagel]

Where I work, we generally get people to someone who can prescribe within 7 days of discharge (or really close to that). If they miss that appointment, that's really on them. I think your treatment relationship basically ends when they discharge, and I wouldn't feel comfortable renewing and especially changing medications. Luckily my county has an urgent mental health walk-in clinic which is always an option. PCPs also do a lot of prescribing in my community, so that should also help.

Maybe our unit secretary does a good job filtering these things because I haven't gotten a single request for a refill since starting my inpatient job.

 

[smalltownpsych]

Educating the staff and working with them is a key to successful practice both inpatient and outpatient. If they feel supported, they will help sort the wheat from the chaff. We get lots of training and education on how to deal with our patients, they don't and I find that if they feel that we are working together, they will handle most of the phone calls that I don't need to anod ensure that the key calls get through to me.

 

[Shikima]

Staff boundaries.

 

[Doctor Bagel]

Yet I also worry about what happens if I don't do anything about their requests and something bad happens.
What do you guys do? Thanks for any thoughts.

I'd be amazed if there is much risk here. I think it's certainly riskier to prescribe for a patient you are no longer treating. Perhaps it's reasonable to make sure the discharge paperwork states clearly that they need to follow up with an outpatient provider for future medication issues and also to state very clearly that you are only giving a certain specific time limited amount of medication.

 

[cookymonster]

Appeasement is much more difficult to avoid over the phone than in person, as I do not get compensated to talk to patients on the phone and after 60 seconds I can't focus on much else besides determining the fastest way to get off the phone.

Generally this comes up most often with controlled drugs or drugs in which you need a specialty or waiver to prescribe them (i.e. Suboxone, ketamine, but unfortunately also long-acting meds and meds not covered or inadequately covered by insurance). You'll make your life a lot easier by prescribing the cheapest, most vanilla meds you can and letting the placebo effect do its job.