The ability to access specialty support services for my post-acute rehab patients has become more difficult over the last 10 years as the specialists in my community have moved from private practice to working for either the Sutter or Providence HealthCare Systems. Many offices have moved to off-site appointment scheduling systems focused on elective care appointments, often with first available appointments months out. Even when an office has a live receptionist, it seems like the default triage of the receptionist is to preserve the specialist’s elective appointment schedule and defer urgent appointments to an urgent care center or the ER. I suspect this default triage system is often implemented without the knowledge of the specialist. 

Over the years, I have accumulated a significant database of cell phone numbers for many specialists. When our unit clerk has had difficulty scheduling timely appointments, I have resorted to texting the specialist and have usually obtained a timely and appropriate response. When I have requested Sutter or Providence for access to the cell numbers of their specialists, that request has been routinely denied. 

The problem accessing timely specialty support was apparent in the care of an independent living woman in her 90s who was seen at a local ER for falls, with the first fall causing a head contusion and the second a large, disabling hematoma (she was on an anticoagulant for atrial fibrillation). On admission to a SNF unit, this cognitively intact person clearly described brief presyncopal circulatory insufficiency symptoms not ascertained in the ER encounter, associated with her falls. When our unit clerk requested a Zyo patch and f/u appointment with her cardiologist’s office, she was told they would mail us a Zio Patch (remote cardiac rhythm monitor), and no appointment was available until her previously scheduled appointment 6 weeks later. However, the Zio Patch did not arrive, which was unfortunate since it would almost certainly have captured the heart rhythm when she had another witnessed syncopal event in our unit. I have faxed this specialist my progress notes (GehriMed), including the one documenting the syncopal episode, but I suspect these records lie in an Epic File that physicians do not routinely review. I subsequently texted this cardiologist, who was not aware of the urgency of our request for his services, and he promptly texted back, “OMG,” and stated he would talk with his office staff. 

In the future, I will be texting specialists sooner when timely services are needed, since the current system in my community seems best suited for truly elective care. I have had some success with obtaining fax numbers from office staff who are familiar with my reputation in the community.  One other possibility is using Doximity messaging for physicians and other practitioners who are on that service (www.doximity.com)

I suspect other CALTCM providers in other communities are having similar difficulties. I hope you share your constructive ideas with the WAVE about ways to improve timely access to specialty care for our rehab patients and avoid the very suboptimal and often traumatic ER alternative.