Multiple PACT Requests for a Patient
A patient can be assigned to multiple stations to facilitate and expedite encounters for that patient, especially if it's medically necessary or if a Veteran relocates. You are able to view all requested assignments for Multiple PC teams for a patient on the Patient Profile screen. There can only be one active request per patient per station at a time. There can be multiple requests for the same patient at different stations at one time.
Note: Multiple PACT requests and Multiple PCP requests refer to the same process -- they are interchangeable terms.
- If there are no active PC Assignments for this Patient at other stations, the multiple PACT request cannot be created.
- Generation of a multi-PACT request will be auto-generated. Only through the assignment of a pending or assigning a patient to a pending status to a new team will it auto-generate the multiple PACT request, if needed.
When a patient is being assigned to a PACT team at the local station, the patient’s PACT assignments will be evaluated enterprise-wide to determine if an active PACT assignment exists in another 3-digit code station. If it is determined that the patient has one or more active PACT assignment(s) at other 3-digit code stations, then the system will automatically generate a Multiple PACT Request (MPCP) for the current pending PACT assignment being made.
-
- There can only be one pending request per patient per 3-digit code station at a time. The Multiple PACT request cannot be used to request an assignment within the same 3-digit code station.
- There can be multiple requests for the same patient for different 3-digit code stations at one time.
- In order to create/edit a Multiple PACT request for a patient, the patient must not have a Date of Death associated with him. If he does have a Date of Death, a Multiple PACT request will not be created.
- The Multiple PACT request process starts when a patient is being assigned to a PACT team at the local station. See the Assign a Patient to a Team section for more information.
- If the system finds the patient is active at another station, The Multiple PACT Automatic Creation popup box will display. Click Assign Anyway to continue, or Cancel to cancel. The Attention popup box will display. Click OK.
- The system creates a Multiple PACT request. The Multiple PACT Request section in the Patient Profile will contain a table that lists all of the requested assignments for the Primary Care teams and display the following fields:
- Status
-
- Pending - Default when creating a new request - If all involved stations have not approved or denied the request
- Approved - If all involved stations have approved the request
- Denied - If any of the involved stations have denied the request or
- Withdrawn - If the station needing assignment canceled the request
- Status Date
- Receiving Station Name
-
- Station Name (Station #)
- Team name
- Focus
- Reason
-
- Medically Necessary or Permanent Relocation
- Action to view the request details
- The system sends out two alerts to all involved stations (i.e. those stations holding a current active PACT assignment or the station needing assignment). An Informational Alert is sent to the station needing assignment PCMM Coordinator for awareness and an Actionable Alert to the Station Needing Assignment TVC requesting to Approve OR Deny an existing Multiple PCP Request.
- The Travelling Veteran Coordinator (TVC) at site and VISN level along with their backups are the only roles that have permission to approve or deny, therefore are the only ones that can enter the approval/denial.
- All involved stations must approve or deny the new pending request in order for the PACT assignment at the requesting station to be considered for activation.
- The authorized user (TVC) opens the Alerts list (see the View Open Alerts List for a Current Station section), locates the correlating Actionable alert for the request, and clicks the View/Action on Alerts icon in the Actions column. The system will display the Patient Profile screen.
- From the Multiple PACT Requests section, the user clicks the Actions icon (magnifying glass) to display the Create or Edit Multiple PACT Request popup screen. This screen will display:
- Status for the Request (will be Pending)
- Request entered by
- Station Receiving Request
- TVC's listed for that station
- Reason for Multiple PACT Request (Medically Necessary or Permanent Relocation)(See note below containing Permanent Relocation information)
- Comments
- The Required PACT Approvals section will include:
-
- Station
- TVC's
- Status-- Not Yet submitted for approval -- for all stations that have an active Team Assignment for the patient (an indicator that receiving station has not provided their approval).
- Status Date
- Clinical Approval By
- Traveling Coordinator
- Comments (if any)
- Actions
- The bottom section of the form will include the Approval section:
-
- Request status
- Entered By:
- Clinical Decision By:
- Comments (if desired)
- Click Approve to continue, or Deny to deny the requested approval. The status will be changed to Approve, the Entered by will be populated, the Approver selects a Clinical Decision by:, and comments may be entered if desired.
- Click Submit to continue, Withdraw the Request to withdraw, or Cancel to cancel. If Submitted, the system changes the Status to Approved in the Patient Profile and sends out an alert to the original station.
- If the TVC denies the request, the pending PACT assignment request will be canceled and closed with a reason of Denied.
- If the Multi PACT Request is in Pending status, ONLY the Station needing assignment TVC role can WITHDRAW the request. This will send an Informational alert to all station(s) TVC(s) and PCMM Coordinator(s) listed on the request stating that the request is no longer needed. The station needing assignment can cancel the request as long as the overall status of the MPCP request is Pending. Even if the station needing assignment has approved the Multi PACT request, that station can still cancel the request if it’s overall status is still Pending.
- If a station has a pending assignment that flips to Active while a Multi PACT request still has an overall status of Pending, this station will be added to the Multi PACT request as a Required PACT Approver. The appropriate alerts will be sent to the appropriate people.
- Once the overall status of a Multi PACT request changes from Pending to Approved or Denied, the request will be closed and no further changes permitted. A new request will have to be submitted.
Approval Station Process:
- The TVC at the receiving station opens the Alerts list (see the View Open Alerts List for a Current Station section), locates the correlating Actionable alert for the request, and clicks the View/Action on Alerts icon in the Actions column. The system will display the Patient Profile screen.
- The TVC opens the Multiple PACT Requests section and clicks the icon in the Action column for the corresponding record.
- The system displays the Multiple PACT Automatic Creation popup box. The user scrolls down to the Required PACT Approvals section.
- The TVC has the option of resending the alert to the stations listed by clicking the Resend Alert button in the Actions column.
- The TVC clicks Approve to continue (and may enter comments if desired), Deny to suspend the approval process. If Deny is selected, the user will be required to select a Reason and Date.
- All involved stations must approve or deny the new pending request in order for the PACT assignment at the station needing assignment to be considered for activation.
- Once a request has been approved or denied – no further edits are permitted.
- The other involved stations will not be able to edit any data, they will only be able to approve or deny the request.
- The TVC(s) must enter who made the clinical decision to Approve or Deny the request. This is used to indicate if the TVC is approving this request or on behalf of someone else who authorized the approval from a clinical standpoint. It is a required field. This drop down list will include all PCMMR users who hold the clinical approver permission.
- The TVC clicks Submit and the record is saved.
- The request will be saved with an assignment status of Approved for the station approving the request. The overall status of the request will remain Pending until all required approvals have been obtained. An Informational Alert will be sent to all TVC(s) at the other approving station(s) except the TVC’s station that just provided the approval.
- If the MPCP request is approved by all involved stations being asked to approve/deny the request, the status of the entire request will then be Approved. An information alert will be sent to all TVC(s) and PCMM Coordinators.
If TVC Denies the Request:
- The request will be saved with an assignment status of Denied. An Informational Alert will be sent to all TVC(s) and PCMM Coordinator(s) at the other approving station(s) except the TVC’s and PCMM Coordinator’s station that just provided the denial.
- If the MPCP request is denied by one station within all the stations being asked to approve/deny the request, the status of the entire request will then be Denied. No further action on this request will be possible by any other approvers whose approval may be pending.
- The system displays the details of the submitted request in the timeline on the Patient Profile screen.
-
- The system will track that all approvals needed are received. When they are, the assignment will be interrogated for activation. If an encounter has been recorded within the previous 30 days from the team assignment date; the assignment status will be changed from Pending to Active using the encounter date as the effective date for the activation.
- Once a MPCP Request is approved and in Approved status, it will be considered valid for 24 months using the Approval date from the last station to submit its approval on the request. If the patient is unassigned from that team and is re-assigned again or if the team itself is inactivated/re-activated in this time period, the earlier approval will be considered 'valid' during this 24 month period.
-
- If the 24 month timeframe has passed and a patient is then unassigned from the team, a new MPCP Request is required.
- If the 24 month timeframe has passed and the patient is still assigned to the team, the original MPCP Request is still considered valid.
- If a MPCP Request is still Pending 15 days after the request’s creation, the system will automatically generate an informational alert to all of the outstanding station approver(s) by sending an Outlook email to remind the recipient(s) to look at the PCMMR Alerts and that action is needed.
-
- If a MPCP Request is still Pending 30 days after the request’s creation, the system will generate an informational Escalation Alert to the VISN TVC coordinator of each station that has not responded to the MPCP Request by sending an Outlook email stating that a MPCP Request has been pending for 30 days and to look at the PCMMR Alerts to take action on this request.
- If a MPCP Request is still Pending 45 days after the request’s creation, the system will generate an informational Escalation Alert to the PCMMR National Coordinator by sending an Outlook email stating that a MPCP request has been pending for 45 days and to look at the PCMMR Alerts to take action on this request.
- If a date of death (DOD) occurs for a patient in the station needing assignment while a Multi PACT Request is in Pending status, the system will automatically unassign the patient from the pending assignment and the Multi PACT Request will be WITHDRAWN. An information alert will be sent to all appropriate people.
-
- If the Multi PACT Request already has a status of APPROVED or DENIED or WITHDRAWN, no changes will occur to those requests.
- If a DOD occurs for the patient at one of the approving stations, the Multi PACT Request will not be affected. (The auto inactivation process of the active assignment at the other station will resolve this issue.)
Permanent Relocation Process
-
If the TVC at the station needing assignment selects Permanent Relocation as the reason for the Multi PACT Request, it is to assist the patient with an easy transition to the patient’s new station. Once overall approval is received by the station needing assignment, the following alerts will be sent:
-
See also:
View a Patient Profile
Assign a Patient to a Team
View Alerts Summary for a Station
View Open Alerts List for a Current Station