Acute & after-hours.

Established patients of this practice with acute clinical concerns appropriate to outpatient management within the next 24 hours. Common presentations: respiratory infection, urinary tract infection, acute musculoskeletal injury, dermatologic flare, gastrointestinal symptoms, acute mental-health symptom changes that are not crisis-level, prescription concerns that cannot wait until the next routine appointment, post-procedural questions, and post-hospitalization questions in the first 30 days.

This monograph also covers the after-hours phone line for clinical questions that arise outside business hours and within the on-call window. Calls outside the on-call window are routed to the answering service, which has explicit instructions for emergencies.

Same-day slots: each adult-medicine clinician holds two 20-minute acute slots per half-day Mon–Thu and one slot Fri morning. Helena Rey, FNP-BC holds three pediatric acute slots per day. Total practice acute-slot capacity: approximately 24 slots per week. Slots are booked by the front desk on a same-day basis; we do not book acute slots in advance.

After-hours line: the on-call clinician carries a pager. The pager is held on a rotating basis by Vanderlyn, Thackeray, and Voorhies for adult medicine and by Rey for pediatrics. Salim Okonkwo holds the BH after-hours pager Monday through Friday evenings and is on-call by phone for acute MH concerns from his existing panel; OUD-related concerns are handled by Thackeray when Okonkwo is unavailable. The pager phone number is given to every patient at the new-patient visit.

The standard answer to the question what does the after-hours line cover? is: it covers situations where a brief conversation with someone who knows you would change your evening — questions about medications, post-procedural symptoms, fever in a child, mental-health symptom changes, anticipatory questions about a planned procedure or hospitalization. It does not cover routine refills, chronic-disease monitoring, or new diagnoses that require a full visit.

Established patients of CCH-001, CCH-002, CCH-003, or CCH-004. We do not accept new acute patients without a prior establishment visit; for this we refer to CityHealth-style urgent-care services or to the HealthAlliance ED.

• Same-day acute (CCH-006-SD) — 20 minutes Mon–Thu, half-day Fri.
• After-hours phone (CCH-006-AH) — 17:30–22:00 weeknights, 09:00–18:00 weekends. Median callback time: 18 minutes (Q4 2025 audit; 90th-percentile 41 minutes).
• Post-discharge follow-up (CCH-006-PD) — within 5 business days of any acute hospitalization, scheduled by the front desk on receipt of the discharge summary.

• We are not an emergency department. Chest pain, stroke symptoms, severe shortness of breath, severe abdominal pain, head injury with loss of consciousness, severe injury, or severe mental-health crisis — call 911 or go to the HealthAlliance ED.
• We do not handle inpatient or hospitalist questions during admission; the hospitalist team is the responsible clinician.
• Prescription refills for chronic medications are not handled through the after-hours line. Send the request through the portal during business hours; the standard turnaround is 1 business day.
• Mental-health crises requiring immediate intervention — call 988 or present to the ED. We will receive you for outpatient follow-up.

1. Walk-in acute care for non-established patients — referred to urgent care or ED.
2. Chronic medication refills via the after-hours line — the line is reserved for acute clinical questions.
3. Repeated use of the acute pathway as a substitute for a continuity relationship — we will, after the third acute visit in 90 days for non-acute concerns, schedule a longer continuity visit and explain why.

If you have an acute concern during business hours: call the front desk. We will offer a same-day or next-business-day slot if one is appropriate. We will tell you, on the call, if it is not appropriate — and we will tell you exactly where to go instead.

If you are calling the after-hours line: please leave a clear message with your name, the patient's name if different, and a brief description of the concern. The on-call clinician will return your call. The voicemail explicitly directs life-threatening emergencies to 911.

If you are post-discharge: we will call you the business day after we receive the discharge summary to schedule a 5-business-day follow-up. You should also bring the discharge medication list and any new prescriptions you started in the hospital.

Insurance: same-day acute visits are billed as standard E&M visits at the office. After-hours phone calls are not billed.

Membership: $95/month adult covers all CCH-006 same-day acute and after-hours line access at no copay.

• Telehealth-only urgent care. Not offered as a standalone service. Amwell and similar are reasonable alternatives for established-patient-but-out-of-region scenarios.
• House calls. Not currently offered. AAFP — house calls describes the model.

This monograph is co-owned by Maren Vanderlyn, MD and Tessa Voorhies, DO, with the after-hours-line operational details contributed by all clinicians who carry the pager.

v2026.04.30 — supersedes v2026.01.20. Significant changes: § Outcomes 30-day readmission added (was previously only same-day-access); § Mechanism on-call rotation explicitly named; § Adverse effects updated to clarify the >3-acute-visits-in-90-days rule. Diff on the errata page.