Triage Department - CHUG

2 Offices

25 Physicians

2 Mid-level

Triage Department:

• 6 schedulers

• 25 nurses

• 680 calls per day

HOW MANY PHONE CALLS?

TREMENDOUS STAFF TIME

TOTAL STAFF TIME ON TELEPHONE EACH YEAR

• Answering calls

• Collecting Clinical Information

• Voicemails

• Outbound Calls

150,000

15,000 HOURS

6TRIAGE CALLS

OUR NURSE EXPERIENCE

VM VM VM

OTHER RESPONSIBILITIES OUR NURSES HAVE

Physical Exams

Blood draws

Fill orders

Care Coordination

Health HistoriesGive Medication

Chronic Care Management

See more patients

PATIENT EXPERIENCE WITH TELEPHONE

Our patient satisfaction scores for the telephone were getting worse.

NEW Workflow

GOALS AND OBJECTIVES

• Operations– Improve documentation of online

encounters

– Gather clinical information up-front

• Clinical– Reduce nurse time

– Standardize the encounters

• Patient Satisfaction– Give patients answers they need quickly

– Provide more avenues for access

• Administrative– Ramping up – maintain SLA

– Reduce nurse fatigue

– More performance reports

OPERATIONS

• Gave simple protocols to schedulers

• All calls follow standard process

• Schedulers gather basic triage information up-front

Non-Clinical Nurses Clinicians

Struggles• Summer call volumes jumped:

April: 9,000 callsJuly: 18,000 calls

• Handled 2x call volumes while implementing a new system –not an easy task!

• SLA’s – as calls spiked, so did dropped calls. SLA improved as we learned and implemented better processes.

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

0%

5%

10%

15%

20%

25%

30%

Call Volume vs Dropped

Calls

Dropped calls Call volume

Lessons Learned

• Don’t implement during your busiest telephone season!

• Don’t under-estimate training for front-desk staff

• Be transparent with your vendor – Keona was responsive

SUCCESS!

• Telephone satisfaction scores are higher – and rising

• Eliminated voicemail

• Reduced nurse burden• Our nurses are floor nurses

• No longer stationed by the telephone all day long!

• Have new metrics to track SLA’s• Total resolution time to encounters

• Time to conduct triage interview

• Implemented our own protocols

• Expanded system outside of clinical triage to billing

IMPLEMENTATION

Oakkar takes over.

Goal = 30 secs/slide

IMPLEMENTATION

Health Desk: 30-day Implementationafter Allscripts completes configuration

Kickoff Meeting

Submit Allscripts Ticket

Detailed discussion on call workflow

Meet marketing and IT

Determine responsible parties, review documentation forms

Software configuration based on client needs

Launch in production environment

Training provided to client

Client starts using software

Software & workflow adjustments

CUSTOMER SUCESS

• Workflow setup and

walkthrough

• Work with you to build new

features / protocols

• Assist with rolling out new

features and updates

• Provide suggestions for

maximizing ROI

Picture of Keona at

NFLWC here

Make telephone

protocols 6th grade

reading level and

non-clinical facing

ANATOMY OF A TRIAGE CALL

Intro Problem Vent Interview AssessmentRecom-

mendation

50-70% of call 30-50% of call

Patient or Front Desk Clinical Staff

50% less clinical time.

Time Saved

Appropriate

Care

Measured in National Institutes of Health Case Study in Partnership with University of North

Carolina – Chapel Hill

80% Prefer Online

Triage

Eliminate Voicemail

TOTAL

RESPONSE

TIME15 min. Patient

Satisfaction

?QUESTIONS

hdillard@wakeinternalmedicine.com

oakkar@keonahealth.com