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Improving Phone Message Follow Up At Keene Family Medicine Clinic
Performance Improvement Leader ship Development Program
University of Missouri Fall 2010
“90% of all QI work begins after your PI-LDP course is completed”
Les Hall, PI-LDP, Fall 2010
Team Members
Rhonda Spooner – Service Coordinator , UP Keene Family Medicine Clinic
Lisa Brockman, L.P.N – Charge Nurse, UP Keene Family Medicine Clinic
Susan Pereira, M.D. – Team Leader , Medical Director UP Keene Family Medicine Clinic
Advisors: Phil Vinyard- MBA, MHA – Asst Manager, Green Meadows & Woodrail Family Medicine Clinics; David Sohl, MHA – Project Manager, Service Excellence
Executive Sponsor: Steve Zweig, M.D., M.S.P.H. – Professor and Chair, University of Missouri Department of Family and Community Medicine
Patient and Family Centered Care
How does this project correlate?
Improved communication leads to better care
Patients deserve timely notification of results, and timely responses to queries.
Engaged Staff is palpable to patients/consumers.
Satisfied and appropriately cared for patients reflect positively on the institution and the likelihood of increased referrals within the system
Patient CommentsSource : Press
Ganey Surveys,
2009-2010 ; patient exit
questionnaires 2009-2010
“ I left 3 messages and no one called me back”
“ I love this clinic, but getting through on the phone is a nightmare“
“ The phones ring and ring and I never get a chance to leave a message”
“ I called 3 times and still haven’t heard about my lab results”
“ I took 28 messages off the machine this morning, and 20 of them required call backs for more information” , Cheri, PSR
UP Keene Family Medicine
The Players
Providers: 4 Physicians ( 3 full time clinical faculty= 7-8 clinics per week; 1 75 % clinical faculty=5 clinics per week) , 1 Nurse Practioner (5 acute care clinics per week), 1 Cardiologist ( 1 clinic per week )
Nurses: 4 floor nurses, 1 triage nurse
PSR’s: 6
The Scope of the Problem One Tuesday morning in November: 34
messages taken between 8 am and 11:30 am= 340 messages per week
30 % of calls are for medication refills 25 % of calls require gathering of information
from patient 40 % of calls are sent to physician/ providers
for clinical decision makingTime from initiation of message to meaningful
patient contact : <1 hour- 4 days Average number of touches per message: 5
Aim Statement
By July 1, 2011, 75 % of all phone calls requiring
additional clinical decision making will
have meaningful patient contact within 4 business
hours.
The Real Aim
“No Dropped Calls”
Timing of messages, snapshot, November 2010
Phone message total, 8am- 11:30: 34Time range to resolution/Patient
Contact=message completion: Minimum: 12 minutesMaximum: > 3 days10/20 messages resolved in <4 business
hours ( 50%, Goal 75%)8/20 resolved in 5-10 business hours 2/20 resolved in >10 business hours ( up to
72 hours after message taken).
Pt calls clinic
PSRcreates messag
e
Perfect Process of Phone Refill Message
Correct
data?
Med on protoco
l?Med called
in, EMR
updated
Message sent
to triage nurse
Med refill
?
Message
complete
Message type
appropriate? Ye
s
Yes
Current Phone Message Process
PSR takes message
Correct
message
type?
Message to Triage Nurse
Message
sent to provid
er
Yes
Provider sends
decision/response to triage
nurse
No
Provider
checks messag
e?
Message
stalled
No
Yes
Yes
Pt Notified
All relevant informati
on present?
No
Driver Diagram
Reduced time to resolution
PowerChart Training of all stakeholders
Reduced Volume of calls
Incomplete message dataWrong message type
Patient call backs excessive
Multiple Calls for refillsMultiple calls for results
Volume of calls increased during peak illness seasonsVolume of calls higher depending on day of week
Providers inconsistent use of PowerChart toolsProviders reply to messages inconsistently
Provider service Excellence
Appropriate Patient Expectations
Intervention Options Pharmacy Phone Line, E-Script
Utilization of tools via PowerChart
Phone Message Type
Standardization of Message Information Gathering
Patient and Provider Education Regarding Follow-up and Results
Health-E
Proposed Timeline for Interventions Phone tree (March 2011)
Message Inbox standards- Proxies, “out of office” tools, patient communication- Current, In Progress
Staff education- Current, In Progress
Provider education (Letter templates for results reporting, patient expectations, pro-activity to anticipate follow up)-In Progress
Pharmacy routing (E-scripts, EMR updates, Pharmacy Faxing, single staff ownership of refills)- Current
Health-E ( Yesterday??- Fall 2011?)
Return On InvestmentPress Ganey Score Improvement
reduced workload for staff and providers
Patient satisfaction and increase referral base, recommendation of clinic and providers
Better outcomes and better care
Staff satisfaction- buy in from changes: efficiency, accuracy
Lessons Learned: Things are not always what they seem… Volume of calls is inconsistent, but consistently
numerous Inconsistency of message response from providers Inconsistent message typingDo we need to consider the culture of phone
messages? Not all messages are necessaryThe reasons we think processes break down are often
not the reasons they break downTo understand a process in order to effect
improvement, the process must be understood in all of it’s complexities, as viewed from multiple perspectives and vantage points of all stakeholders
Summary A phone message as an avenue for extended
patient care is complex and is influenced by many variables
Not all communication with patients in the form of phone messaging is appropriate nor necessary
When all participants have clear expectations and adequate support and training, any complex process can, and will likely, improve
All team members (clinic, OR, ancillary service) have a part in the patient experience and all members are significant.