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.