The impetus for Alfred I. DuPont Hospital for Children’s switch to a centralized system came about because the hospital administrators wanted patients communicating with live people. An admirable goal for sure, but with only two live people available to take calls at anyone time, patients often ended up spending 15 minutes on hold waiting for a human voice, becoming frustrated and hanging up.
The impetus for Alfred I. DuPont Hospital for Children’s switch to a centralized system came about because the hospital administrators wanted patients communicating with live people. An admirable goal for sure, but with only two live people available to take calls at anyone time, patients often ended up spending 15 minutes on hold waiting for a human voice, becoming frustrated and hanging up. This was a doubly frustrating occurrence because patients had the ability to leave messages for call back, but were unaware that they could do so.
The entire episode, while troublesome at the time, served as a powerful impetus for a proactive approach to changes in call routing policy for the hospital and has resulted in a streamlined, cost-effective system that can serve as a model for any practice looking to gain cost and time savings, reduce redundant work, and improve patient safety and satisfaction.
Gail McIlvain-Simpson, MSN, PNP, BC, of the Alfred I. DuPont Hospital for Children gives us a few things to consider:
Repeating messages and choice of music, while seemingly minor decisions overall, can be enough to sour the patient experience and deter them from using your call service in the future.
A robust menu allows for efficient prioritization of calls, rather than an arbitrary message order in a general mailbox, through choices such as emergencies, scheduling, prescription refills, consultation requests, prior authorization, and billing. The key is presenting the right mix and number of choices for your patient population
Computerized system vs. paper-based
McIlvain-Simpson advocates a computerized system like the Epic system currently in place at the DuPont Hospital for Children, but does concede that the transition phase from paper to computer is not an easy one due to the difficulty of incorporating all of the internal processes that just come naturally with a paper-based system.
However, once the time and monetary investment is made McIlvain-Simpson says, the switch is worth it. A computerized system eliminates the lag time associated with paper-based systems in academic settings and metropolitan areas, where different departments can be separated by a few buildings or city blocks.
A computerized system’s real benefit unfolds through what she calls statused computerized notes which allow for immediate alerts depending on priority level as well as the ability to cross reference calls in a patient’s history.
A good deal of cost-effectiveness and practice efficiency comes from staffing adjustments associated with a thorough analysis of peak call volume. By looking at the gender, age, and diagnoses of your patient population, research suggests that you will be able to identify predictable caller patterns, allowing you to allocate staff more appropriately to deal with the ebb and flow.
Research suggests that peak call volume varies dramatically, occurring for primary care Monday-Friday between 10:00 and noon; in pediatric settings during early morning and afternoon hours; and emergency rooms on holidays, weekends, and after hours.
Empower employees and patients
Effective phone calls start with an educated staff and a patient population that can practice good etiquette when reaching out to their healthcare providers.
DuPont Hospital for Children accomplishes this with a new patient packet that requests as much personal and disease-specific information as possible to reduce games of phone-tag down the road. Staff also consistently reminds patients of the information that they need from a voice mail, and proper procedures for presenting documents (eg Family Medical Leave Act) or notifying them of lab work and imaging results done outside of the hospital.
In the end, patient satisfaction is of the utmost importance, and the ability to provide, when a patient is in contact with a live person, rests squarely on the shoulders of the individual sitting in your office. It is highly important that you consider their personality when selecting your telephone triage nurse. Is this person a good listener? Are they organized? Can they multitask and problem solve? An effective liason must be able, says McIlvain-Simpson, to facilitate, clarify, reflect, support & reassure, lead, and inform, all while filtering the “noise.”