Place incoming referring physician calls in the appropriate CT authority within 1 minute, 90% of the time, by January 2014. ______________________________________________________________________ 3
Project Milestones • Team Created • AIM Statement Created • Held 1st Team Meeting • Background Data • Workflow and Fishbone Analyses • Interventions Implemented • Data Analysis • CS&E Presentation
August 2013 September 2013 September 17, 2013 October 2013 October 2013 December 2013 December 2013 January 2014 4
Optimize the referral interactions between referring physicians and UT Medicine Cardiothoracic Surgery.
Minimize difficulties associated with finding appropriate faculty surgeon oncall.
Minimize ability for referring physicians to circumvent existing systems in place.
We anticipate pushback from faculty and staff normally encountered in making changes to existing systems.
Leadership is supportive of the need to make changes.
I believe if we are able to make our call schedule work easily and get appropriate on-call faculty on the phone reliably and promptly, the work will serve as a template for UT Medicine.
How will we know that a change is an indeed an improvement? – Types of measures – The measure is quantitative in nature with a multiple timed series comparison of pre and post intervention results. – How you will measure – The Return Call Cycle Time is collected on each call and measures the Date/Time call received to Date/Time of call returned by the on-call physician. – Specific targets for change – The target set within the Aim Statement is to place incoming calls into the appropriate CT authority within 1 minute, 90% of the time, by January 2014. 6
What Interventions Can We Make That Will Result in an Improvement? Outline the changes that will be implemented by the UT Medicine Call Team and Cardiothoracic Surgery. Determine findings from your process analysis tools, decision-making tools and relevant organizational factors.
University of Texas Medicine – CT Surgery – Optimizing the Call Center System -- Flowchart Determine Location NO
Provider Questions: How can I help you? Calls to CT Business Office Redirected to 450-9000
Calls to Clinic UTM MARC Redirected to 450-9000
Incoming call received on Priority Line 450-9000 (5pm – 7am)
Operator answers Priority Line with prompted script
Follow Script: Dr. X is not on call tonight. Dr. Y is covering. Would you like me to contact Dr. X anyway, or is this something that can be referred to the on-call surgeon?
Determines Type of call (MD vs Pt.)
Patient Verify patient demographics in EPIC
Patient Questions: What kind of durgery? What hospital? What doctor? When was your surgery? What are your present symptoms? How long experiencing symptoms?
Dr. X available?
Send an email to Dr. X documenting the call.
Call Dr. X on the primary # listed. Relay message or Patch Call
Contact Resident per Call Schedule
Hold Call if: - Appointment - Billing - Prescription - Other office calls
Resident calls Back <15 minutes
Call Resident back within 15 minutes
Relay message to resident or patch call
Resident calls back <15 minutes NO
Complete Call Center Ticket
Faculty notified of Call Relay Message or Patch call
Pre-Intervention Data Con’t Labels 5PM-11PM 11PM-7AM Grand Total
Pivot Table - Jan - Aug 2013 Count Sum of Page to Page Avg of Page to Page of Calls Return Cycle Time Return Cycle Time 131 847 6.5 60 857 14.3 191 1704 8.9
Descriptive Statistics Jan - Aug 2013 Mean 8.8 Standard Error 0.9 Median 3 Mode 3 Standard Deviation 12.6 Sample Variance 159.5 Kurtosis 5.2 Skewness 2.3 Range 59 Minimum 0 Maximum 59 Sum 1600 Count 182
Pivot Table - Jul-Aug 2013 Count Sum of Page to Page Avg of Page to Page Labels of Calls Return Cycle Time Return Cycle Time 5PM-11PM 30 221 7.4 11PM-7AM 19 233 12.3 Grand Total 49 454 9.3
Descriptive Statistics Jul - Aug 2013 Mean 9.3 Standard Error 1.8 Median 4 Mode 3 Standard Deviation 12.5 Sample Variance 155.7 Kurtosis 4.4 Skewness 2.1 Range 52 Minimum 0 Maximum 52 Sum 454 Count 49
Intervention Plan • Primary Contact Medium will be Cellular Telephone. Backup after 2 attempts will be Pager
• Standardized Call Algorithm for Adult Cardiac & General Thoracic Surgery
Implementing the Change • Led Meeting with Cardiothoracic Surgery Faculty, Residents & Staff to Communicate Changes in Call Center Protocol on Thursday December 5th, 9:00am. • Outline Proposed Intervention Strategies. • Answered Questions and Addressed Concerns. • Asked for Feedback the following Thursday. 13
Implementing the Change • Led Meeting with UT Medicine Call Center on December 18th with Call Center Director Debbie Gold and Supervisor, April Lopez. • Asked John Calhoon, MD & HelenMari Merritt, MD to illustrate how call center operations play a critical role in the quality of care patients receive.
Intervention Implemented 12/18/2013 15
Expansion of Our Implementation Act There is potential to expand the intervention strategies across the clinical practice as there are cost savings, measures of efficiency and increased effectiveness. There is an opportunity to improve customer service to referring physicians and patients, optimizing speed and response time.
Potential Return on Investment The Return on Investment can be measured in the potential benefits derived and costs avoided as described below: • Potential Referring Physician Satisfaction – Ease of Referrals
• Increase & Measurable Level of Efficiency & Effectiveness – Standardized Call Center Operations
• Improved Productivity – Potential for Reduced Staffing 17
Conclusion/What’s Next • There was an 85% improvement in call response time. • There was a 43% improvement in the number of calls that were routed to the appropriate faculty physician within 1 minute. • 66% of calls met the project aim as describe above. • The intervention strategies can be easily implemented across most disciplines in the practice plan. • The call algorithms promote measures of efficiency through standardized operations and a significant reduction in the reliance on pagers and reduced expense associated with redundant methods of communication. 18
Educating for Quality Improvement & Patient Safety 19