Whenever Sarah Thomas, senior director of access systems at Seattle Children’s Hospital, hears a registrar sigh in frustration, she makes a beeline to that employee and asks what’s wrong.
“If you are getting annoyed in the course of doing your job, then you’ve just discovered an opportunity for improvement,” Thomas says. “I want to stir up that conversation.”
Like many patient access leaders, Thomas often hears comments such as “Why is that never here when I need it?” “Why can’t I get this information more easily?” or “Why am I doing this over and over again?”
“This has identified many problems, which we are then challenged to find solutions for,” says Thomas.
The department made these changes:
• The process of referrals from community providers for specialty care was revised.
A team quickly enters these requests into the Epic system, so when the family calls to make the appointment, the information can be brought up right away.
“Nurses need to do a certain amount of triage to make sure we have the right clinical information to connect patients to the right specialty,” says Thomas.
This step avoids the patient being sent to a nonsurgical provider if the case is likely to be surgical, for example. However, says Thomas, “we were finding that as much as half of our referrals go unscheduled.” The patient’s problem might have resolved, or he or she might have gone to the ED in the interim. “If nurses are processing all of these referrals, and only half end up in an appointment, that’s pretty expensive triage,” says Thomas.
To reduce the amount of upfront work done, nurses go through the process of reviewing the clinical documentation only when the family schedules.
“We tried the new process for a particular diagnosis that was pretty heavy on the records-gathering work,” says Thomas. “We saved 160 hours of nursing labor, just with that one diagnosis, in only four months.”
• The cost of interruptions was addressed.
While registrars need to multitask and switch between applications, “if you are knee-deep in something and the phone rings, to take that call means you have to retrace some steps,” says Thomas.
The department identified the right number of nurses needed to take referral calls, which allows everyone else to work uninterrupted. “We also looked at what kind of work is more interruptible, so registrars can fill in the gaps between phone calls,” says Thomas.
• Patient access staff members call providers offices with questions about scheduling, instead of emailing them.
“We were seeing more delays from when the specialty provider gave us new dates for scheduling and when those were actually open,” explains Thomas. “It was starting to become a dissatisfier.”
The problem is that patient access couldn’t schedule those dates until the calendar was open. “We had a five-day turnaround time for requests,” says Thomas.
Some requests had errors, such as when the provider indicated a day was open for scheduling, but the provider was out of the office. “The team didn’t know what to do without clarifying the request,” says Thomas.
Previously, patient access emailed the provider’s office, but it sometimes took several emails over a period of days to resolve the issue. “We started a new process, with some good old-school communication,” says Thomas. The process was piloted with four specialties.
Patient access now picks up the phone to speak to someone immediately about any scheduling problems that come up. Most can be corrected right away. “Just by getting rid of this back and forth by email, we reduced our turnaround time from five to one and a half days,” reports Thomas.
• Reminder calls allow families to cancel appointments with no further action.
The department’s previous system allowed families to indicate their desire to cancel, but actually canceling required another phone call. “The delay inherent in reaching each other was starting to become a negative,” says Thomas.
Patient access found that an update to the system allows families to cancel on their own, with no further action required by the family or patient access. “By solving a problem for our families, we actually eliminated work for our staff,” says Thomas.
Fewer families need to be called back to confirm the cancellation. Michelle Harkins, manager of scheduling and intake, says, “This allows us more time to be doing what we do best: taking incoming calls from our patients and families who are ready to schedule appointments.”
Previously, it took about 40 minutes a day to make the calls; it now takes half as long.
“In the 20 minutes we save, we can schedule four appointments,” says Harkins.
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