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Parents in Georgia don’t have to guess whether it is appropriate to rush their child to an urgent care center in the middle of the night. When they telephone the Children’s Healthcare of Atlanta Call Center, they speak to an experienced pediatric nurse who, through a series of questions based on a protocol, helps them determine the suitable level of care for their child.
"We do a lot of teaching as we go through the protocol. Then, if we get to the home care page and they haven’t fallen out as far as needing additional follow-up immediately, we teach there as well," says Pennie Graham, RN, MS, director of the call center, which receives 325,000 calls from consumers each year.
The mission of the call center is to make sure everyone in the Atlanta metro area has access to the best possible advice and care and is making the best choices they can about the care their children need, she notes.
The Children’s Healthcare of Atlanta Call Center was launched 12 years ago with two nurses at a counter in the back of the emergency department. Originally, its purpose was to make sure people calling the emergency room for advice were getting good information and being sent to the appropriate place for their care. It also was a way to help the underserved patient population connect with the resources that they needed.
Today, about 60% of the calls are from patients of subscribing pediatricians. The answering service transfers those patients who call after office hours to the center for triage and education where they learn how to care for the condition. While the purpose of call centers varies, generally they provide an opportunity for consumers to get information when they need it.
The Help Line in the Women’s Health Center at Sacred Heart Medical Center in Spokane, WA, has been so beneficial to new mothers that they continue to call for advice and information as their children continue to grow. An employee in the technology department originally created the Help Line for the obstetrics department, but it now is used for other women’s health issues. However, one of the key purposes is to support the women who deliver babies in the hospital’s Birth Place.
About a month before delivery, mothers come to the Birth Place to learn about baby safety and infant care as well as how to care for themselves following the birth of their child. At that time, the medical history sent by the physician’s office is reviewed. This information is entered into the Help Line database so registered nurses can educate mothers on issues they may struggle with once discharged from the hospital, such as sore nipples while breast-feeding.
"We can talk them through anything they may have problems with once the baby is born," says Julie Emery, RN, assistant nurse manager of the Women’s Health Center.
A nurse from the call center telephones mothers 24 hours after they go home to see if they are having any problems. At that time, they ask several questions based on the protocol, such as whether the baby is eating and in what position the baby is sleeping.
Seventy-two hours after the mother and child go home, a second phone call is made in which another set of questions from the protocol are asked. Any problems discussed during the two phone calls are entered into the computer so additional follow-up calls can be made, as needed.
New mothers can call with questions 24 hours a day. After hours, calls from the Help Line are forwarded to the Birth Place. A call log is kept and sent to the Help Line so the information can be entered into the database. Also, each time a protocol is used, the information given to the patient is automatically recorded in the database along with the date and time the call was made and the name of the educator. "People love it. They know that there is someone there to help them if they need it. It is good public relations for the hospital," reports Emery.
Training is essential
Training staff to handle the calls received at a center is often extensive. At Children’s Healthcare of Atlanta, applicants must have three years of pediatric nurse experience. Also they need good communication skills and very good listening skills because information is gleaned by what is not said as well as what is said, explains Graham. "Because you cannot see the child, and you are talking to people who have no medical background, for the most part it takes a certain set of skills to convey the information in a way they will understand," says Graham.
When a nurse is hired he or she undergoes a 90-day formal orientation that includes listening to calls and working with the computers. Following that, training nurses receive nine months of supportive orientation. During this time, they learn the 80 protocols and take tests on them.
While information given on the M.D. Anderson Information Line in Houston is not clinical, training is essential for staff. Job qualifications include a college degree and a background in health or communication. Because the institution is one of the leading cancer treatment centers in the United States, training covers both the phone service and also cancer information.
"Each health information specialist spends a good deal of time in the first four or five weeks studying booklets and taking many tests on the different types of cancer. We also have them shadow other specialists on the phone and listen to how they take calls," says Darren Skyles, director of the M.D. Anderson Information Line.
If a caller has lung cancer, the information specialist explains M.D. Anderson’s standard treatment for that type of cancer and explains some of the clinical trials for the disease currently being conducted at the health care institution. The specialist then advises the patient to discuss the information with his or her physician.
Callers are generally looking for additional cancer treatments as well as information on how to be admitted to M.D. Anderson for treatment. "Information specialists can direct callers to resources and counsel them in a way that tells them the benefits of coming to M.D. Anderson, but we aren’t nurses or doctors," says Skyles.
As the Internet increases in popularity, the calls on the information line have decreased and e-mails are on the rise. In the 1998-99 fiscal year, the call center received 32,564 calls and 8,685 e-mails. And in the past year, there were 24,005 calls and 21,869 e-mails, thus indicating that e-mails now are a substantial part of the M.D. Anderson Information Line service.
When a health care system includes 13 hospitals, creating a call center that distributes information for all facilities can be cost-effective.
"It is certainly a more cost-efficient way to provide the service. There is one set of overhead costs vs. [multiple] overhead costs for each of the hospitals," says Julie Bruns, call center manager for BJC HealthCare in St. Louis. People call for a physician referral, to schedule a screening mammogram on the mobile van, to enroll in a childbirth class, to ask about parking at a particular facility, or to inquire about obtaining their medical records.
"When the hospitals are promoting a service, or providing an educational program, or just letting customers know they can call for a physician referral, they use the phone number that rings into our call center. We have 10 or 12 different numbers that ring in here," says Bruns.
Because the calls are nonclinical, the phone lines are staffed by customer service representatives who receive six weeks of training before taking calls on their own. A couple of nurses are available to provide assistance when a customer calls with a particular condition and wants to be referred to a specialist.
A call center similar to the one at Children’s Healthcare of Atlanta is operated at one of the hospitals within the BJC HealthCare system. When parents call the St. Louis Children’s Hospital Answer Line, they talk to a registered pediatric nurse.
In addition, the Answer Line provides an asthma management service. There is a process in place where the nurse recommends asthma treatment and then follows up with phone calls. By using more aggressive management practices, fewer children are sent to the emergency department and, when they are sent, they are not admitted to the hospital as often, says Bruns.
"We have come up with a model that follows standard practice and, even though it takes our nurses more time for the calls, it has proven to be better for the children in that they get the rescue treatment more quickly and may not have to go to the ER," she reports.
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