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When a depressed young woman called the ED at Eastern Maine Medical Center in Bangor, she began asking questions about a strange mix of medicines. The call was forwarded to a special triage line used for ED patient calls. "The patient’s voice was slurred, and she would not answer basic questions," recalls Karen Clements, RN, BSN, department head nurse for the ED.
The patient hung up after she had given her telephone number, and Clements was immediately contacted by the nurse who had taken the call. "I chose to have the police involved so they could check on her," she says. When the police arrived, they found the woman unconscious on the couch, having overdosed on all the medications she had asked about. "We saved her life that day," says Clements.
ED nurses at the 400-bed hospital were routinely bombarded with dozens of calls a day from the public looking for medical advice, says Erik N. Steele, DO, ABFP, administrator for emergency and trauma services. "These calls created problems for the staff because they were uncomfortable giving medical advice over the phone, but at the same time they wanted to help the callers," says Steele.
The ED now outsources the non-emergency nurse calls coming into the ED to Intellicare, a Web-enabled patient contact center that provides nurse triage services. (See "Sources/resource" at end of article for more information.) The patient contact center provides 24-hour triage of all symptom-based and health information calls coming into the medical center’s ED, Steele says. (See "Here’s what happens when a patient calls," in this issue.) The ED pays a variable monthly fee based on call volumes, which is approximately $80,000 annually for Eastern Maine. This is less costly than owning and operating a call center, says Steele.
Here are some benefits of outsourcing patient calls:
• Unnecessary ED visits are reduced.
The system reduces unnecessary visits to the ED for primary care, says Steele. "It provides measurable redirection to the appropriate levels of care," he adds. Outsourcing brings answers to patients who don’t need emergent care, while also convincing seriously ill patients that EMS is needed, says Clements. "There is one call, and one answer," she says. Documentation of triage calls allows ED nurses to make follow-up calls to check on the status of the patient’s condition and find out what type of care they received.
• Nursing staff are freed up.
The system allows the nursing staff to concentrate on the patients at hand, says Clements. "Prior to outsourcing, we were answering 20-30 calls a day without much follow-up," she says.
Steele estimates that about five to 10 minutes of ED nurses’ time is saved per call, including several minutes for the call itself and several minutes of lost efficiency when a nurse is pulled away from some other task. "We have 20 to 40 such calls a day, and some days it has been as high as 60," he reports. "We have estimated it costs us about 0.5 FTEs. It is also a nursing satisfaction issue."
• Patient satisfaction is increased.
Before outsourcing calls, nurses were faced with two unpleasant choices, says Steele. "We had to either tell these callers that we couldn’t help them, or give them inconsistent advice by a harried nurse who didn’t have the time or interest to really be helpful," he says. According to Steele, the system allows the ED to provide a valuable patient service, and surveys have shown that 95% of patients say they are "satisfied" or "highly satisfied." He adds that the service helps the ED differentiate itself in the marketplace by providing a leading-edge solution for patient contact.
• Liability risks are reduced.
Previously, patient calls were a liability risk for the hospital because the information that staff were giving to callers was inconsistent and there was no documentation of the call, says Steele. "Nurses either told callers that they couldn’t give medical advice over the phone or gave undocumented advice," he says. This resulted in mutual dissatisfaction for callers and the staff and a risk of bad advice given over the phone, he says. The quality of advice given by ED nurses over the phone is inconsistent and rarely documented, says Steele. "There have been a number of phone advice malpractice cases with multimillion-dollar settlements in the past 10 years, most frequently inappropriate advice for febrile children and for adults with chest pain," he says.
Steele gives the example of a parent calling the ED about a child with a fever, and the nurse recommending Ibuprofen. "If that child ends up with meningitis, the hospital is could end up paying $5 million in a malpractice settlement," he says. "We are self-insured as a hospital, so one avoided case for us will pay for this service for 20 years."
• Nurses are more satisfied.
The nursing staff initially was suspicious about turning calls over to an outsourced center, says Steele. "Some of the more reluctant nurses pretended to be patients and tested the service by calling the ED," he reports. "They were very satisfied with the level of customer service and quality advice they received." Most EDs are frequently overcrowded, and the staff is barely hanging on,’ notes Steele. "The outsourcing solution removes a difficult, potentially high-risk task from the staff," he says.
For more information about outsourcing patient calls, contact:
• Karen Clements, RN, BSN, Emergency Department, Eastern Maine Medical Center, 489 State St., Bangor, ME 04401. Telephone: (207) 973-8010. Fax: (207) 973-7985. E-mail: Kfclements@emh.org.
• Erik N. Steele, DO, ABFP, Eastern Maine Medical Center, 489 State St., Bangor, ME 04401. Telephone: (207) 973-8270. Fax: (207) 973-8267. E-mail: firstname.lastname@example.org.
IntelliCare provides patient communications systems. The company provides customized nurse triage services and technology for a variable monthly fee based on volume. For more information, contact:
• Katherine Taudvin, Senior Vice President of Product Development and Marketing, IntelliCare, 500 Southborough Drive, South Portland, ME 04106. Telephone: (207) 775-2600. Fax: (207) 775-0359. E-mail: email@example.com. Web: www.intellicare.com.