Participants Jean Bruggemeier, RN Jacqueline Ciombor Geoffrey Emerick, MD Dianna Greening, RN Marilyn Hauser, MBA Nancy Quandt, RN Peggy Squires, LPN Tammy Wolfe Phone Triage in Ophthalmology

Opportunity Statement and Desired Outcome Low patient satisfaction survey scores and negative verbal feedback reveal three areas of concern: Inability to bypass the phone system Delays in returned phone calls Prolonged wait times Our goal is to maximize patient satisfaction by improving our phone service and clinic wait time.

Most Likely Causes for Current Opportunity Increasing phone call volume ties up all existing phone lines necessitating the use of voice mail to handle the overflow Increasing phone call volume ties up all existing phone lines necessitating the use of voice mail to handle the overflow –Call center not being utilized for scheduling new patients –Out-of-date scheduling messages provide inadequate guidance to schedulers, resulting in inappropriate appointments Inappropriate calls to triage nurse line Inappropriate calls to triage nurse line –High volume of calls to triage nurse sends additional calls to voice mail delaying return calls –Lack of a wait list causes additional calls for sooner appointments to be forwarded to triage nurse for overbooking Open access to appointment times is constrained by high number of acute patient visits resulting in physician overbooking Open access to appointment times is constrained by high number of acute patient visits resulting in physician overbooking Overbooking results in prolonged wait times in clinic Overbooking results in prolonged wait times in clinic

Solutions Implemented Shifted all new patient scheduling to the Healthcare Access Call Center (HACC) Shifted all new patient scheduling to the Healthcare Access Call Center (HACC) Created “Helpful Hints” sheet for scheduling patients correlating specific patient problems with appropriate ophthalmologists Created “Helpful Hints” sheet for scheduling patients correlating specific patient problems with appropriate ophthalmologists Centralized all calls Centralized all calls Evaluated and revised scheduling messages Evaluated and revised scheduling messages Increased number of acute appointment slots available each day Increased number of acute appointment slots available each day Trained all triage nurses to use the scheduling system to eliminate calls transferred from the triage nurse to HACC Trained all triage nurses to use the scheduling system to eliminate calls transferred from the triage nurse to HACC

Progress to Date NOTE: Increase in number of calls between January’03 and March’03 is due to the rerouting of inappropriate calls that had been going to phones at the clinic reception desk. These were not included in the original data set.

Progress to Date Initial customer satisfaction data is concerning. However, change is not statistically significant. Unable to determine cause. Fourth quarter data will be the telling factor.

Results and Analysis Enabled the call center to schedule appointments for new and return patients Enabled the call center to schedule appointments for new and return patients Rerouted inappropriate calls from clinic reception desk to triage line Rerouted inappropriate calls from clinic reception desk to triage line Reduced number of new and return patient visit calls to triage line Reduced number of new and return patient visit calls to triage line Reduced the number of calls taken from voice mail Reduced the number of calls taken from voice mail Reduced the number of duplicate calls (from the same patient) Reduced the number of duplicate calls (from the same patient)

Results and Analysis (cont.) At the same time the number of valid phone calls to the triage nurse continues to increase, increasing the ratio of valid calls to those that are inappropriate Increase in questions to triage nurse Increase in questions to triage nurse Increase in calls for prescriptions, glasses and contacts Increase in calls for prescriptions, glasses and contacts Questions for physician and emergency appointments remains constant Questions for physician and emergency appointments remains constant

Conclusions We are at the midway point of this project and there is more to accomplish before it can be deemed a success. Our results to date demonstrate that: Shifting all new patient scheduling to HACC significantly decreased inappropriate calls to the triage nurse line Shifting all new patient scheduling to HACC significantly decreased inappropriate calls to the triage nurse line Creating the Helpful Hints sheet enabled schedulers to appropriately match patients with the correct ophthalmologic sub-specialist Creating the Helpful Hints sheet enabled schedulers to appropriately match patients with the correct ophthalmologic sub-specialist Revising scheduling messages reduced scheduling errors Revising scheduling messages reduced scheduling errors Increasing acute appointment times decreased number of overbooked patients Increasing acute appointment times decreased number of overbooked patients

Next Steps Introduce the patient wait list for sooner appointments Introduce the patient wait list for sooner appointments Smooth out clinic flow by reducing overbooked patients Smooth out clinic flow by reducing overbooked patients Continue to refine physician schedules to achieve shorter wait times Continue to refine physician schedules to achieve shorter wait times Continue to further identify how and why new and return patient appointment calls get to triage nurse Continue to further identify how and why new and return patient appointment calls get to triage nurse Identify a method to answer all calls as they are received Identify a method to answer all calls as they are received Validate process changes by continued monitoring of call volumes to triage line, pharmacy/contact lens line, and third front desk phone Validate process changes by continued monitoring of call volumes to triage line, pharmacy/contact lens line, and third front desk phone