CQI Project 2009 Team Leader: Melinda Chandler Team Members: Jeanie Neumeyer, Jennifer Reist, Reagan Hall, Bridgette Williamson Increasing Patient Access between Vanderbilt Children’s Hospital and Vanderbilt Sports Medicine

To standardize procedures for referrals and communications between VCH Peds Emergency Department and Vanderbilt Sports Medicine Athletic Trainer’s. Design and implement a patient satisfaction survey for families being referred to VUMC by our Outreach Athletic Trainer’s. Purpose

Process and Procedures A 10-minute powerpoint presentation was designed to education VCH Emergency Department (VCH-ED) and Pediatric Orthopaedics (Peds Ortho) staff on the role of Vanderbilt Sports Medicine (VSM) Outreach Athletic Trainer’s. Face Sheets displaying a picture and school assignment of each of our Outreach Athletic Trainer’s was distributed to the VCH ED and Peds Ortho. Meet with Dr. Andrea Bracikowski, Director of Pediatric ED Patient Affairs and Bobby Neely, Manager of Pediatric Orthopaedics to discuss referral procedures. Implemented a 9-question patient satisfaction survey (based on current VUMC survey) using the referrals from July 2008-December 2008 and contact information collected through the EPIC database.

In combination with Dr. Andrea Bracikowski, MD, Director of Pediatric ED Patient Affairs, we were able to standardize a written protocol for athletes being sent to Peds ED. o This included: o Implementation of the “Expect” form in STARPANEL when VSM Athletic Trainer’s or Physician’s call ahead to the Peds ED. o Standardized “call-in” procedure o Peds ED “Back line” Phone Number o Information required at the time of “call-in” o Each patient will be given a handout with discharge instructions, including recommended physician follow-up, clearance to begin rehabilitation, and participation guidelines. o ED etiquette for Athletic Trainer’s present at the time of evaluation. Outcomes- Pediatric ED

Outcomes- Peds Ortho In combination with Bobby Neely, Manager of Pediatric Orthopaedics we were able to confirm scheduling protocols and procedures for referral of athletes from the Peds ED to an Orthopaedic Department. o Dr. Andrew Gregory, MD and Dr. Sarah Cribbs, MD cross over between Pediatric Orthopaedics and Sports Medicine increasing number of available appointment openings. o For TennCare patients there is no referral needed, but PCP information must be provided before the athlete can be seen. o An educational session between Mrs. Neely and her staff was scheduled to discuss the role of Athletic Trainer’s and the need for a summary of care and recommendations be given to each patient, so that the Athletic Trainer would be aware of participation and rehabilitation guidelines. o Peds Ortho was given facesheets to be posted in the scheduling and staff bays.

Referral Flow Injured Athlete referred by VSM-ATC Peds EDPeds OrthoVOI Rehab Services or ATC

Outcomes- Patient Satisfaction Survey 144 Referrals were logged from 17 high schools between July-December Individuals did not have accurate contact information in StarPanel or EPIC. 46 Individuals declined the survey or were unable to be contacted. 69 Surveys were completed.*Surveys were completed.* * 73% Response Rate

89% of responses fell within “Excellent” or “Very Good” categories. Top rated categories: –71% “excellent” likelihood of referring family & friends. –71% “excellent” team work between all staff members. Outcomes- Patient Satisfaction Survey

Question # 8 What could have been done to improve you/your family’s outpatient experience? Common Responses: Extended wait time for MD (x4) Difficulty scheduling surgery and PT. Being scheduled with different Physical Therapist (PT) or Athletic Trainer (ATC) each time. Physician did not explain certain services/equipment was not covered by insurance (i.e. braces, splints, etc.) Physician did not give activity restrictions or activity guidelines. Additional follow-up with ATC and MD after appointment. Poor attitude of the MD front desk staff. More privacy and information at beginning of appt. Outcomes- Patient Satisfaction Survey

Question # 9 Were there any staff members you would like to mention for any reason, and what these individuals did for you/your child? Recognition of People:  10 Certified Athletic Trainers  5 VSM/VOI Physicians  1 Physical Therapist  3 VUMC Employees (unknown)  1 Fitness Center Recognition of Quality Service:  Excellent communication  Immediate care and attention  Attentiveness  Professional  Friendliness  Good bedside manner  Experienced  Calming

Assessment VCH Emergency Department Improvements were immediately noted in the collection of information and recognition of Vanderbilt Sports Medicine staff. Athletes were able to get the rehabilitation recommended with fewer delays because of improved communication on the discharge summaries. Decreased confusion in the ED upon patient check-in and Athletic Trainer observation of care. VCH Pediatric Orthopaedics Increased access to TennCare athletes by increasing the number of physicians who cross-over between departments. Decreased confusion on PCP involvement with regards to TennCare patients, especially when surgical intervention is warranted. Reduced scheduling wait time from average 3-4weeks to 3-4days. Overall improved communication and awareness of services provided by Vanderbilt Sports Medicine.

Assessment Patient Satisfaction Survey Needs to be completed in more timely manner closer to appointment completion. Questionnaire will be abbreviated to 3-4 questions. Questionnaires will be completed at check-out or by mail. In the process of determining the most appropriate individual to conduct and collect survey data.

Plan Continue efforts to encourage open communication between Peds ED, Peds Ortho and Vanderbilt Sports Medicine. Update Face Sheets for redistribution at VCH ED, Peds Ortho, and VOI including scheduling areas, staff bays, and front desks in July A brief presentation, possibly via will be conducted with Peds ED staff to educate and refresh them on the roles of VSM Outreach Athletic Trainers in August 2009 prior to the start of the next football season. An action plan has been designed an implemented within the VSM Outreach staff. This plan includes: Educate ATCs on importance of using key words like “Excellent” and “Team” when speaking with parents. Require ATCs to follow up via phone with parents within one week of an athlete being seen at VOI. Create a brief 3-4 question survey for parents to complete during check-out with the PSR OR have Clinical Coordinator mail them weekly. Educate ATCs about encouraging parents to review their insurance policy prior to seeing MD.