Participants

1
Phone Triage in Ophthalmology

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

2
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.
3
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
• 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• Out-of-date scheduling messages provide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
• 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
• Overbooking results in prolonged wait times in
  clinic

4
Solutions Implemented

• 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
• Centralized all calls
• Evaluated and revised scheduling messages
• 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

5
Progress to Date
NOTE Increase in number of calls between
January03 and March03 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.
6
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.
7
Results and Analysis

• Enabled the call center to schedule appointments
  for new and return patients
• Rerouted inappropriate calls from clinic
  reception desk 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 duplicate calls (from the
  same patient)

8
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 calls for prescriptions, glasses and
  contacts
• Questions for physician and emergency
  appointments remains constant

9
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
• Creating the Helpful Hints sheet enabled
  schedulers to appropriately match patients with
  the correct ophthalmologic sub-specialist
• Revising scheduling messages reduced scheduling
  errors
• Increasing acute appointment times decreased
  number of overbooked patients

10
Next Steps

• Introduce the patient wait list for sooner
  appointments
• Smooth out clinic flow by reducing overbooked
  patients
• 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
• 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