The Virtual Office Visit: Innovative Seasonal Nurse Advice Program Primary Care - San Diego MSA

Transcription

1 The Virtual Office Visit: Innovative Seasonal Nurse Advice Program Primary Care - San Diego MSA Valerie M. Brown, MSN, RN, PHN Ruth Ann Obregon, MSN, MBA, RN Objectives: Describe the historical challenges and barriers to the implementation of a seasonal centralized call center consisting of a interdisciplinary team Examine the key elements of a seasonal program based on an educational system and launched through multi-disciplinary efforts Illustrate the power of a standardized protocol and its use to utilize the RN at their full potential to preserve access and deliver quality care 1

2 Historical Perspective: In 1997, Primary Care initiated the centralized Adult Cold and Flu program Improved utilization of resources including partnership with Education and Consulting Fully leverage staff education into program development of training all staff assigned Result implementation of a new model to deliver services in Primary care Template for supporting other initiatives that utilize the RN to their full scope Our Vision: What we set out to do: Decreased appointment demand for services during the cold and flu season Provide the appropriate level of care Improve utilization of resources including: the appointment center, physicians, NP/PA s, nursing staff. Decrease cost, while maintaining high quality Maintain high patient satisfaction Mitigate physician concerns regarding: patient satisfaction, safety, inappropriate use of antibiotics and access 2

3 Program Goals: Quality Decreased Cost Increased Access Standardized Protocol: In the state of California, the BRN requires an approved standardized protocol to allow the RN to adjust medication in the absence of a physician. The current primary care work flow is complex and fails to utilize the registered nurse to their full potential as defined by their scope of practice. Optimizing the registered nurse role in the primary care setting improves patient outcomes in a costeffective manner for the organization and the members they serve. 3

4 Actualizing the Standardized Protocol: Calibrating knowledge and practice - leveling the field Knowledge exchange - NPPA and registered nurse - Clinical - Psycho-social, bonding/team work Integrating business with customer focus, and patient safety Assuring the BRN standards are met Education: Simple to complex Five days of classes including a resource/reference notebook» Fundamentals of Telephone advice» Unique aspects of assessing the patient over the phone with only auditory senses.» Legal/quality/regulatory implications and applications» Pharmaceutical and medical dialogue with experts»protocols» Simulations using Health Connect Multidisciplinary NP/PAs with registered nurses rich exchange of knowledge and expertise Simulation Identity and role actualization 4

5 Our Model: RN Member Standard Procedure RNP/PA Patient Criteria: Inclusion Criteria: Advice is available to all callers aged 16 to 69 years. Exclusion: Members greater than 65 years and older will receive an appointment and or have a message sent to the PCP. Members with a history of MI, CHF, and COPD will be carefully assessed by the criteria described in the protocol. Based on the evaluation, will receive appropriate level of care. They may receive advice, appointment, or message their PCP. If the patient meets any of the Exclusion Criteria categories, the patient will be given an appointment or message will be redirected to the PCP If the patient is not excluded according to criteria, the advice professionals will continue with assessment and intervention. All members who state they are immunosuppressed will be given an appointment. 5

6 Prescription Rates Comparison: Antibiotic Prescription Rate (relative to volume of calls managed) Overall 12% antibiotics RN 10% antibiotics RNP/PA 24% antibiotics Cough Prep Prescription Rate (relative to volume of calls managed) Overall 16% cough preparations RN 13% cough preparations RNP/PA 26% cough preparations February 2013 Antibiotic Prescription Rate (relative to volume of calls managed) Overall: (594 encounters) 24% of the 2431 calls resulted in a prescription for an antibiotic 15 Years Later: 6

7 Statistical Comparison : CCTE TAT February hours CCTE TAT February hours 100% Encounters Closed 84% Four Hours CCTE TAT February Hours 100% Encounters Closed 85% Fours Hours The Sum Total of Our Efforts: Total Messages DONE 12/10/ /19/2013 December: 3,202/avg 200 daily January: February: March: April: 9,237/avg 420 daily 7,754/avg 388 daily 4,988/avg 250 daily 2,202/avg 147 daily 7

8 Statistical Data: Productivity

9 Quality Measures: Each advice professional will be concurrently monitored on at least one call per month. Callers age years of age, who received home care advice, will receive a follow-up call in 72 hours (three business days). The patient s call back encounter will be closed if the patient symptoms are abating or warrant an appointment. An antibiotic may be ordered, per protocol if symptoms warrant this. If unable to reach a caller, a message will be left detailing how to reach the Cold and Flu Call Center for a return call. If no response from the patient after the third attempt, the chart will be forwarded to the patient s primary care physician. Team Dynamics: Clarity of purpose Open communication and collaboration Participation and involvement - Ownership Respectful listening Achievement of goals 9

10 Connecting the Dots: Improved Professional Satisfaction! Increased Loyalty/Member Retention! Improved Patient Satisfaction! Better Clinical Outcomes - Quality Reduced Cost - Affordability Continuity Care Promotes Optimal Wellness Promotion of Self Care - Empowerment Our Philosophy: The Purpose Has Sustained The Process Has Retained The Outcomes Have Maintained 10

11 Reference Laurant, M., Reeves, D., Hermens, R., Braspenning, J., Grol, R., & Sibbald, B. (2009). Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Reviews (4). Nagykaldi, Z., Calmbach, W., DeAlleaume, L., Temte, J., Mold, J., & Ryan, J. (2010). Facilitating patient self-management though telephony and web technologies in seasonal influenza. Informatics in Primary Care 18, Redsell, S., Stokes, T., Jackson, C., Hastings, A., & Baker, R. (2007). Patients accounts of the differences in nurses and general practitioners roles in primary care. Journal of Advanced Nursing 57 (2),