Triage Call Reduction in the OB GYN Clinic A Lean Six Sigma Green Belt Project

Transcription

1 Triage Call Reduction in the OB GYN Clinic A Lean Six Sigma Green Belt Project Robyn Thurston, MBA, CMPE Practice Director, Obstetrics & Gynecology Loyola University Health System October 9, 2013

2 Charter Project Overview Problem Statement: Due to program growth, telephone encounters by nursing staff have significantly increased over the past year. This increase must be more efficiently managed in order for nurses to spend time with patients in the clinic or manage acute callers. Goal: Reduce phone volume by 20%. Resources Champion: Cathy Lenz, Dr. Sondra Summers Process Owner: Robyn Thurston OpEx Mentor: Marque Macon Margaret O Connor, Nancy McDermott, Sharon Bird, Jennifer Dudek, C. Bailey, M. Steinbrenner, Urogynecology RN team.

3 D M A I C SIPOC Suppliers Inputs Patient arrives for clinic visit Outputs Customers EPIC Medical Equipment Clinical Supplies Pharmeceutical s Facility/space Health Care Providers Nursing Service Reps Lab Techs Counselors Historical Medical Records Patient receives assessment, dx, lab/radiology orders in req. Patient receives a treatment plan Resolved complaint Patient receives medical care Results of testing Interpretation of results THE PATIENT Patient received appropriate intervention to eliminate need to call between visit A and visit B Patient receives guide to better health

4 Process Map Patient arrives in CLINIC The Goal: Patient receives all appropriate intervention necessary to eliminate the need to call between Visit A and Visit B. Verify Patient Registration RN/PCTII take vitals, reconcil meds and document reason for visit Physician/Provider complete an evaluation and assessment Diagnosis during course of visit? No Labs required? Yes Order tests and or labs Yes Complete labs or testing today? Yes Go to Lab or Fetal Monitoring Schedule follow up testing or appointments GO HOME Tests are resulted, further diagnosis Yes No No Document Diagnosis Develop treatment plan Schedule a follow-up visit?? Plan of care developed

5 Data Collection Epic telephone encounters are tracked through Ambulatory Services portal application. The following is captured in a clarity report: Date of telephone encounter RN generating telephone encounter Physician Reason for call Nursing documented 130+ reasons for patient calls. These were grouped into 14 major groups. Beginning August 15, nursing has narrowed reason for call into the following groups:

6 14 Reasons for Call Advice/Sick Question Results Follow Up Orders Appointments Surgery Scheduling Disability form Needs Medication Pain/Vaginal or Vaginal Problem Heavy Bleeding Prior Authorization/Disability Letter

7 Number of Calls D M A I C Pareto Women's Health - Telephone Encounter Volume April 2012-June 2012 Call Volume by Reason 100.0% 90.0% % % 60.0% % % % % 10.0% 0 0.0% Reason for Call Questions, advice, and test results account for 50% of total volume

8 Number of Calls D M A I C Pareto Women's Health Center Telephone Encounter Volume by Provider April 2012-July % % 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% Patients from two providers account for 65% of total volume Providers not shown are grouped in other and each account for less than 20% of total call volume 0 0.0% Provider Name

9 Fishbone Diagram People Method Growing clinical practice Patients not aware of MyLoyola Patients wanting sooner appts Doc cancels clinic Patient expectations for results Acute appts Printers not in every exam room (AVS summary) Poor patient education AVS disregarded AVS not charted High volume = less time w/patient Train delay Patient arrives At wrong location Surgical scheduling Communication Of results MFM schedule Not released Unclear signage Reasons for a high volume of triage calls Materials Environment

10 Pilot Plan Affinity Grouping Patient Education: AVS (discharge planning) must be clear, charted and discussed with patient Results Expectations: Patient given clear expectation as to when test results will be available and how they will be communicated (MyLoyola) Appointments: Patient makes future appts to discuss status of new treatment plans

11 Provider RN/PCTII Service Rep Patient D M A I C Future State Map Loyola Outpatient Center - Women's Health Center - Obstetrics and Gynecology Practice Telephone Encounter Phone Triage Reduction Project Future State Map - October 2012 Arrives in Clinic Sign up for MyLoyola Leaves with clear patient educational materials, MyLoyola access, and follow-up appointment Verify Registration, print meds, labels, MyLoyola Direct Patient to use PC for MyLoyola Schedule F/U Visit Vitals, medication reconcil, reason for visit Verify MyLoyola access; Offer first time MyLoyola parking Obtain AVS, review patient education, and discuss f/u with patient, expect results via MyLoyola PCTII/SR Schedule F/U Visit Completes an examination, evaluation/assessment Diagnosis? Order Diagnosic testing, print AVS Document Diagnosis develop treatment plan, print AVS Obtain AVS from hall printer and discuss f/u with patient, expect results via MyLoyola Follow-up visit? Communicate results during f/u visit or MyLoyola Communicate order for next visit (ex: one year, further symptoms, referral

12 Pilot Plan Selected highest call volume practice to pilot interventions MIGS/CPP Incorporate Welcome to Our Practice Letters Patients actively approached to sign up for MyLoyola (Tablet and Parking) Patient educational materials placed in the exam rooms Physicians to include specific information re: condition and plan in pt. instructions Primary RN to MIGS/CPP at Check Out Area AVS is charted, discussed and handed to patient Use APN to f/u appointment with providers develop scripting to direct patient to APN schedule Printers in exam rooms (pending)

13 Data After Pilot

14 Control Plan SR Checklist: Print MyLoyola access code for all inactive arrivals encourage enrollment in wait room PCT/RN Checklist: Offer patient tablet to sign up for MyLoyola Make f/u appointment from exam room using the AVS Ask patients on intake if they need letters, refills, or have specific questions of providers prior to assessment be prepared with patient educational materials

15 Lessons Learned Robyn: Find the data map the process, what we thought was a solution, was only part of the solution. Pilot one practice, follow results one practice, be open to changing route prior to general roll out. S. Bird Patients in pain call often but if we can impact this group, we can have a major impact on the entire practice.

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