Objectives
- Improve and standardize the processes for contacting physicians from the Emergency Department and Intensive Care Units.
- Help physicians communicate with each other quickly and directly to eliminate the handoffs to front office staff and switchboards that waste time and can cause communication errors.
- Increase the percentage of calls from hospital departments to physicians that are answered in real-time.
- Improve call response times for intensivists and physicians covering unassigned patients within the ED.
Actions
- Implemented an ED pilot program among an engaged group of internists.
- Established filters to distinguish calls originating from the ED (and later the ICU). This allowed physicians to route calls directly to their cell phones. Callers from other departments were directed to leave voice messages, text messages or pages.
- Encouraged ED physicians to contact internists directly.
- Measured percentage of calls that went directly to physicians without third-party handoffs, as well as physician response times.
- Expanded ED program to include more physicians who participate in covering unassigned patients.
- Initiated a similar program involving the ICU clinical staff, intensivists and physicians from other departments who admit patients to the ICU.
Results
- For the ED-to-internist pilot program, the percentage of communications that occurred in real time increased from zero to more than 85 percent in just a few months.
- When expanded to include all physicians covering unassigned patients in the ED, the number of real-time calls connecting the ED with these physicians increased more than fourfold, from eight percent to 38 percent.
- The number of ED calls requiring a third- party intermediary dropped in half, from 20 percent to less than 10 percent.
- More than 70 percent of contacts from the ICU to intensivists now occur in real time.
Keys to Success
- Gaining the support and active involvement of leaders on the medical staff.
- Providing physicians with airtight data that shows the importance of improving communications and proves the reliability of the proposed solution.
- Listening to the medical staff and giving them tools that make it easy to accept and adopt new communication protocols.
- Enabling physicians to prioritize ED calls over those from other departments, so only ED calls were routed directly to them in real time.
- Understanding physicians’ concerns about efficiency and aligning communication processes with their workflow.
- Maintaining an ongoing dialog with the medical staff and refining processes to meet their needs.
Client Quotes
Dr. John Frownfelter“The key is having physicians who are willing to participate in improving clinical communications. Tools such as PerfectServe that align with physicians’ workflows and enhance physician-to-physician communications can be as beneficial as electronic health records in enabling clinicians to better coordinate care.”
Chief Medical Information Officer
Dr. Steven Harrington“PerfectServe standardized our communication system and reduced variation of care. Problems arise if you have 50 different answering services or if you’ve got a telepage system with five different operators and one goes on break and doesn’t remember to leave a message. With the PerfectServe system, you’ve got one reliable source of truth.”
Medical Director of Cardiothoracic Surgery
Chairman of the Quality Committee
Cardiac Robotic Surgeon
Dr. Rajinder Sikand“I had my doubts at first because physicians are so used to doing things in a certain way. Once we got buy-in from the other departments, everyone realized that using PerfectServe was the best way to reach a critical care doctor. As a result, we’re able to get intensivists involved in the patient’s care much more quickly.”
ICU director