Piedmont Physician’s Group consolidates answering services for reduced costs and improved physician satisfaction

Piedmont Physician’s Group chose PerfectServe to standardize its after-hours services across its expanding employed physician base, reducing costs by 21%. Learn how PerfectServe helped Piedmont to improve communications and patient care.

Background

As Piedmont expanded through the acquisition of hospitals and physician practices, it started acquiring a large portfolio of third-party vendor contracts as well. Across more than 170 physician practices, Piedmont utilized 13 different after-hours answering services vendors, each with different fee structures.

Problem

Before implementing PerfectServe, some physicians were happy with their answering services, but many more were unsatisfied with operator error and inconsistency. Piedmont knew they needed to standardize to control costs, help their physicians communicate reliably and create a singular experience for patients.

Piedmont Reduced Costs

Process

Gaining visibility to the individual answering service contract terms and actual monthly spend were key first steps. The project team partnered with practice-level stakeholders to understand contracted rates, auto-renewals and termination clauses.

The purchasing department also gathered general ledger data to quantify the fixed and usage-based/variable monthly fees.

Finally, the quality and efficacy of services were evaluated in terms of outcomes, metrics, stakeholder satisfaction and ease of doing business.

Piedmont evaluated standardization options using these three criteria:

  1. Ability to address the stakeholder needs and goals
  2. Enterprise contracting opportunities
    1. Impact on overall spend
    2. Service standards and agreements
  3. Piedmont’s corporate direction
    1. Goals for growth and expansion of the organization and of the communication platform
    2. Best practices for eliminating manual steps, streamlining communication workflow, meeting service quality metrics, ensuring HIPAA compliance and patient/physician satisfaction

Employed Physician Growth

Solution

Today, PerfectServe’s automated answering service replacement is the standard after-hours solution for Piedmont’s physician practices.

At Piedmont, PerfectServe eliminates the opportunity for human error, reduces communication cycle times to expedite care and improves patient and physician satisfaction.

Piedmont Physicians enjoy the following benefits:

  • Non-urgent messages are delayed until the next working day, so they aren’t called in the middle of the night for routine issues
  • Home and mobile phone numbers are masked when calling patients
  • Call schedule changes can be made on the fly, straight from the PerfectServe app, and when physicians are called into surgery unexpectedly, their calls are routed to the covering provider
  • Easy communication and sharing of information with colleagues, without compromising PHI

PerfectServe helps hospital manage risk and improve patient safety

St. Rita’s Medical Center serves a 10-county area in northwestern Ohio and is the largest hospital in a 70-mile radius. Since 2005, the hospital has been using the PerfectServe clinical communications system to ensure that calls and messages route to the right clinicians at the right time, based on their workflow, call schedules, contact preferences and on the clinical situation.

Among St. Rita’s clinicians, PerfectServe processes about 180,000 clinical communications events annually. From these, PerfectServe provides analytics that enable detailed reporting about each contact event. This information gives St. Rita’s invaluable insights into its clinical communications processes and the outliers that increase risks.

Managing risk: Detailed documentation of communication events and timelines

PerfectServe eliminates the need for subjective interpretations when St. Rita’s must establish the steps and timeline of a communications process preceding an adverse event. Using PerfectServe Analytics, the hospital can quickly identify and drill into data that show:

  • The specific time each communication event was initiated
  • The originating department and number
  • The intended recipient
  • The actual recipient
  • The contact modality (e.g., cell phone, voice message, text message)
  • The length of the call
  • The time a specific call was answered and confirmation that the call was answered by a clinician (for calls that employ fail-safe contact processes)
  • The elapsed time to retrieve a voice message

The hospital uses these data when it investigates cases relating to quality or risk management. In fact, St. Rita’s decided to implement PerfectServe after it was unable to prove that one of its nurses had contacted a physician three times. The lack of documented evidence was a key factor in an unfavorable lawsuit that cost the hospital hundreds of thousands of dollars.

“PerfectServe is our ‘black box’ for communications that lets us piece together exactly what happened and when,” said Dr. Herbert Schumm, St. Rita’s Vice President of Medical Affairs. “Also, our physicians have become conscientious about being responsive, in part because they are aware that we automatically document the communications process.”

Safeguarding patients: Legibility of physician orders

At most hospitals, including St. Rita’s, the vast majority of physician orders are still written by hand. A recent report found that only 14 percent of all U.S. hospitals are entering at least 10 percent of orders electronically, which is the level of computerized physician order entry (CPOE) required to reach the federal government’s proposed standard for Stage 1 of meaningful use. The legibility of handwritten orders can be a problem that is more pervasive, and more of a threat to patient safety, than most hospitals realize.

In an article in Trustee® magazine,* an executive from The Joint Commission notes that his agency “almost always finds instances where handwriting is of poor quality.” According to the Agency for Healthcare Research and Quality, poor penmanship is responsible for an estimated 6 percent of all hospital medication errors.

To address this issue, St. Rita’s used PerfectServe to document and measure incidents of illegible handwriting. For defined periods of time, PerfectServe prompted callers to indicate when they were calling to clarify an illegible order.

The system captured data on where the order was received as well as who wrote it. PerfectServe compiled this information into reports for the Patient Safety Steering Committee at St. Rita’s.

“We sat down with about four or five doctors and showed them the number of calls that were made to clarify their orders,” said Dr. Schumm. “We also reminded them to use preprinted order sets whenever possible.”

The analysis showed that during the first three months of the study, an average of more than 80 calls per week were made to clarify orders. After discussion with some of the doctors, subsequent analyses indicated the average was 53, a drop of more than 40 percent.

improve patient safety

Improving clinical communications: Physicians’ responsiveness

According to The Joint Commission, communications breakdown is the single greatest contributing factor to sentinel events and delays in care in U.S. hospitals. St. Rita’s uses PerfectServe to track a key source for such breakdowns (i.e., physicians who do not respond to calls).

Of the hospital’s approximately 15,000 monthly communication events processed by PerfectServe, about 15 to 25 are directed to the PerfectServe Help Center to report a problem with a physician not responding. Dr. Schumm and the patient safety team use these reports as a way to open a constructive dialogue with physicians whose names repeatedly appear on this list.

“It really helps to have such clear, objective evidence for the physicians,” said Dr. Schumm. “Most of the time, showing them the reports is enough to prevent future incidents.”

Since PerfectServe collects communications process information automatically, nurses do not have to “tattle” on doctors who do not always respond in a timely manner. This not only relieves nurses of an uncomfortable task, but also enables St. Rita’s to avoid adversarial situations that can undermine nurse-physician relationships.

*Glabman, Maureen. “Death by Handwriting,” Trustee®, October 2005.

Addressing clinical communications security with PerfectServe

Healthcare leaders are increasingly concerned about the security of clinical communications in their organizations. The enhanced HIPAA enforcement environment, a number of well-publicized breaches and settlements and a simultaneous increase in the use of asynchronous electronic communication in the clinical environment — specifically text messaging — have made the issue top-of-mind for many leaders. They are concerned about the potential dangers of the transmission of protected health information (PHI) without adequate safeguards; the risk of privacy and security breaches that may result in adverse legal and financial consequences; and the loss of patient trust and reputation in the marketplace.

The recent uptick in the use of text messaging for clinical communications has resulted in a greater focus on the security of text messages sent via mobile devices. While secure text messaging is an important aspect of clinical communications security, simply addressing the security of text messaging leaves organizations vulnerable to breaches in other modes of communication, such as voice messages and texts sent from mobile carrier websites, Web-based paging applications, call centers, answering services and hospital switchboards.

PerfectServe is a communications system that stores data on a secure server, rather than on individual devices, thus maintaining the security of messages sent via the system, no matter which mode of communication is used. This success story describes how two healthcare organizations have implemented PerfectServe to address their need for a secure, comprehensive communications system.

St. John Providence Health System

According to Mike Burke, HIPAA privacy officer for the health system, the need to address the security of clinical communications recently became increasingly clear. “It became apparent over the past two years that more physicians wanted to communicate with other caregivers by electronic means,” he says. Physicians were finding the communications process inefficient and cumbersome when they needed to contact another physician after a consultation or after test results were posted to the electronic medical record — for example, when a consultant wanted to report their findings quickly to a primary care physician. According to Burke, “The physicians were specifically asking about text messaging from their mobile phones.”

A loss highlights security needs

In 2010, the health system experienced the loss of a portable device. Since the loss, the organization has solidified its security processes, including the training of physicians and other staff about the need to ensure that PHI is communicated in an encrypted manner across secure networks. Because of this attention, physicians were cognizant of the security requirements but were struggling to communicate clinical information in a manner that was both secure and efficient. “Our physicians were aware of the need to send encrypted messages and were looking for a way to do this safely.”

The organization had implemented PerfectServe in 2007 to facilitate communication between the system’s staff and individual physicians. In September 2013, the health system added a PerfectServe module to ensure secure direct communication between physicians. The calling physician can access PerfectServe via a smartphone or by dialing a toll-free number, which allows him or her to bypass answering services, front office staff and switchboards to quickly contact colleagues for real-time discussions of patient care issues. If the receiving physician is unavailable, the calling physician can leave a secure, HIPAA-compliant voice message, which the recipient will receive immediately or at a predefined future time.

According to Burke, the implementation process went smoothly: “Once the physicians realized how easy it was to use PerfectServe, they began signing up to access the application. To date, about 1,000 physicians have signed on for the voluntary service. Adoption at all five hospitals has been more rapid than expected. Physician leaders at our hospitals have been happy with PerfectServe and have been really helpful in getting the message out to other physicians.”

Reduced frustration and a market advantage

Since implementation of PerfectServe, Burke has seen a reduction in the frustration level of physicians regarding clinical communication. He has also found that implementation has reduced a major area of personal concern for him. “My goal is to make patient information as secure as possible. What keeps me up at night is portable devices — they are prevalent, and it’s really difficult to make sure that all devices on our campus are secure. PerfectServe helps address this worry.”

Burke also believes that implementing PerfectServe has provided the organization with a market advantage. “We want to make practicing at our organization as easy as possible. Having a common communication system between all five of our hospitals makes it more convenient for physicians to care for their patients at the hospitals within our organization.”

KishHealth System

KishHealth System is a community-owned health system in the DeKalb, Illinois area that includes 98-bed Kishwaukee Hospital, an acute care facility, and 25-bed Valley West Hospital, a critical access hospital. In addition, the health system provides hospice, home health, behavioral health and cancer care services and serves the local community with almost 39,000 ED visits and about 8,300 admissions each year.

An inefficient system for communicating patient-specific information

According to Michael Kulisz, Jr., DO,chief medical officer of the health system, physicians were finding it difficult to efficiently and securely communicate patient-related information. For example, when a physician requested a consult from a specialist via the computerized physician order entry (CPOE) system, he or she might also text the consultant with a specific question. In order to comply with HIPAA privacy regulations, however, both physicians had to exclude specific patient information. This process, and any follow-up discussions after the consultation, often required one or more telephone calls to communicate patient-specific information — which frequently resulted in callbacks and phone tag. In addition to the lack of direct information exchange, the process was frustrating for physicians and slowed patient flow through the hospital. Health system leaders realized that the organization needed a platform for securely communicating PHI between physicians.

In June 2013, the health system implemented PerfectServe at both hospitals. According to Kulisz, the implementation process was relatively painless. “There is a learning curve, but once physicians are trained, they really like the system. Uptake and use have been more rapid than we had expected.”

A secure platform plusa streamlined process for direct conversations

In addition to providing a secure platform for clinical communications that includes PHI, PerfectServe has decreased the number of calls required by a physician trying to track down a colleague for a direct conversation. Utilization has grown over time as a greater number of physicians exchange more specific information than they could communicate safely on an unsecure network. Kulisz believes that having a secure platform is an essential ingredient for success. “With so many devices and modes of communicating, it’s easy to misstep. It’s important to have a strong information structure to alleviate that risk.”

Conclusion

Compliance with HIPAA privacy and security regulations has become a priority for healthcare organizations. The use of text messaging highlights the importance of a secure platform for all modes of clinical communications.

St. John Providence Health System in Detroit and KishHealth System in DeKalb have implemented PerfectServe to successfully streamline communication between physicians and ensure a secure environment for the efficient exchange of PHI and other clinical information.

Rapid team notification accelerates treatment at St. John Hospital

Stroke occurs frequently in the United States, with almost 800,000 people suffering a new or repeat stroke each year. It is a common cause of death in this country and a major cause of disability.

Timely treatment of acute ischemic stroke has been shown to significantly reduce disability and mortality.

In-hospital mortality was significantly lower among acute stroke patients who were treated with intravenous tissue plasminogen activator (tPA) within 60 minutes of ED arrival, compared with those who were treated after more than 60 minutes.

A recent study found no benefit to tPA when administered 4.5 hours or more after symptom onset; beyond this time point, the risks associated with the therapy may outweigh the potential benefits.

Current treatment recommendations emphasize the need for rapid evaluation and treatment of patients presenting with symptoms of acute stroke.
Joint American Heart Association/American Stroke Association guidelines call for interpretation of the CT scan within 45 minutes of ED arrival and treatment initiation within 60 minutes.

Few organizations are currently able to meet these challenging goals. To assist in achieving them, in 2000 the Brain Attack Coalition recommended the development of primary stroke centers to deliver standardized acute stroke care.

As of January 2011, there are more than 800 certified primary stroke centers across the country. (7) Experts have identified key elements of these focused treatment centers that are associated with improved outcomes.

These elements include certification by an independent entity and identification of an acute stroke team that can be mobilized to the bedside within 15 minutes of patient presentation.

However, operationalizing a coordinated rapid team response on a 24/7/365 basis can be a daunting administrative task and a significant barrier to providing timely acute stroke treatment.

Staff at St. John Hospital & Medical Center (SJHMC) have built a reliable process for rapidly evaluating and treating patients with acute stroke — and have seen their door-to-treatment times decline steeply and the number of patients treated with tPA increase substantially. Single-call notification of the acute stroke team with PerfectServe is central to this process.

Closing the gaps in acute stroke care

A member of the St. John Providence Health System, SJHMC is a 772-bed acute care hospital located in Detroit.

Known for its centers of excellence in neurosciences, cardiology, oncology and several other clinical areas, the hospital was in the process of preparing for The Joint Commission certification as a primary stroke center in 2009.

Carrie Stover, MSN, NP-C, director of neuroscience for the St. John Providence Health System, was charged with reconfiguring the program to meet certification standards.

Along with a multidisciplinary team of physicians and other staff from neurology, the ED and neurosurgery, Stover identified single-call team notification as an important priority.

“We were looking for a mechanism to contact both the neurologist and the neuroendovascular physician at the same time. We realized that PerfectServe — which we were in the process of setting up for all providers — would let us alert more than one person at a time, provide a backup, and track calls.”

According to Stover, there were a number of shortcomings in the acute stroke treatment process prior to the overhaul.

“We had no system for escalation or backup if the neurologist didn’t call back quickly. We had to update the on-call list in the ED continually. The neurologists couldn’t easily tell if an incoming call was routine or related to a stroke. We couldn’t track calls. And we didn’t have a mechanism for easily tracking patients who were evaluated for acute stroke but discharged with a different diagnosis.”

Paul A. Cullis, MD, chiefof neurology and director of the stroke program at the hospital, recalls that identifying the correct physician to contact was a major issue.

“The ED staff never knew who was on call. The schedule wouldn’t get disseminated properly or got lost. A few times, the wrong physician was contacted because the staff was looking at the schedule for the correct month but from a previous year. Nobody knew who to contact, when, how, why and where. Sometimes a particular neurology group might be assigned to take stroke calls, but until you called their answering service, waited on hold and finally spoke with someone, you wouldn’t know who was on call that day. It was a major bottleneck.”

According to Robert B. Dunne, MD, vice chief of the emergency department, the lack of an automated escalation system for callbacks added extra work for the ED physician.

“We had written policies on escalation, but they were all driven by physicians in the ED. I might become busy, then remember that the neurologist I paged 25 minutes ago hadn’t called back. The clerk would try him again and then the next neurologist on the list. A busy ED physician shouldn’t have to remember that.”

Dunne also points to challenges with collecting and extracting data regarding calls and call times, difficulty altering the call schedule (a task requiring 5 to 10 phone calls to inform others of the change), and delays in treatment initiation due to a lack of timely communication. He also saw a great deal of variability in the timeliness of treatment.

“If the ED physician was very motivated and the ED wasn’t too busy, he or she could make the calls, set up the CT scan and speak with the radiologist. But the ED physician had to create the protocol on the fly every time. A problem in any one of those steps could cause a delay.”

Launching a team-based approach

The planning group at St. John Hospital listed several priorities for the future treatment program: a dedicated neurologist on call for acute stroke, integration with the interventional group and the radiology department and a simple team communication system that would be consistent 24/7, yet easily updated by users.

The group chose PerfectServe because of its successful use in other clinical areas within the medical center.

After getting commitment from the neurology groups regarding a call system for acute stroke and achieving buy-in from primary care physicians that the designated on-call neurologist would be contacted for acute stroke patients, the group launched the treatment program, which was dubbed “Code Stroke.”

The group initiated a weekly meeting to review data and identify bottlenecks in the system. Over time, they honed the process into a highly efficient system.

Implementing a standardized process

Acute stroke treatment is now a standardized process, based on reliable, rapid team notification.

The ED staff makes a single call to PerfectServe; the on-call schedules are automatically analyzed and the appropriate team members are identified.

The entire acute stroke care team is contacted simultaneously based on the individual preferences of team members and the specific rules established for the team.

Because team members are immediately aware of the reason for the call, they respond quickly. If needed, repeat call backs and escalation occur automatically.

Users can easily change the call schedule via phone, Web and mobile apps. Changes are reflected in real time.

Moreover, the new process eliminated the need for ED staff to refer to printed schedules because the schedules are built into the PerfectServe platform, and messages route automatically to the appropriate clinician.

Finally, team members can easily track and analyze call times and patient data. Using these data, the team can identify and address areas of concern to drive continuous process improvement.

Results

By deploying the new process, the team was able to reduce on-call neurologist response time by 90 percent, from 22 to 2 minutes.

before after perfectserve

Using the revised process, SJHMC staff administered tPA to three times more patients with acute ischemic stroke in 2010 compared to 2009.

ischemic stroke improvements

The process also reduced the door-to-CT completion time by 41 percent, from 78 to 46 minutes.

door-to-CT completion time

During this study period, the number of patients with acute stroke remained relatively flat.

number of acute stroke patients

Reaping the rewards of rapid team notification

With the new process in place, the St. John Hospital team has achieved a significant reduction in the time to treatment for acute stroke patients.

Neurologists on call for acute stroke respond to the ED call in an average of two minutes, down from an average of 22 minutes.

“Because the notification is immediate and because the neurologist knows the call is coming from the ED, they respond quickly. I rarely get backup calls anymore because the notification system works so well,” says Cullis.

The door-to-CT completion time averaged 78 minutes before the notification system was implemented. That number is now 46 minutes.

Although the number of patients diagnosed with acute ischemic stroke has remained stable, the number who receive tPA has increased substantially, according to Dunne.

“We were below the national average before, and now we’re way above average — and getting better all the time.”

Using call tracking to improve data collection

The team’s ability to collect data regarding patients evaluated for acute stroke also improved.

According to Stover, the process increased by 25 percent the number of patients with stroke-like symptoms who are tracked in the system.

“We can now easily identify patients who presented with symptoms of stroke but were discharged with a different diagnosis. Before, we could only easily track patients with a discharge diagnosis of stroke. It gives us a much bigger pool from which to identify trends, barriers and opportunities to improve.”

According to Dunne, the ability to capture data is important to The Joint Commission stroke certification process.

“The Joint Commission wants to see that we’ve collected 95 percent or more of the data, not 70 percent. Using PerfectServe we’re able to get these numbers in an automated fashion in very close to real time.”

The findings of the St. John Hospital team were presented at the Society of Academic Emergency Medicine’s national meeting in Boston in June 2011 and at the Michigan State Medical Society Quality Symposium in Novi, Michigan in October 2011.

The team plans to continue identifying and improving delays in tPA administration time, develop a database for objective outcomes analysis of National Institutes of Health stroke scores at admission and discharge and improve outreach to community hospitals for patients needing interventional treatment via telemedicine.

Dunne sees the benefits of the new program for both patients and physicians. “The notification system has made the management of stroke easier for the ED doctor, which is great for patients. It reduces the frustrations of the ED physician and frees him or her up to care for patients. We have a really busy and fast-growing emergency department, so it’s important that we have a system that works well forus.”

Stover agrees. “PerfectServe really helped us to affect a practice change, making treatment better and safer for patients and easier for ED staff.”

Cullis recalls the importance of rapid treatment for a particular patient. “We had a patient who came in recently with a lack of blood supply to his brain stem — a very important part of the brain. He was treated quickly and effectively and is going to walk out of the hospital almost completely normal because of the speed of the treatment.”

He credits the PerfectServe notification system as being an essential factor in the team’s ability to treat patients quickly.

“The slogan we like to use in treating stroke is ‘time is brain.’ Cells are dying at a prodigious rate for every minute that you don’t do something, and it’s important to intervene quickly. PerfectServe helps us do that and has become an important part of our acute stroke treatment program.”

References

  1. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Executive summary: heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation. 2010;121:948–954.
  2. Kochanek K, Xu J, Murphy SL, Minino AM, Kung H-C. Deaths: Preliminary data for 2009. National Vital Statistics Report. 2011;59:1–51.
  3. Fonarow GC, Smith EE, Saver JL, Reeves MJ, Bhatt DL, Grau-Sepulveda MV,et Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes.Circulation.

Automating ED call schedules at St. Elizabeth Healthcare

Nowhere is the on-call schedule more challenging than in an Emergency Department. By definition, every case is an emergency. By necessity, the ED must be able to quickly reach the on-call physician in every service line. And within hours of any given day, the ED’s list of on-call doctors is likely to be out of date.

Now imagine five EDs, together treating more than 100,000 patients a year and needing to reach on-call doctors in more than 30 departments, each with its own constantly changing call schedule.

That was the situation faced by St. Elizabeth Healthcare in Northern Kentucky. One of the oldest and largest medical providers in the Greater Cincinnati region, St. Elizabeth Healthcare encompasses seven hospitals, 1,200 physicians with admitting privileges, nearly 100 primary care and specialty office locations, three freestanding imaging centers, two ambulatory surgery centers—and five very busy Emergency Departments.

Responsibility for maintaining call schedules for those EDs belongs to Michele Kenner, Assistant Vice President, Physician Services & Engagement. “Physician Services are the problem solvers,” Michele says. “Our role is to resolve medical staff issues and meet the needs of our doctors. We also maintain the on-call schedule for the EDs. Before PerfectServe, it was a paper process—a very labor-intensive paper process.” Providing that labor is Renee Loveless, who works with Michele as Medical Staff Coordinator for Medical Affairs. “It was tough,” Renee recalls. “Everything was paper. Nothing was in the system. The work was tedious, and it was difficult to get the latest updates out to everyone quickly. Plus the schedules might not get posted right away— or at all—so there was a lot of confusion with service calls.”

A Word document that was never the last word

Each day Renee would contact as many as 30 departments to update her list of who was on call. She would then distribute a Word document calendar to each Emergency Department by email and fax. Hard copy call schedules were printed and posted manually on bulletin boards in various locations for the staff— and were ripe for being taken down when someone needed to find a physician, and not rehung. Other times, paper call schedules were simply overlooked.

Sometimes multiple changes occurred within hours as physicians traded on-call days and responsibilities. The situation was even more confusing if Renee wasn’t notified, or the changes occurred after “Medical Affairs” business hours, or over the weekend. The resulting inaccuracies in the posted schedules often sent Emergency Departments scrambling to find the right physician.

For example, Ashel Kruetzkamp, who manages the Emergency Department at St. Elizabeth Edgewood (which averages more than 175 patient visits a day), says, “A patient might come in with a fractured arm and we’d call the orthopedic physician only to find out that he or she wasn’t on call that day, and we didn’t get the change on the new schedule,” she says. “We’d get a lot of requests to change who was listed as on call.”

Laying the groundwork made for a seamless transition

Michele said it took some time to realize a better solution was right in front of them: St. Elizabeth Healthcare had used PerfectServe for years to manage physician-to-physician and nurse-to-physician communications.

“Even though we were one of the early users of PerfectServe, there were some things we weren’t using it for because of legacy behaviors,” Michele says. “We were looking for ways to increase utilization of the app, and we thought of our call schedules.”

The first step was getting the Emergency Departments to buy in on the idea of automating the call schedules. “Physicians and nurses have gotten used to going to the computer because of the EMR—it’s familiar to them,” Michele says, indicating the timing was right for eliminating an obsolete, paper-based process. “We gave a lot of advance notice and laid the groundwork. We talked to them about data integrity, which is really important to clinicians—knowing that the information they’re getting is accurate. And they appreciate knowing that the physician they’re going to wake up at 2 a.m. is the right doc.”

With this reassurance, the ED managers were quick to embrace the idea.

“What was most compelling about the PerfectServe solution was that it would speed up the time it took to contact a provider,” Ashel says. “We would be able to respond to schedule changes in real time, and everyone was very receptive to that.”

With several months of careful preparation and ongoing communication, the team at St. Elizabeth Healthcare was primed for a smooth transition. “I was surprised that it was such a non-event,” Michele says. “It was pretty seamless. Everyone just embraced it.” Ashel agrees, saying, “Having real-time, accurate call schedules to reference makes everyone’s job easier.” She reports that all the ED managers are pleased with how the solution was rolled out, and how it’s working. Most telling, she says, is that “there have been no complaints at all.”

Real-time schedules at their fingertips

Renee is even more enthusiastic about the results. Although physicians still sometimes swap on-call duties without informing administration, any last-minute changes are documented and updated in real time. Rather than needing to rely on Word documents and email, any user in PerfectServe can see who the right on-call doctor is by using the mobile or desktop application. Michele says, “Nurses on staff have access to the schedules in PerfectServe as well. We’re providing all our staff with the ability to see who’s on call for the ED—from anywhere in hospital—and it’s always up to date.”

“Everything is real time in PerfectServe, and it’s just fantastic,” Renee says. “In the past the docs couldn’t get to their emails or see the posted updates. Now, all the ED locations have up-to-date information at their fingertips.” Even more rewarding is that some providers have requested access to their call schedules via the PerfectServe mobile app, so that they can make any “after hours” or “weekend” changes to their group service call. They appreciate that this technology is now available to them.

Patients and care team members all benefit from process improvement

Everyone agrees that the most important impact is on patient care and timeliness. “[Using PerfectServe] cuts down on the guesswork—calling the wrong doctor and then tracking down the right information,” Ashel says. “The time savings is obviously beneficial to the patient.”

While the medical staff at St. Elizabeth Healthcare was already using PerfectServe for clinical communications, using the tool to automate call schedules for the ED further increased adoption across the board. “Since rolling out the automated ED call schedule, more physicians also have downloaded the PerfectServe app to their cell phones,” Michele says. “Usage rate is phenomenal and continues to grow.”

And as the staff starts to recognize the extended value of PerfectServe, they see other useful applications, like implementing stroke alerts across the system. Says Michele, “If you look at the past five years, we’ve steadily laid a foundation of increasing PerfectServe utilization.”

When asked what advice she would give to a colleague considering going paperless for ED call management, Michele says, “PerfectServe is an absolute no-brainer. If you want to decrease staff time dedicated to managing a paper process, this is the system to use.”

Optimizing communication at San Jacinto Methodist Hospital

Chief executive officer Donna Gares and the leadership team at San Jacinto Methodist Hospital (SJMH) in Baytown, Texas, knew that something had to be done to make contacting physicians easier and more efficient. A member of the Houston-based Methodist Hospital System, the 275-bed community hospital was experiencing a challenge common to many hospitals and health systems.

As leaders looked to improve the continuity of care and clinical integration, they came face-to-face with a longtime complaint of clinical staff: communicating with physicians efficiently. On the verge of installing an updated information system, they believed the timing was right to address the issue.

Searching for a solution

Medical staff leaders, emergency medicine physicians and nurses were eager for a solution that would enable nurses, administrative staff and physicians to get in touch with doctors quickly, reduce delays and decrease wasted staff time. “The communication system was cumbersome,” says Bruce Kennedy, MD, chief medical officer of the hospital. “It was time-consuming for hospital staff to reach doctors. Nurses and emergency medicine physicians were especially ready for a change.” The electronic contact list at the hospital was difficult to keep updated with call schedules and with physicians’ preferences for modes of contact at different times of the day. “The system was convoluted, with many places for potential missteps. It frustrated everyone,” says Gares.

If a physician needed to make a change to the schedule, he or she had to contact the medical staff coordinator or, if after hours, the hospital operator. Changes didn’t always get widely distributed, which sometimes led to missteps, such as calls to a physician who was not on call at the time. Nursing staff spent extra time checking and double-checking call lists and still ended  up having to call a second physician after learning the first one was not on duty. Physicians, especially those in the emergency department (ED), were frustrated by the difficulty in reaching colleagues quickly to discuss a treatment decision or provide follow-up.

Recalling a report from Kennedy about a clinical communications platform he learned of at a national conference, Gares asked for the contact information for the company. After a presentation, Gares signed on and PerfectServe was implemented at the hospital in February 2012.

Implementing PerfectServe

PerfectServe is a comprehensive and secure communications platform that routes voice, text and Web- and system-generated communications based on practice group workflow and personalized algorithms, and allows physicians to control when and how they are contacted. The single-network platform and directory give staff easy access via voice search, web and mobile interfaces. The service also includes a 24/7 help center staffed with clinical communications experts.

According to leaders, the implementation process went smoothly and staff were able to get up to speed quickly. “I was very impressed with the responsiveness of the PerfectServe team,” recounts Kennedy. “They met with the key stakeholders and were available on-site for three weeks to provide support and help staff learn how to use the system.” He reports that nurses were happy with the system from the start.

“Once physicians know how PerfectServe works — that they can go online or call and change their preferences at any time — the vast majority are positive. Overall, the results have been excellent. It is so easy for any staff member — physician, nurse or administrator — to contact a physician. We dial one five-digit number and tell PerfectServe who we are trying to reach, and PerfectServe does it for us.”

Gares recalls a recent conversation with a physician feeling challenged by the new order entry system. “He felt the process was not as user-friendly as PerfectServe and asked, ‘Why can’t you make it like PerfectServe?’” She has noticed substantially fewer complaints about missing calls or communication missteps since PerfectServe was implemented.

Streamlining communication in the ED

Emergency medicine physicians and other ED staff have noticed the improvement in clinical communications. Amir Rassoli, DO, medical director and vice president of the medical staff, appreciates the decreased wait time for return calls and reduced delays in moving patients through the ED.

Rassoli says, “Flow is a big issue in the ED. To be efficient, we need to be able to contact admitting physicians or consultants quickly and transfer patients to an inpatient room or discharge them.” In the past, there were frequent issues with the accuracy of the call list in the computer. When ED physicians placed a call, they often found they had contacted — and possibly awakened — a physician who was not currently covering the patient. Or they might leave a message and remain uncertain whether the call would be answered in a timely fashion. “It was like a puzzle,” he explains. “Who’s on first? Who’s on second? Who’s on call? Who’s covering for whom?”

With PerfectServe, the communications process in the ED is more streamlined, according to Rassoli. “We ask the patient the name of his or her doctor. We dial one number and are directed to the physician covering that patient at that time. If there’s no answer, we can leave a message and have third-party documentation that we placed the call.”

The process reduces inefficiencies, frustration and disagreements. As ED medical director, Rassoli is responsible for investigating complaints from attending physicians about not receiving calls from ED physicians. He explains, “In the past, we relied on desk clerks recording that a call was placed. Now we simply contact PerfectServe for a detailed report.”

PerfectServe also supports continuity of care by making the contact between physicians more efficient. “I see it as my responsibility to contact the patient’s doctor and tell him or her what I did for the patient. If the patient is not improving, the physician will know what to do and won’t be in the dark about treatment in the ED,” says Rassoli.

Optimizing communication throughout the hospital

Greg Terry, MD, a family medicine physician at SJMH, appreciates the fact that PerfectServe can handle the intricacies of a complicated call schedule. Terry says, “Physicians in my group will see their patients in the hospital over the weekend — if [they are] in town — but not on call. However, when they’re out of town, the doctor on call will see their patients. It can be confusing for nurses to know which physician to contact.” PerfectServe collates information about each physician’s schedule and preferences for contact. Terry also finds PerfectServe makes it easier to contact other physicians directly. “It makes getting ahold of other physicians a lot easier — it facilitates communication and makes it more reliable,” he says. Medical/surgical nursing director Jon Ann Watson, MSN, RNC, found that nursing staff made the transition to PerfectServe easily: “Nurses took to PerfectServe quickly and like it. We welcomed the improvement.”

With PerfectServe, there is one less non-care-related task for nurses — checking the call list — and less chance for human error due to using an outdated call list or misreading the list. “Our nurses felt immediate relief in terms of nursing tasks. There is just one number to remember, and they can count on the call list being up to date,” says Watson, who sits on the hospital’s monthly Physician-Nurse Collaboration Committee. She reports a marked decline in the number of complaints presented to the group from physicians regarding “3 a.m. phone calls when not on call.”

Staff Pharmacist Ray Daves reports that PerfectServe has made his work more efficient. In the past, if he had a question about a medication order, he would check the electronic contact list, make a call, and hope that the call list was accurate. If needed, he would leave a message and await a callback. The process inserted extra time in his workflow. With PerfectServe, Daves has noticed a shorter response time to his calls and fewer extra steps in fulfilling medication orders: “I make one call now, not repeat calls, and can get my work done faster, now, not in two or three hours.”

Daves believes PerfectServe helps him better serve his direct customer, floor nurses and his ultimate customer, patients. “I want to be right in what I do and move on to the next challenge, rather than waiting around to finish an order. PerfectServe is a move in the right direction for customer service.”

Spreading the word

At a recent meeting of medical staff officers of the system’s hospitals, Rassoli, the medical director of the ED, heard a physician leader raise a familiar complaint, “I wish there was an easy way to contact physicians. I’m busy, and when I put aside time to call colleagues, nine out of 10 times I can’t get in touch with them.” Rassoli replied, “I have a solution for you.”

He described the experience at SJMH with PerfectServe. The other physician leader’s interest was piqued.

Rissoli says of his first introduction to PerfectServe, “We were waiting for years for something like this. I can’t say enough about PerfectServe.”

Using PerfectServe to enable secure, rapid clinical communications

A member of MemorialCare, Orange Coast Memorial Medical Center is a not-for-profit, 218-bed hospital located in Fountain Valley, CA. The organization serves the community with more than 12,000 hospital admissions and 23,000 visits annually. Both the hospital and the health system have a long history of focusing on quality and safety and were early adopters of an electronic medical record (EMR) system to improve clinical communications.

Although Orange Coast Memorial Medical Center had implemented lean management techniques for several years, leaders saw additional areas in which to remove excess waste, including the clinical communication process. As part of an ongoing commitment to performance improvement and reliability, leaders focused on improving clinical communication in two key realms: between nurses and physicians and between emergency department (ED) staff and physicians. The organization’s specific goals were to reduce variation in time to call back, reduce time wastage for “phone tag,” increase nurses’ time in direct care and improve nurse satisfaction.

Communication inefficiencies caused delays

According to Orange Coast Memorial’s executive director of information services, inefficiencies in the communication process prior to the improvement efforts affected throughput, added costs and caused frustration for patients and staff. Nurses spent a significant amount of time contacting physicians, which sometimes translated into delays in care.

Tim Horttor, BSN, RN, CCRN, a critical care nurse at Orange Coast Memorial, notes that before PerfectServe, nurses often searched in three different locations to find telephone numbers to contact physicians—a paper list of the call schedule, within the EMR system to identify the assigned physician and on notes taped to patient charts. When nurses contacted the physician’s answering service, they spent precious minutes providing a host of information, including the patient’s name, status and room number.

A time-motion study found that the communication cycle for nurses contacting physicians was complicated and disjointed and included multiple potential points for gaps. In addition, nurses waiting for callbacks after a shift change clocked overtime hours (at 1.5 times the standard hourly rate), which increased costs.

Emergency department staff struggled to communicate efficiently with primary care and specialty physicians. The delays sometimes translated into slower flow through the ED, with patients waiting for admission or additional care.

More times than hospital leaders would like, the ED was required to go on diversion status.

In addition, executives in the information systems and compliance departments were concerned about unsecure texting on personal phones. They wanted a secure communication system that would also provide physicians with autonomy to control the mode by which they are contacted.

Streamlining the clinical communication process

Orange Coast Memorial implemented PerfectServe over the course of four months in 2012. A dedicated team helped train staff and enroll physicians. After a relatively short learning process, hospital staff noticed a substantial streamlining of the communication process. With PerfectServe, nurses can open a Web portal and send a secure text to a physician. Often they find that the requested order change is entered directly into the EMR by the physician within a few minutes — with no additional time required for callbacks. Nurses are more confident that their message is received with the new communication process. They can also easily place a telephone call to the right physician if a direct conversation is needed.

Pre-implementation process flow

pre-implementation flow

With a single secure communications platform, Orange Coast Memorial leaders are now confident that texts and other modes of communication are HIPAA-compliant. They can track communication cycles if need be, to identify whether messages have been sent to unsecure devices and, if so, to ensure that personal health information was redacted.

Documented improvements

Orange Coast Memorial has reported seeing a number of improvements in clinical communications since implementation. A repeat time-motion study confirmed that the communication process was much more streamlined, with nurses spending less time in the communication cycle than prior to implementation (see figure below).

post-process flow

Physician call-back time was shortened substantially, from an average of 45 minutes to an average of 14, and the proportion of call cycles completed within 2 minutes increased from 11  percent to 22 percent. In addition, the variability in response time was reduced, with fewer outlier cycles (see figures below).

Pre-implementation response time (in minutes)

pre-implementation response time

Post-implmentation response time (in minutes)

post-implementation response time

Percent of contact cycles completed within 2 minutes

contact cycle percentage

Nursing satisfaction has improved since implementation due to reduced frustration and more time for direct patient care, according to Horttor. Orange Coast Memorial has received unsolicited comments from frontline nurses and nursing executives about the substantial improvement they’ve seen with PerfectServe. One nurse shared, “This is the best thing you’ve ever done for us…” Orange Coast Memorial believes their response reflects the fact that PerfectServe has a direct impact on their daily life, enhancing their workflow and quality of life.

Horttor has found that PerfectServe has vastly simplified the process of communicating with physicians. “PerfectServe has changed contacting physicians from a 10-step process to a one-step process,” he says. He notes that it has reduced the time spent on communication and the frustration level of patients due to delays in care, “The patients didn’t know that the delay in receiving their pain medication was due to waiting for the physician to call back. They were just frustrated with the delay. Now there is less delay, patients are in pain for less time and we receive fewer complaints.”

Improving patient experience and reducing costs

Patient satisfaction has also improved. Overhead paging has been virtually eliminated, reducing the noise level within the hospital and improving the patient experience. The hospital’s HCAHPS scores have increased by 2.4 percent between the year prior to PerfectServe implementation and the year after implementation. The specific measure of pain control was improved by 4.4 percent, a change that Orange Coast Memorial believes is directly tied to the faster communication cycle with PerfectServe.

Administration at Orange Coast Memorial is pleased with the investment made in PerfectServe. In addition, the hospital has received a direct cost savings since PerfectServe implementation. The number of overtime hours was reduced by more than 1,000 over the year after implementation, translating to a savings of more than $56,000.

Orange Coast Memorial Medical Center implemented PerfectServe in 2012. Use of PerfectServe has streamlined clinical communications, improved ED flow, reduced response time, improved nurse satisfaction and enhanced the patient experience. PerfectServe is helping support increased direct care time and an improved patient experience as part of Orange Coast Memorial’s ongoing commitment to providing high-quality care.

 

Elimination of delays in consultant care

Munroe Regional Medical Center (MRMC) had a long history of prioritizing performance improvement initiatives. Leaders at the 421-bed, not-for-profit, community hospital were well-versed in Six Sigma and other performance improvement strategies. The organization had already streamlined many care processes and had eliminated waste throughout the system. However, MRMC leaders recognized the need for a standardized process to ensure timely clinical communications, especially given the high volume of communications events at the organization: the 450 physicians and 2,500 clinical staff members completed more than 150,000 calls per year. MRMC had been using a home-grown system for contacting physicians, relying on telephone calls to physician offices or answering services, which often proved unreliable and inefficient. Leaders realized the organization needed a systematic, reliable process for contacting physicians. Senior Vice President of Medical Affairs and Chief Quality Officer Lon H. McPherson, MD, had previous experience with PerfectServe in another healthcare organization. McPherson was familiar with the benefits of PerfectServe and was able to champion the project using his past experience with implementation.

While the implementation of PerfectServe helped MRMC improve all forms of clinical communications, this case study focuses on the ways in which PerfectServe specifically helped the organization monitor and refine its physician consultation process.

Eliminating inefficiencies with PerfectServe

PerfectServe is a comprehensive and secure communications platform that routes voice, text and Web- and system-generated communications based on clinician workflow and personalized algorithms, allowing physicians, clinical teams and practice groups to selectively filter and control when and how they are contacted. PerfectServe’s “rules engine” filters communication events based on multiple variables unique to each clinician, which can be updated easily via a phone or mobile device.

To contact a physician using PerfectServe, the individual calls a single extension or uses the web-based texting function. By indicating either the physician’s name or specialty, the caller is automatically connected to the physician via the mode of communication preferred by the physician at the time. If the physician prefers not to take the call or text at the time, a message is sent. Either way, the contact is tracked and documented. The caller does not need to know the physician’s call schedule or office hours beforehand — PerfectServe stores this information and routes calls and messages accordingly. Data are housed securely with PerfectServe rather than on the caller or recipient’s device, ensuring compliance with HIPAA regulations.

A communications process ready for change

Prior to PerfectServe implementation, staff at MRMC used a fairly common process for communicating with consulting physicians. During the day, the secretary in the relevant unit would telephone the consultant’s office staff, who would relay information about the consult request to the physician.

On nights and weekends, however, the process was variable and rife  with delays. Staff at each unit would enter consult requests in a log book. Non-urgent consult requests were held over for first shift staff the next morning, or on Monday mornings after a weekend, creating a backlog of work for the clerical staff. Urgent consult requests were telephoned to the answering service of the consultant on call, sometimes based on inaccurate on-call schedules or word-of-mouth requests to call a specific cell phone number. Because the hospital requires that patients are seen by consultants within 24 hours of consult request, staff felt pressured to stay on top of the communications and yet found the current system unmanageable. Bottom line:

The process resulted in delays in the notification of consultants and in patient care, as well as frustration for nurses, physicians and clerical staff.

MRMC leaders were not only concerned about the timeliness of consultant contact, but were also looking to assist physicians in dealing with the overwhelming number of calls and emails they fielded, a portion of which had been directed to the wrong physician.

Implementation with consult requests initially overlooked

Having identified an opportunity to improve clinical communications, the organization implemented PerfectServe in 2010. Implementation across the hospital went smoothly, according to Diane Coleman, performance improvement manager at MRMC. After an initial adjustment period, staff and physicians were pleased with the ease and reliability of communication. Staff readily adopted the tool for contacting physicians throughout the hospital and beyond its walls.

Several months after implementation, MRMC leaders reevaluated the process to ensure that all components were in place and that users had no concerns or issues. During a meeting with unit secretaries, it became apparent that some aspects of the old process were still in place. Coleman and the performance improvement team performed a gap analysis based on PerfectServe analytics, and found that the number of consult requests logged through PerfectServe was smaller than the number registered in the computer order entry system. With further investigation, Coleman discovered that the staff were using PerfectServe for much of their clinical communications, but had retained the old process for requesting consults. Physicians continued to advise the unit secretary to “hold routine calls.”

Coleman says the finding was surprising: “During implementation and education we emphasized that PerfectServe was to be used for all clinical communications.” Instead, staff members were continuing to use paper log books and to hold consult requests on nights and weekends.

“Knowing this helped us to understand the required shift in culture that needed to accompany the use of PerfectServe,” says Coleman. “In the past, MRMC staff had followed the instructions of each physician about what to do with their calls. To be successful with PerfectServe, we needed staff and physicians to be compliant. By further addressing the culture and having dialogue on where we needed to be, we were able to change this process.” As staff and physicians began using PerfectServe for all communications, the variance was eliminated, call time improved and users gained more confidence in the system.

Improvement in care processes

With PerfectServe in use for referral requests as well as otherclinical communications, MRMC is better able to manage the consult process, with a standardized, streamlined process that includes tracking and analytic capabilities. Now, the unit clerk accesses PerfectServe either by phone or the web link and requests the consultant by name or specialty. The consult request is transmitted directly to the physician, based on data stored in the rules engine regarding contact preferences, time of day and call schedule. The process removes the middle person — the consultant’s office staff or answering service — thus streamlining communication and reducing the chance for human error.

As Coleman describes it, “Without all the ‘noise’ on how to communicate to whom, we could focus on the timely and safe delivery of patient care.” Leaders are assured that staff are consistently using PerfectServe for all communications, and the number of consult requests in the PerfectServe logs now matches the number in the order entry system. PerfectServe analytics demonstrate the substantial increase in call volume related to consults once staff had been re-trained in late 2012 (see figures below). The use of PerfectServe has removed variability in the process of contacting consultants and has decreased call-cycle time.

MRMC has seen positive results in a number of areas. A value stream map showed that the process for contacting a physician dropped from 17 steps to six. Use of web contacts versus phone calls increased from 2 percent to 51 percent, saving staff time and reducing the need for repeat calls. In addition, because of the reduction in rework (e.g., making multiple calls to contact a physician), labor requirements for clerical staff dropped from 72 to 46 hours per day, which resulted in $232,000 in hard savings per year. Simultaneously, the throughput time in the emergency department (ED) also declined, and the organization is meeting its target numbers for door-to-physician and door-to-discharge time in the ED.

Other benefits

According to Coleman, consulting physicians appreciate the fact that they can receive urgent requests for consults in the communication mode they prefer and can have routine requests sent to them in the morning rather than during the night. Also, by accessing the stored routine requests on Sundays, they can better plan their Monday morning rounds and workflow.

Clinical and clerical staff appreciate the streamlined communications process. Office staff can make changes in a physician’s call schedule easily via the computer. The standardized, reliable process ensures that they contact the right physician the first time. Beth Bennett, RN, charge nurse on the cardiology unit, appreciates that she can send a consult request when it is ordered, even in the middle of the night, and can receive a confirmation that it was sent. In the past, she would need to call several times if a consultant’s office was closed, which meant another task to remember until the call was completed.

Shirley Regal, secretary in the cardiology unit, likes the quick access to physicians in emergencies: “If they have set their preferences to call directly, I will ring and the physician will answer immediately. Or I can text the patient’s status via the web link, which the physicians like because it saves them having to call back.” Ebony Jones, secretary in the cardiology unit, also finds the text feature to be time-saving: “The best part of PerfectServe is being able to text. I can include information specific to the patient. Plus, I have proof that the message was sent.”

Coleman points to some additional benefits. PerfectServe allows for multiple clinicians to be notified at once, reducing delays or gaps in care. For example, a surgeon who is beginning a surgical procedure while on call can have a physician’s assistant and other surgeons notified to cover for consultation requests or new admissions, which means that patient care issues can be addressed more quickly.

The four cardiovascular surgeons of Munroe Heart exemplify communication streamlining with PerfectServe. Before implementation, the call routing process included many variations and particulars, requiring staff to make multiple calls to contact the surgeon and the on-call team. Now staff make just one call and five different team members receive notification. The new call routing supports their team efforts in the delivery of patient care. According to Coleman, “If it can reduce time to notification for heart surgeons, then it will work for any service line.”

Plus, the data regarding team calls have helped with resource planning. Managers have used PerfectServe analytics to assess and adjust staffing levels for specific care teams.

Conclusion

MRMC implemented PerfectServe to improve the standardization and reliability of clinical communications. Having identified a gap in the consultation referral, the organization provided additional training and facilitated the use of PerfectServe for contacting consultants. Within a few months, call-cycle times for referrals had dropped. MRMC also experienced decreased staffing needs and increased throughput in the ED. MRMC plans to continue using PerfectServe analytics to improve clinical communications and optimize patient care throughout the organization.

Automating stroke response for efficiency and effectiveness

When a patient exhibits symptoms of a potential stroke, time is the most important consideration in the battle between life and death. As they continually strive to deliver the best patient care, healthcare systems work to reduce the time involved in every segment of the process: door to tPA; door to CT; rst neurology exam; and more. The strongest programs are able to meet the criteria to become credentialed as Primary Certi ed Stroke Centers. One such program is Genesys Regional Medical Center in Michigan.

According to Rebecca Banat, RN, Director, Neuroscience, Stroke Center, Neuro Tele-Med & Oncology Services at Genesys Regional Medical Center, “We have been accredited as a certi ed stroke center three times, but we knew we still had opportunities for improvement.” Some of the issues they faced were:

  • A pager system that was unreliable, with delayed delivery of messages
  • Inconsistent messaging content, which led to confusion among responding clinicians
  • A work-around that used overhead paging, disrupting the hospital’s intent to provide a quiet healing environment

The solution

In 2010, Genesys worked with a sister ministry at St. John Providence for support of its neurovascular programs. When it became clear that this was not a good long-term solution, Genesys developed a contractual relationship with eight neurologists who would provide coverage for the stroke program.

With a goal of neurologist response-to-page in 15 minutes or less, Genesys leadership knew they needed a better system. The neurologists couldn’t be held accountable for responding when the systems contacting them were inconsistent and unreliable. And Genesys needed an escalation process if the physicians didn’t respond. With implementation of PerfectServe, Genesys believes it has found the solution.

“We are still early in the process, having just gone live on May 5,” said Banat. “But we have high stroke volumes — as many as 50-60 patients per month — so we were able to see most of the issues and tweak the system early in the change process. We’re on the right path.”

Results

Results are admittedly anecdotal to date, but according to Banat, Genesys is already seeing positive change:

  • There had been as many as 30-50 people on the stroke team at any given time. With individual paging, the last people on the list could have pages delayed by as much as 20-30 minutes.
  • In the past, emergency physicians didn’t call the neurologists until after they had assessed the patient, a potential delay of 45 minutes or more. Now, EMS and emergency physicians contact the neurologists immediately through PerfectServe and quickly involve them in the process. Emergency department physicians and neurologists are becoming more collaborative and effective as a result.
  • Neurologists are responding in a matter of a few minutes or less. And if they don’t respond, the escalation process alerts the Medical Director, who becomes involved and keeps the communication moving.
  • EMS has adopted new processes to call ahead and relay information, including expected time of arrival, glucose count and other symptoms, before transport to the emergency department, so the hospital team is prepared. And EMS now transports directly to Radiology for CT scans, further reducing treatment time.
  • Ancillary department turnaround times appear to have decreased. And the frontline staff are no longer worried about delays or inconsistent information.
  • The Medical Director has a better understanding of the intricacies of the process and is able to identify trends and issues in the program for intervention and improvement.
  • Call schedules are automated in the system so they can be easily changed. Previously, call schedules were handwritten and nurses and office staff had to contact many physicians to make changes.

Going forward

Genesys is early in its implementation of PerfectServe, but Banat views the program as a pilot. “In talking to peers in other services, like trauma, they can’t wait to get the system implemented,” noted Banat. “They have to deal with manual records and weekly reports. PerfectServe gives us automated, real-time information.”

New processes can sometimes create resistance to change. But Banat says the “results, and the realization that this system makes their clinical practice easier, more consistent and reliable, and most importantly improves patient care, have created tremendous support for PerfectServe.”

As the process is fully implemented, Genesys has set aggressive goals. While the Joint Commission’s requirement is “door-to-drip” (arrival to tPA infusion) in 60 minutes, 50 percent of the time, Genesys is aiming for 45 minutes, 100 percent of the time.

About Genesys Health System

Genesys Health System is a member of Ascension Health, the largest not-for-profit health system in the United States.

Genesys Health System is a group of affiliated medical campuses, outpatient centers, primary care locations and ancillary healthcare organizations with a mission and history of improving the community’s health for more than 90 years. As the leading healthcare provider in mid-Michigan, Genesys is anchored by a 21st-century inpatient facility — Genesys Regional Medical Center at Health Park — one of the first medical centers of its kind built both clinically and architecturally around a patient-focused care philosophy. Genesys Regional Medical Center is a 400-bed center that includes a level II verified emergency trauma center with a cardiac rapid diagnostic center, the Genesys Heart Institute, the Genesys Family Birthing Center and expanded clinical expertise in neurosciences, orthopedics, geriatric services, oncology and minimally invasive surgical procedures in almost every specialty area.

About PerfectServe

PerfectServe provides healthcare’s only comprehensive and secure communication and collaboration platform. The company’s flagship solution, PerfectServe, unites physicians, nurses and other care team members across the continuum and facilitates timely interaction among them.

PerfectServe automatically identifies and provides immediate access to the right care team member, enabling effective population health management through communication-driven workflows. More than 100,000 clinicians in organizations such as Advocate Healthcare, Ascension Health, Covenant Medical Group, Hoag, MemorialCare Health System, Orlando Health, St. Joseph Health and WellStar Health System rely on PerfectServe to help them speed time to treatment, promote physician alignment, enhance the consult process, increase transition efficiency, provide nurses more time for direct patient care and reduce HIPAA compliance risk. Headquartered in Knoxville, Tennessee, PerfectServe has been serving the needs of forward-looking healthcare provider organizations since 2000.

Eliminating physician pages results in higher productivity, happier staff

Reducing noise in a hospital can have a positive effect on staff productivity and on patient satisfaction, a key component of HCAHPS scores. All kinds of noise can come from the normal, daily activity in a hospital. Overhead paging, alarms, phones ringing, doors opening and closing, conversations in the hallway — all contribute to noise.

Advocate Good Samaritan Hospital in Downers Grove, Illinois, was looking for a new technology-based communications solution that would provide a quiet, restful and healing environment for its patients. At the 333-bed hospital, with more than 1,000 physicians representing 63 specialties, the volume of overhead pages for physicians was very high. In one month alone, the hospital tracked 609 overhead physician pages.

Mancill Stewart, communication lead at Good Samaritan, says, “We were doing about 30-40 overheads a week… Anytime a doctor would walk away from a unit, they would call us to overhead page them.”

Solution to the problem

Before PerfectServe was implemented, nurses and other care team members who wanted to page a physician would call the switchboard to request a page, the request would wait in a queue and then the switchboard would initiate the page. This is the way overhead paging had been done at Good Samaritan Hospital for almost 30 years.

During the implementation of PerfectServe, the communications team created a reminder system for any overhead physician page requests. If someone called the switchboard to request a page, the switchboard team would remind that person to use PerfectServe instead. This way, the care team member could communicate with the physician directly, and their request doesn’t have to wait in a queue.

The uptake in usage of PerfectServe was almost immediate. In just a few weeks, the switchboard was down to one or two physician page requests.

After nearly 30 years using the former paging process, Mancill says, “To take that culture and turn it around in the time frame we did was amazing.

PerfectServe really had a great plan in place prior to launch. They did a great job working with physicians. Now physicians don’t want to be contacted any other way than through PerfectServe.”

Results

Good Samaritan Hospital saw a 99 percent decrease in overhead physician pages. Mancill reports, “[PerfectServe] has almost eliminated the amount of overheads we do on a general basis… So, now with PerfectServe, it has dramatically reduced the amount of overhead noise in the hospital.”

In addition to the reduction in noise from overhead paging, Good Samaritan Hospital noticed some other benefits:

  • The switchboard call queue decreased dramatically, which enabled the team to answer calls from patients and their families faster.
  • Nurses and other care team members took pride in learning the new system and even in teaching others how to use it.

About Advocate Good Samaritan Hospital

Advocate Good Samaritan Hospital is committed to providing clinically excellent, compassionate care. Through strong partnerships with outstanding physicians and nursing staffs, they are improving the health of residents in their communities and meeting the highest standards for patient care.

Over its nearly 40-year history, Good Samaritan Hospital has evolved into a recognized national leader in healthcare. The hospital was named by Truven Health Analytics in 2015 to the 100 Top Hospitals list, for the sixth time. It also is the only healthcare organization in the state to earn the prestigious Malcolm Baldrige National Quality Award, achieving the honor in 2010.

Good Samaritan Hospital features DuPage County’s only Level I trauma center, a certified Level III neonatal intensive care unit and Magnet® recognition for nursing excellence. A range of services are offered at the hospital, including cardiology, orthopedic surgery, general surgery, gastroenterology, stroke care, obstetrics and gynecology, low-dose diagnostic imaging and a comprehensive breast center. Good Samaritan Hospital is part of Advocate Health Care.

About PerfectServe

PerfectServe provides healthcare’s only comprehensive and secure communication and collaboration platform. The company’s flagship solution, PerfectServe, unites physicians, nurses and other care team members across the continuum and facilitates timely interaction among them.

PerfectServe automatically identifies and provides immediate access to the right care team member, enabling effective population health management through communication-driven workflows. More than 100,000 clinicians in organizations such as Advocate Healthcare, Ascension Health, Covenant Medical Group, Hoag, MemorialCare Health System, Orlando Health, St. Joseph Health and WellStar Health System rely on PerfectServe to help them speed time to treatment, promote physician alignment, enhance the consult process, increase transition efficiency, provide nurses more time for direct patient care and reduce HIPAA compliance risk.

Headquartered in Knoxville, Tennessee, PerfectServe has been serving the needs of forward-looking healthcare provider organizations since 2000.