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 And within hours of any given day, the ED’s list of on-call doctors is likely to be out of date.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.”