IPC is a publicly traded company, founded by physicians, that consists of more than 300 hospitalist practices across the country. The Memorial City IPC practice covers the 426-bed Memorial City Medical Center (MCMC) in Houston as well as two long-term care facilities, two rehabilitation facilities, 10 skilled nursing facilities and several assisted and independent living facilities in the local area.
Escalating volume for practice
The Memorial City practice had seen a swift uptick in patient volume. In 2012, MCMC began distributing 50 percent of unassigned cases from the ED to the group, with the remainder assigned to physicians in the community. The practice expanded from eight physicians, adding 10 more physicians and two nurse practitioners. Since 2012, the proportion of unassigned ED admissions that the group receives had increased to 90 percent, as community physicians took fewer admissions. While the increased volume of patients was welcomed by the group, it emphasized some gaps in the practice’s existing communication processes.
Dealing with high-volume clinical communications
The Memorial City practice had used an electronic voice system with alphanumeric paging for years. Nurses or other callers would page and leave a phone number, and the physician would call back. However, with the expansion of the practice in 2012, this communication process became untenable. When physicians returned calls, they had no information about the caller or the facility, and often the person answering the call was unaware who had placed the page, leading to care delays and frustration. In addition, the group used a time-consuming phone-based process to update its call schedule.
The practice transitioned to a live answering service in December 2012. The group quickly found that the system was unable to handle the large number of physicians and the high volume of calls. Hold times were unacceptably long, frustrating nurses and physicians and sometimes causing delays in care decisions. “The live service didn’t have the staffing to keep up with the call volume. It was a nightmare, unacceptable for nurses and physicians,” says Jo-Ann Reilly, director of practice management and business development for IPC.
According to Steven E. Walker, MD, a hospitalist in the practice, the group needed a system that could reliably and efficiently manage the large volume of calls and be a secure method for physicians to communicate with each other. In addition, the group needed a process that could deal with the complicated call schedule of 20 care providers, a large number of facilities and multiple shifts per day.
Implementing PerfectServe to manage clinical communications
In 2013, the practice implemented PerfectServe to address its pressing communication needs. 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 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. 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 beforehand — PerfectServe stores this information and routes calls and messages accordingly. Data are housed securely in the PerfectServe cloud-based server rather than on the caller or recipient’s device, ensuring compliance with HIPAA regulations.
Addressing communication concerns with a streamlined process
PerfectServe has effectively and reliably handled the group’s large volume of calls and complicated call schedule. As shown in the figure, the practice’s volume of communication often exceeds 5,000 calls or messages each month. One hundred percent of communications are routed to the physicians, and many include a level of detail that was not possible with the prior communication methods.
PerfectServe utilization Memorial City
Timeliness of communication
In contrast to the hold-time delays with the live answering service, with PerfectServe, physicians receive and retrieve most calls and messages within five minutes (see figure). According to Reilly, nursing staff appreciate the rapid response time. “The nurses love that they can get a hold of doctors quickly. Calls are getting to the right doctor at the right time, which has helped streamline care.”
Securing communication between clinicians
With PerfectServe, physicians and clinical staff can share patient-specific information via a HIPAA-compliant process. Walker says that the group uses PerfectServe to ensure clear communication at transitions. “We can sign out to each other in a HIPAA-compliant way. For example, we send secure text messages when transitioning a patient from acute care to post-acute care, in addition to a verbal sign-out.” The hospitalist working the night shift can also easily ensure that messages in the early morning hours are forwarded to the physician who will be caring for the relevant patient. “Using PerfectServe ensures that the right physician gets the message after a patient is admitted by the nocturnist.”
Saving time with more efficient processes
According to Walker, PerfectServe saves the physicians valuable time because they can respond to many communications from nursing staff without a return phone call. For example, a nurse can send a physician a text message regarding a lab result, and the physician can enter an order through the electronic health record, which automatically notifies the nurse. In the past, physicians needed to place a phone call to respond to every call or page.
Walker says the biggest impact for him personally has been the ease of scheduling, which has also saved time. “The flexibility has allowed us to customize the process to fit the complexity of our group’s call schedule. We can manage all changes to the schedule easily, on the fly throughout the day.”
According to Walker, the only thing his group would change about PerfectServe is the date they implemented the service. “We wish we had gone to PerfectServe at an earlier time. It was such a struggle with the two prior systems. If we had known, we would have switched sooner.”