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.
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.”