Milestone 17 Summary

Description: Practice has a system in place for patients to speak with their care team 24/7.


What does success look like?

0

1 2

3

After hours, practice has an answering system with a recorded message. Message may tell patients to go to an ER or leave a message for a call back in the morning. Practice uses a live answering service that takes messages from patients. Clinicians and care team members may call in for messages but time frames are not standard. The service does not use any triage algorithms. Practice uses a contract clinician or a nurse triage service that provides algorithm-driven advice to patients who call after hours but the service or clinician does not have any access to the patient’s records. Practice has a clinician available from the practice or on contract who can speak to patients after hours while being able to access the patient’s record.

Note: numbers are PAT scores


Why is this important?

Patient access to their care team is vital for care coordination and continuity. Since care needs do not always align with normal office hours, providing access to the care team at any time can increase likelihood of appropriate care, care continuity and patient satisfaction while reducing inappropriate use of medical services.1-3 When patients cannot access their provider, they often seek care at Emergency Departments (ED) for non-urgent conditions. ED visits are not only costly, but the care provided in an emergency setting is disconnected from the patient’s primary medical record, has an increased chance for duplicative testing, and lacks follow-up.4 By providing access to a member of the care team at all times, patients will avoid unnecessary use of the ED, be routed to appropriate care in a timely manner, and have continuity with their care team. Patients have reported increased satisfaction, in general, with no significant difference in patient perception of triaged care or accuracy of assessment received from either a nurse or physician.2,3 Enhanced access to the care team also benefits providers as there are fewer gaps in care, more effective follow-up, and more efficient use of provider time. With a rotating on-call schedule or the ability to contract with triage services, physicians can also reduce their workload demands and potential burnout. 1,3


Potential Tactics

  • Create a centralized call center operation to more efficiently manage patient calls
  • Maintain a patient portal and encourage its use by patients and families
  • Provide 24/7 access to provider or care team for advice about urgent and emergent care
  • Provide care team with access to medical record after hours
  • Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate small practices to provide alternate hours’ office visits and urgent care)
  • Use alternatives to increase access to care-team and provider, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers)
  • Provide same-day or next-day access to a consistent provider or care team when needed for urgent care or transition management
  • Implement a 24-hour nurse call line that is algorithm-driven
  • Partner with urgent care clinics

 


Tools and Resources

 


What might this look like in practice?

A practice set out to increase patient access by establishing a telephone triage system for patients to speak to a clinician during non-office hours. The on-call clinician triages the patient’s concerns and assesses their status using an algorithm. Based on the assessment, the clinician recommends an appropriate level of care and a time frame to complete next steps. Appropriate routes of care include: seek care at an Emergency Department immediately, seek urgent care, see provider for next day visit, home-care/self-management. All contact is recorded in the Electronic Medical Record and flagged for review and follow-up by an appropriate staff member the following business day. Based on the frequency and content of calls within a certain season, it is sometimes appropriate to deliver patient education to address any knowledge gaps (e.g., medication refills/concerns, pain, fever), potentially reducing the call volume.

 


References

  1. Safety Net Medical Home Initiative. Neal R, Moore LG, Powell J. Enhanced Access: Providing the Care Patients Need, When They Need It. Safety Net Medical Home Initiative Implementation Guide Series. 2nd ed. Seattle, WA: Qualis Health and The MacColl Center for Health Care Innovation at the Group Health Research Institute; 2013.
  2. O’Connell JM, Johnson DA, Stallmeyer J, Cokingtin D. A satisfaction and return-on-investment study of a nurse triage service. Am J Manag Care. 2001;7(2):159–69.
  3. Poole SR, Schmitt BD, Carruth T, Peterson-Smith A, Slusarski M. After-hours telephone coverage: the application of an area-wide telephone triage and advice system for pediatric practices. Pediatrics. 1993; 92:670-9.
  4. Stephen R. Pitts, Emily R. Carrier, Eugene C. Rich and Arthur L. Kellermann; Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s Office; Health Affairs 29, no.9 (2010):1620-1629; doi: 10.1377/hlthaff.2009.1026