Improving Patient Care through Technology and Best-in-Industry Process Improvements

 

Author:

  • Sharon Cartaya RN 1

1 Centene – Nursewise, St. Louis, MO

Program Description

Telephone triage begins with non-clinical staff (service representative) gathering demographic and symptomatic information from a patient to determine whether the call is an emergency or non-urgent. Service representatives use a “red flag” list to match patients’ issues to specific phrases or symptoms. This process can cause discrepancies. Symptoms often don’t match the database, causing service representatives to mark the status as a crisis to ensure patient safety and then warm transfer the call to nurses. As a result, nurses are inundated with urgent requests that may not be urgent, while trying to focus on caring for patients. With queues flooded with false-crisis calls, patients experiencing true crises may wait longer for nurse care. In order to solve the false-crisis calls issue, NurseWise developed a best-in-industry practice model in November of 2014.

This presentation describes the success of providing a best-in-practice method for service representative personnel to consistently and effectively identify true crisis calls.

Methods

Health Navigator was selected to provide non-clinical staff with a consistent, safer method of screening calls. The NLP engine takes unstructured narrative text and converts it to data to provide more organized and intelligent coded chief complaints. The NLP Engine also provides an acuity level for each coded chief complaint that assists in determining whether the call is crisis or non-crisis.

A process improvement plan was created by NurseWise Quality, Operations and Training departments, and frontline subject matter experts for continuous feedback and engagement. They provided recommendations to Health Navigator for the development purposes, to produce successful
outcomes, and give staff a methodical workflow.

Outcomes

The red-flag and instant message rate dropped from 39 to 14%.

Qualitative outcomes included:

  • Immediate staff delight – they feel they are able to provide more appropriate patient care
  • Patients experience less waiting time for nurses
  • Nurses able to provide better care because of less interruptions
  • Nurses able to better focus on the patients they are helping at the time
  • More consistency in identifying true crises
  • Reduced patient safety issues related to missed symptoms
  • Increased single-call resolution
  • Reduced attrition

Citation: Cartaya S.  Improving Patient Care through Technology and Best-in-Industry Process Improvements. Poster Presentation. American Academy of Ambulatory Care Nursing (AAACN) 41st Annual Meeting. 2016.