Efficient scheduling of follow-up appointments plays a major role in gaining compliance from patients, and major scheduling delays understandably have a direct impact on patient satisfaction. Follow-up appointments are vital touchpoints where complications can be addressed with an eye toward preventing a potential readmission.
At the University of Tennessee Medical Center’s Catheterization Laboratory and Cardiovascular Recovery Unit, scheduling appointments involves communication with a few disparate entities, which include nurses, medical assistants and the cardiologist’s office.
That is where the complication arises, said Becky Newport, RN, nurse manager of the cardiac cath lab at the University of Tennessee Medical Center.
“Done manually, this communication chain started with nurses, who contacted medical assistants in the cath lab to let them know which patients required a follow-up appointment, and with which cardiologist,” she explained. “The medical assistant then contacted the cardiologist’s office to schedule the appointment, which almost always involved leaving a voice message. After that, the wait began for a callback.”
“When patients are ready to be discharged, it is understandably frustrating when the last box to be checked – confirming a follow-up appointment – gets delayed even though it seems like a simple task.”
Becky Newport, RN, University of Tennessee Medical Center
Sometimes a game of phone tag ensued, leaving hours, or even full days, between the time the patient was ready to be discharged and the time when the follow-up appointment was scheduled.
“When a patient was ready to go home and had waited too long for the follow-up appointment to be scheduled, they left,” she said. “Given that the Society for Cardiovascular Angiography and Interventions recommends all cath lab patients have their next appointment confirmed before discharge, UTMC knew it needed to eliminate as much of this scheduling delay as possible.”
PerfectServe, a secure clinical communication and collaboration platform, already was in place across University of Tennessee Medical Center’s facilities to enable real-time, interdisciplinary communication among members of the extended care team.
“The platform’s intelligent routing capability, which is built with customized algorithms made up of workflow rules, call schedules and contact preferences for every user, was tailor-made to alleviate the cath lab’s scheduling delays because it ensures you can get a hold of the right person at the right time,” Newport explained.
“Rather than conduct a series of calls that could take several hours to complete, the technology offered medical assistants at the cath lab the ability to send simple appointment request details to the person in the cardiologist’s office who was available at that time and could schedule a follow-up,” she said.
The patient experience element here is pretty obvious, she remarked.
“When patients are ready to be discharged, it is understandably frustrating when the last box to be checked – confirming a follow-up appointment – gets delayed even though it seems like a simple task,” she said. “By eliminating the guesswork of finding an available person and automating most of what used to be a manual process, the technology streamlined the discharge process by reducing waiting time for patients.”
Importantly, patients who leave without a confirmed follow-up appointment are less likely to schedule one, and show up for one, themselves; so improving this process had important implications for patient outcomes, as well, she added.
There is a variety of clinical communication and collaboration platforms on the market today. Some of the vendors of these platforms include Ascend HIT, Beekeeper, Halo Communications, LiveProcess, pMD, Spok, Telmediq, TigerConnect and Vocera.
MEETING THE CHALLENGE
The process of using the clinical communication and collaboration platform is simple, Newport explained.
“To coordinate the scheduling of follow-up appointments for discharge patients, medical assistants in the cath lab now use the PerfectServe web app on a computer to send all appointment request details to the appropriate cardiologist’s office,” she said. “Rather than picking up the phone, leaving a voicemail and ultimately initiating a game of phone tag, these medical assistants can now be sure that the platform will deliver a secure message with all relevant patient information to the exact person who can take action on that request at that moment in time.”
Going a step further, the platform also features an automatic escalation process to make sure no request falls through the cracks.
“If an appointment request is not acted upon within 30 minutes, a higher-level supervisor is notified through the platform and can step in to complete the appointment scheduling process,” she said. “Workflows like these were scoped out by PerfectServe’s implementation team ahead of time, so they were baked in to the process from launch, and the platform works by incorporating patient data from other systems like the EHR and staff scheduling tool.”
Newport points to two overarching success metrics associated with use of the clinical communication and collaboration platform.
“First, there’s almost never an instance where it takes more than 30 minutes for the lab to get a follow-up appointment scheduled,” she said. “Before the platform, getting a follow-up appointment scheduled could take all day, and often the patients would simply leave without an appointment. If you are a patient, the idea of waiting 30 minutes for a confirmed appointment versus waiting all day only to leave without an appointment on your calendar is a tremendous improvement.”
Second, the cath lab also has been able to track a significant reduction in the amount of time spent on coordinating patient follow-up appointments. In the first full year after implementation, the number of calls placed from the lab to individual cardiologist offices decreased by 4,000, resulting in efficiencies for everyone involved.
“It’s an obvious win for both sides in terms of time saved, and it’s had the side benefit of improving the working relationship between our lab and the cardiologist offices,” Newport added.
ADVICE FOR OTHERS
“It almost seems too obvious to state, but streamlined and secure follow-up appointment scheduling should be included as a best practice in any office,” Newport advised. “It really has worked well for us, and we’ve shared this best practice across our organization, including with nurse leadership, orthopedics and GI.”
Using a communication platform that already was adopted broadly by University of Tennessee Medical Center staff made the learning curve pretty small, and going with a technology that provides secure messaging, intelligent routing and built-in failsafe measures gave staff confidence that this process would improve results, Newport said.
“Think through your workflows,” she suggested, “consider the parts that can be automated, and pick the solution that will reduce the amount of work it takes to get your job done.”