Consolidated call center corrects commander's concerns
June 22, 2009
- New system provides for answered calls within 90 seconds
FORT POLK, La. -- Col. George Giacoppe, commander of Fort Polk's Bayne-Jones Army Community Hospital, knew there was a scheduling problem at the hospital, but couldn't put his finger on - or as he put it, "quantify" - it.
"We were making appointments two weeks out, and if there were no appointments available, we were telling the patients to call back in two weeks," Giacoppe said. "If a patient needed to be referred to an LPN (licensed practical nurse) or RN (registered nurse), we'd jot the information down on a Post-it note and the next time someone in the call center was headed across the hospital, they'd carry it with them and pass it on. It wasn't a good way to do business."
Giacoppe said he thought two moves would help provide the "unmet needs" of BJACH's patients: put call center operators, appointment bookers and triage nurses in one room and hire more doctors and nurses.
"We consolidated our call center and immediately saw results," Giacoppe said. "We set a goal of having a patient's telephone call answered within 90 seconds, as well as only requiring them to make one telephone call. Our operators can transfer them to whomever they need to speak."
The consolidated call center made communication easier for patients, but did nothing to fill the shortage of doctors and nurses at BJACH. However, Giacoppe had a plan for that problem as well: sending patients downtown.
"The staff at MEDCOM (U.S. Army Medical Command) takes notice of where the money flows," Giacoppe said. "If we couldn't provide a patient with an appointment within two weeks we sent them to an off-post provider."
The first month the center was operational, Giacoppe said there was a 10-fold increase in the number of patients sent off post.
"Once MEDCOM saw we were sending that many patients off post - and that's where the money was going - we received approval to hire more doctors, physician assistants and nurses," Giacoppe said. "We haven't filled all of our available slots yet, but we're getting there."
When a patient calls the BJACH appointment system at 531-3011, a recording asks those who have a touch-tone telephone to press "1" and make their selection from the following choices:
Aca,!Ac Option 1 - For those who need an appointment or to speak with a triage (advice) nurse.
Aca,!Ac Option 2 - For those who wish to cancel an appointment.
Aca,!Ac Option 3 - For those who need a refill on their medicine.
Aca,!Ac Option 4 - For those who need their medication renewed or test results. Callers can also leave a message for their provider at this option.
Aca,!Ac Option 5 - For those who need authorization for civilian care.
Aca,!Ac Option 6 - For those who need an appointment with a specialist.
Aca,!Ac Option 7 - For those who need to speak with a patient representative.
At the first option, an operator determines whether the patient needs urgent or routine care.
"Calls go through us," said operator Susan Cannon. "We ask patients if they are calling for urgent or routine care; sometimes we help them determine what type of care they need."
If urgent care is needed, the patient is transferred to a triage nurse. RN Tracy Tidwell is one of the six RNs who currently man that line.
"We get calls that want same day appointments or are having difficulty getting an appointment," Tidwell said. "We also give medical advice if an appointment is not needed or the patient needs to go to the ER (emergency room)."
Tidwell said the RNs at the first option also do case management.
"We try to educate younger patients and parents on available resources," she said.
Supervisor Sandra Babineaux keeps an eye on things to make sure calls don't stack up.
"I have monitors that let me observe how calls are flowing," she said. "If the calls start backing up for the nurses, I let the operators know to just take down the patient's information and the triage nurse will return their telephone call."
If routine care is needed, patients are transferred to a booking clerk for an appointment or cancellation.
"We book appointments seven days out for routine care," said booking clerk Clarence Knight. "Well appointments - physicals and routine checkups - are made two weeks out."
Babineaux also shifts operators and appointment bookers as needed to help maintain the flow of patient calls.
If no appointments are available within the two-week window, the patient is transferred to a triage nurse. The triage nurse then attempts to set up an appointment with an off-post provider.
At option three, the patient is transferred to the pharmacy's automated refill line.
At option four, patients are transferred to an LPN.
"When a patient calls in, we find out what they need and forward the information to a provider," LPN Judith Martin said. "We call the patient back within two hours and let them know the provider has three working days to give them an answer."
Kathy Hooper, LPN, said it's important patients leave a good telephone number.
"If you don't leave a number, we can't get in touch with you," she said.
For those needing a refill on medicine, the LPNs get the information to the provider, who lets the LPNs know when the refill will be available. The LPNs let the patient know when they can pick up their prescription at the pharmacy.
For option five, patients are transferred to a managed care operator. RN Marianne Whaley said it is her job to ensure patients receive needed care when away from Fort Polk.
"We are referral management," she said. "We work with patients who are out of town, PCSing (permanent change of station) or on leave. We try to make sure everyone is taken care of."
For those who require a specialist, option six has nine additional options to choose from. Option seven puts the caller in contact with a patient representative.
RN Nona Key, chief of managed care operations, is in charge of referral management, the travel program and the call center staff. She said the consolidated call center has helped BJACH meet MEDCOM standards.
"The standard is to have patients speaking to a person within 90 seconds," she said. "The center has made things much more streamlined and is a single point of entry for patients to access care, same-day appointments, routine care, medicine refills, lab results and out-of-town help."
Key said the center handles about 800 calls a week.
While no system is perfect - "we've had dropped calls with the system we're using," Key said - the new system is an improvement.
"We can monitor and track patients better and provide help sooner," she said. "Most of the time we can resolve issues within 72 hours."
Mary Horne is chief of the clinical support division, in charge of administrative services for out-patient clinics and helps streamline services for patients.
"Everything is out is in the open and the staff can better work together," Horne said of the new call center layout. "It also allows us to shift people quickly to where they are needed."
Horne said one of the major improvements is that patients don't have to keep calling back for assistance.
"It's not perfect - yet," she said. "But it's getting better."
As proof that there is improvement with the new call center, patients have been quick to praise its employees. The following are just a few of the examples:
Aca,!Ac "This morning I called the appointment line to schedule an appointment for my son. I was pleasantly pleased and surprised with the new process. I heard about the changes in the Guardian and was skeptical. For the first time I was number one in the queue. My call was answered in less than 20 seconds and my appointment was scheduled. My Family and I have been stationed at Fort Polk for more than three years and I have never had an easier time making an appointment. Congrats to Colonel Giacoppe and the rest of the hospital staff. Whatever Colonel Giacoppe is doing, it's working. Keep up the good work."
Aca,!Ac "This is a 'pat on the back' for Kathy Hooper (LPN, medication renewal) at Family practice, a nurse/same day scheduler. I have spoken with her twice now and both times she was helpful, professional and pleasant. She is an asset to the hospital."
Aca,!Ac "I want to rate one of the medical advice nurses, Kristi Carver (RN, triage nurse). I had the opportunity to talk with her on two occasions prior to being hospitalized. She spoke very softly and with respect. She called me back promptly with appointments. She is a great asset to your team."
Aca,!Ac "I have dealt with this office many times over the course of the last couple of months. Heather (Ashworth, RN, referral management) was assigned to my case and did an excellent job of making me a priority. If she couldn't answer my question, she found it and got back to me immediately. She helped my specialist get referrals to other specialists needed for my care. Working with Heather and this office has been wonderful."
Giacoppe said the bottom line is patients receive better, quicker care.
"To get reform, you have to shine a spotlight on the problem," he said. "The consolidated call center has allowed us to do that. Because we were able to increase our providers, we have an increase in the number of available appointments. We've got the clinic space; we just needed the providers.
"As a result of the center, we've gotten a lot more support from MEDCOM, and that translates to better care for the Soldiers and Family members on Fort Polk."
The consolidated call center is open from 7 a.m.-4 p.m., Monday through Friday. It is closed on weekends and federal holidays.