| | Telephone Nurse Advisor Access Annual Update
Purpose
To improve telephone access to a nurse advisor.
Background
In 1995, Gundersen Lutheran implemented a 24-hour nurse advice line. The Pediatric Department provided a similar service to their patients during clinic hours. In July 1997, new computer software provided on-line access to established protocols and records advice given for both the nurse advice line and the pediatric line. These two services were fully integrated into the Telephone Nurse Advisor Line in April 1998. Several changes in processes have also affected the workload for the nurse advisors in 2000 including verification of demographics and insurance information, completing "Change of Insurance" forms for Patient Business Services, completing intake worksheets for Customer Relations, appointment scheduling for patients declining triage, and concerted efforts in scheduling pediatric patients with their primary care provider. During 2000, the call abandonment rate aim was decreased in order to coincide with the Gundersen Lutheran facility-wide standard. Beginning in September, 2000, TNA began taking off-call hours for peritoneal dialysis patients and two months later, began taking nurse advice calls for several Onalaska Family Practice physicians. A number of process changes occurred in 2002 that affected TNA workflow. These changes included a trial of having one TNA answer calls during peak times, taking messages and forwarding to appropriate staff; a simplified registration process with the Caller Registration Screen; a pilot study with a non-nurse assisting with incoming calls; and answering nurse advice calls for an additional three Onalaska Family Practice physicians. Finally, during the last month of 2002, PP+ replaced CyCare.
Aim
1. Achieve a Telephone Nurse Advisor Line service level of at least 80%.
2. Reduce the Nurse Advisor Line call abandonment rate to 5% or less.
3. Reduce the average delay in answering calls on the Nurse Advisor Line to 20 seconds or less.
Changes
January 2003: TNA began taking calls for the entire group of Family Practice - Onalaska MDs
April 2003: TNA began taking Pediatrics Home Care after-hours calls.
April 2003: Telephone Service Assistant role instituted.
July 2003: TNA began providing lab data to transplant patients.
July 2003: Began canceling appointments for additional clinic departments as part of Telephone Service Improvement Project.
September 2003: Telephone Service Assistant (TSA) hours adjusted to reflect call volumes
October 2003: Patient Contact access. After-hours message service available to departments with Patient Contact.
Methods/Measures
The Automatic Call Distribution (ACD) telephone system software collects:
Call Volumes - all in-coming calls (both answered and abandoned)
Number of calls abandoned - calls that coming into the system, but where the callers hang up before being served
Average delay in answering calls - average time in seconds that a call rings before it is answered
Service level - number of calls answered or abandoned within 30 seconds divided by total call volumes.
Results
Conclusions
Service level and speed of answer goals have been met or exceeded since Telephone Service Assistant role went into effect.
Next Steps
Implement changes associated with RN Role Redesign.
Revise voice message in an effort to decrease abandonment rate.
Continue to explore ways to increase value to GL system within budget constraints.
Continue to evolve toward a Contact Center.
Pursue Care Enhance, a system designed to assist telehealth agencies in managing patients’ symptoms and health concerns.
Team Leader
Bev Nelson, RN
Kathy Mydy, RN
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