Issue link: https://beckershealthcare.uberflip.com/i/961245
169 PRACTICE MANAGEMENT THOUGHT LEADERSHIP Steal this idea: The call center that enables Erlanger to care for 1.5k more patients a year By Alia Paavola K evin Spiegel, FACHE joined Chatta- nooga, Tenn.-based Erlanger Health System as president & CEO in 2013, and under his leadership the system estab- lished a unique call center to streamline the patient transfer process. is innovative cen- ter has been a main driver of the health sys- tem's 15 percent net patient revenue growth and greatly improved Erlanger's market share, finances and payer mix. e seventh largest public health system in the U.S., Erlanger is an academic medical cen- ter comprised of six hospitals. Since fiscal year 2013, Erlanger has seen an average annual growth rate of 15 percent, which puts the organization "in the top per- centile nationally for nonprofit health sys- tems," explains Mr. Spiegel. Here, Mr. Spiegel and Senior Vice President and Chief Strategy Officer Mathew Gibson, PhD, FACHE, discuss the call center that has contributed to the health system's organic growth. Question: What is one pioneering idea you've implemented at Erlanger? Kevin Spiegel: One idea that has gained trac- tion and is responsible for our organic growth is called the Erlanger Regional Operations Center (EROC), a state-of-the-art disaster preparedness and transfer center and its auto-accept policy. Four years ago, a committee that included executive team members among others had an extensive discussion about how services ran. As an outcome of that conversation, we established, by protocol, admitting privileg- es for critical care nurses. We realized many community and rural hospitals, while they provide positive patient care for the commu- nity, were not always prepared to handle se- riously ill patients. So out of that discussion came the idea for a streamlined transfer pro- cess, where [rural and community hospitals] relied on us and trusted us to provide care. is is how EROC emerged. EROC, or the call center, improves the effi- ciency of patient transfers. At the Erlanger call center, critical care nurses actually answer the phones. We have from six to 12 certified nurses answering the phones in the call center at all hours of the day. It's a bank of operators, but they are critical care nurses so they have the medical information, bed board informa- tion and knowledge about which doctors are on call. e calls come into the call center and a telephone tree gets the call to the next available nurse. e nurse who answers the phone goes over the case with the sending doctor and the nurse accepts the patient on the spot. It is instantaneous. [e call cen- ter operates under] an auto-accept policy, meaning transfer requests are not denied. Aer nurses accept the patient, an air or ground ambulance is sent auto- matically to the rural or community hospital send- ing the patient. Once that process is complete, the nurse writes a comprehensive note detailing the conversation with the sending doctor. is note, which says whether the patient is arriving by air or ground and when the patient will arrive, is directly sent to the on-call doc- tor. e on-call doctor is then awaiting the patient's arrival so they can meet him or her in the surgical unit, directly in the patient's room or emergency de- partment, based on the patient's condition. In the new program, doctors are awaiting transfers - they are neither operating nor taking calls. ey are paid to be on call and to receive patients from the region. e call center logs the times of each call, logs when the patient came in and we trend on-call doctor's behavior and give them a scorecard based on those results. Q: What types of insights can be made from the data collected by the call cen- ter that is presented on the scorecard? Dr. Matthew Gibson: EROC is staffed with certified critical care registered nurses who must have a minimum of five years of bed- side nursing experience before qualifying for EROC. Our EROC RNs operate off of service line physician-approved algorithms for patient acceptance. e EROC RNs are measured by several metrics including: calls answered in less than six seconds, less than a 4 percent abandoned call rate, a hold time of less than 10 seconds and a time of call to pa- tient acceptance less than six minutes. Our accepting service line physicians have agreed to an auto-acceptance algorithm for patients, to expedite the transfer process. All transfer requests are reviewed by the EROC medical director and put through a multi-lay- ered quality assurance process to assure com- pliance with the auto-accept program. Any accepting physician can flag a transfer for quality assurance review if they feel there was an issue with the transfer. Q: How did the admitting process work before EROC was established? KS: Erlanger was the typical health system with an admissions office. Calls would come into the office or the ED and get routed by tra- ditional pagers to the doctor on call. Once the doctor received the page, the doctor would call the operator and the operator would say, 'Dr. Smith at XYZ hospital is trying to transfer a patient.' en the doctor would ask, 'What's his phone number,' and would call Dr. Smith to get the details. It was a doctor-to-doctor discussion. It didn't really have any parame- ters or rules. In this scenario, clearly the sending doctor was overwhelmed because his or her hospital couldn't properly care for the high-acuity pa- tient. But this traditional way of transferring a patient had setbacks, because the receiving doctor could've been in the middle of surgery, taking call at a different hospital or maybe just too tired aer receiving their fourth transfer Matthew Gibson, PhD Kevin Spiegel, FACHE