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Improving telephone management of patient clinical concerns.

137 Background: As the majority of oncology care is delivered in the ambulatory setting, patients and families require reliable and efficient ways to contact the care team with clinical concerns. The Abramson Cancer Center is comprised of 40 medical oncologists seeing over 100,000 annual outpatient visits. Press Ganey phone access satisfaction scores in the 12th percentile reflect patient dissatisfaction with phone communication. We initiated a pilot project to improve phone access.


METHODS
Baseline data was collected from 3 main sources of patient calls: intake office, administrative assistants, and triage RN's. Over 2,000 patient calls were tallied during a one week period documenting: time of call; live answer vs voice mail; reason for call; whether and to whom the call was transferred. A subset analysis of calls related to symptom/medication management (SM) was performed via EMR audit to determine: time to call resolution (TTR), % resolved within 2 hours, % documented in the EMR, and % answered live. The TTR of patient SM calls and % resolved in < 2hrs were calculated by comparing the time of call receipt per log to the time of closed phone encounter in the EMR. The percent of calls documented was determined by comparing the call log to corresponding EMR encounters. The percent answered live was determined by review of the call log. As a pilot test of change, all calls in one of the practices were forwarded to a single source (intake office) to ensure live answer. The staff was educated to create an EMR encounter for each SM call and then route the encounter to a clinical pool (RN, APP and MD). An automated report enabled monitoring of key metrics.


RESULTS
The goals set for the pilot project were exceeded for 2 of the 3 performance metrics (Table).


CONCLUSIONS
Within a complicated academic health system, we utilized our EMR and modified our phone triage system to streamline and reduce variation for management of SM calls. 62% of these calls were resolved within 2 hours, and the mean time to resolution of SM calls was reduced from 127 to 87 minutes. [Table: see text].