Methods

1. ED Overcrowding at 60,000 annual encounters (50% above capacity)

2. Medical staff use of ED to evaluate and write holding orders for evening admissions.

3. Multiple confusing routes for incoming calls, each with different processes

4. Lack of Hand-off communication among referring facility, ED and inpatient staff

5. Patients are accepted without notification of relevant responsible specialist

6. Unclear ED Diversion policy7. Inefficient Mental Health admission and

screening process8. Staffing and work flow inefficiencies among

Switchboard, Patient Placement, Call Line and Transfer Line staff.

• Regional Referral Transfer Volume (57% increase)

• Regional Referral Provider Satisfaction • Local Medical Staff Satisfaction• Total inpatient census• Total inpatient payer mix • Increased total inpatient census (>200

additional admissions per year)• Call Center expenses (28% reduction in total

expenses)• Improved Hospitalist Service and overall

inpatient Patient Satisfaction (satisfaction of inpatients admitted through ED increased from <10th %ile to 77th %ile)

• Hospitalist Service and overall payer mix and revenue

• CMS “core measures” compliance with reduction in rework required

• ED discharges against medical advice and patients left without being seen

• Improved ED overcrowding/delays (40% reduction in hours over capacity, 10.5% increase in overall ED capacity)

• ED throughput / ED patient satisfaction / ED capacity

• ED Patient Satisfaction • Avoidance of duplication of ED services and

charges• $1.3 million cost reduction through

elimination of the waste of idle resources, waiting and processing through consolidation of services between switchboard, transfer line, patient placement and call center functions

Introduction

0

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

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July ‘09 August ‘09 September ‘09

October ‘09

Regional Transfers

Begin Roll Out

Complete Roll Out

Incoming Call Strategy PASTEplus

Project Measures Scorecard FYE June 2010 Performance >= Goal Performance < Goal & Variance < 5.00%

Performance < Goal & Variance >= 5.00%

Baseline Benchmark Goal Jul Aug Sep Oct Nov Dec Jan Feb YTD

Conformance to Quality

1 Reduction in CHL Triage and Answering Phone Throughput

1

-Triage Throughput13.9 TBD by Pilot 14.4 12.3 13.3 13.6 13.6 13.0 13.4

-Answering Service Throughput6.0 TBD by Pilot 6.5 6.0 6.5 6.2 6.2 6.2 6.3

2 Volume of Transfers from the Region

364 311 344 362 304 360 2 2,045

3 Volume of Regional Transfers through Emergency Dept

62 36 11 9 8 7 3 133

4 Volume of Transfers Direct Admitted

45 23 83 98 78 108 81 4 435

5 New Patient Volume

12 11 32 32 35 43 5 165

Capacity YTD Savings

6 Increased ED Capacity due to Direct Admits in Minutes (ED Transfer Line)

2,275 4,383 12,689 12,386 10,237 13,983 6 55,953

6aIncreased ED Capacity in Beds due to Direct Admits (ED Transfer Line)

0.05 0.10 0.29 0.28 0.24 0.31

7 Increased CHL Nurse Capacity due to reduction in Triage Throughput in Minutes

-1,150 969 -486 -381 27 27 7 -994

Cost YTD Savings

8 Communications Rep Flex Variance FY09 Budget Base

- Expected$110,500 $13,731 $11,829 $12,068 $9,232 $8,065 $8,970 $8,932 $7,476 8 $80,303

9 Call Center Flex Variance FY09 Budget Base

- Expected$256,000 $5,677 $17,654 $10,549 $7,523 $6,741 ($18,077) ($9,407) ($4,510) 9 $16,150

10 Contribution Margin New & Recaptured Volume

FY09 Budget Base - Expected

$39,020 $58,928 $76,984 $158,426 $96,979 $220,528 $193,879 10 $844,744

11 Estimated Downstream CM New & Recaptured Volume

NA 11

12 Reduction in Paper Expense Patient Placement

FY09 Budget Base $4,000 12

13 Reduction in Shipping Expense Communication Desk

FY09 Budget Base $712 59 -18 -106 -45 -12 -6 -8 -14 13 -$149

14 Reduction in Catering Expense Communication Desk

FY09 Budget Base $380 16 16 16 16 16 16 16 16 14 $127

15 Reduction in Small Equipment Expense Communicaitons Desk

FY09 Budget Base $2,063 206 206 206 206 206 206 206 206 15 $1,645

16 Reduction in Maintenance Expense Communications Desk

FY09 Budget Base $1,618 16

17 Reduction in Dukane Expense Communications Desk

FY09 Budget Base $5,418 298 513 193 -1,458 -1,712 -98 -1,666 -2,604 17 -$6,535

A 59,006$ 89,127$ 99,909$ 173,899$ 110,282$ 211,538$ 191,952$ 936,285$ B 66,667$ 66,667$ 66,667$ 66,667$ 66,667$ 66,667$ 66,667$ 66,667$ 333,333$

Variance From Budget (7,661)$ 22,460$ 33,242$ 107,232$ 43,615$ 144,871$ 125,285$ (66,667)$ 602,952$

Projected Annual Savings: $800,000

Transition

Total Budgeted Impact

Solutions

Total Financial Results

Waiting on Implementation of Dual Monitors for Pilot Results.

Marketing developing Downstream Revenue Report

Developing Measurement

Developing Measurement

Heartland Regional Medical Center had unsuccessfully attempted to redesign the transfer process for regional referrals for over 10 years. This presentation documents a successful performance improvement initiative that addressed this issue.

The PASTE plus methodology was used which utilizes the following process:

PASTE plus uses the PASTE approach supported by formal Six Sigma Black Belt support staff.

Problem

AnalysisSolution

Transition

Evaluation

Opportunity Statement: Improve access to the Integrated Delivery System through a coordinated standardized incoming call process that is more efficient and cost effective.

Desired Outcomes Incoming Call Strategy :

• Increase Patient/Customer Satisfaction• Increase Internal Satisfaction• Increase local, regional and sub-specialty

provider satisfaction.• Decrease the cost per Incoming Call.• Create a model that anticipates capacity to

support preparation for Tele-Monitoring Services and potential CHIS revenue.

• Decrease the volume of inappropriate Incoming Calls.

• Ability to monitor Abandonment Rates and Avg Speed to Answer to meet Best Practice Benchmarks.

• Decrease volume of inappropriate call transfers.

Desired Outcomes Transfer Line: • Decrease Cost per Case and Revenue (elimination

of ER charges and prevention of unnecessary tests and treatments)

• Decrease LOS immediate workup.• Increase Patient Satisfaction• Increase local, regional and sub-specialty provider

satisfaction.• Increase Core Measures Compliance (Best Practice

Care)• Increase direct admission volume from regional

facilities by incorporating the Hospitalist program and the transfer line.

• Decrease Emergency Department departure Against Medical Advice and Left Without Being Seen rates.

• Reduction in duplication of work done by ED for patients that have already been evaluated.

• Increased ED Staff/Physician Satisfaction.1. Expansion of the Hospitalist program to allow

24x7 in-house coverage. This allowed transfer patients to be directly admitted to hospitalist thereby bypassing the ED.

2. Change in call center staffing mix from clerks to LPNs who were able to transcribe verbal admission orders for direct admits.

3. Redesign patient placement process to optimize value stream

4. Call Center consolidation

1. Extensive outreach to Medical Staff within the organization as well as regional referring physicians

2. Development of action plans with explicit deliverables and individual accountability.

3. Support from key Medical Staff leaders.4. Sufficient Hospitalist Staffing to support the

Transfer Line responsibilities 5. Ongoing voice of customer assessment with all

stakeholders to allow real time resolution of issues and process redesign to prevent recurrence.

Key elements of successful implementation included:

Our calling in life is life itself.

The results of the Performance Improvement initiative include the following significant improvements:

H3 CONSULTING LLC

Incoming Call Strategy / Transfer Line Redesign Performance Improvement Initiative

Philip J. Fracica1, MD, MBA, Kerri L Jenkins2, RN MBA and Michelle Hensley1, LPN

Heartland Regional Medical Center1, St Joseph, MO; H3 Consulting LLC.2

www.heartland-health.com