Clinical advice services: Using lean chassis to optimize nurse-driven telephonic triage of after-hours calls from patients

47^th Global Nursing & Healthcare Conference

March 01-03, 2018 | London, UK

Eric Lee G Escobedo Wu, Amanda Wheeler, Nidhi Rohatgi, Nawal Johansen and Fouzel Dhebar

National Institute of Standards and Technology, USA
Colorado State University, USA
University of Colorado, USA
National Research Institute for Metals, Tsukuba, Japan

Posters & Accepted Abstracts: J Nurs Care

Abstract :

It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support afterhours. CAS is founded on key lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g. appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 2,28,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls were escalated by CAS nurses to the physician on call. An average of 5% of patients were triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success, while striving for continuous improvement.

Biography :

Fouzel Dhebar is Administrative Director of Navigation Services at Stanford Health Care As an integral leader at Stanford Health Care and formerly Lucile Packard Children’s Hospital at Stanford, Fouzel has lead operations and strategy in the Physician and Patient Relations arenas as well as other key ancillary areas for over 20 years now. More recently, at Stanford, she is responsible for the operational oversight of Navigation Services within the Patient Experience Office. Programmatic services include; general and site-specific Information Desk services, specialty/high touch navigation services to include International Medical Services, Special Patient Services and Aging Adult Services, clinical navigation services to include Clinical Advice Services, Enterprise Discharge Call and Clinical Navigation Services extended to Corporate Partners.  As a core administrator she has driven clinical and operational effectiveness priorities, electronic medical record/ CRM optimization, management systems development and implementation, benefits and outcomes achievement, workflow redesign, physician engagement, community and corporate partnerships, global long range strategic planning, and change management.  Additionally, Fouzel is adjunct faculty at the University of San Francisco, where she lectures on Leadership Development and Human Resource Management. She has also held consulting and senior advisory roles with the National Health Services (NHS) at the South West London Improvement Academy, the Ministry of Health in Pakistan and Shaukat Khanum Memorial Cancer Research Hospital in Pakistan. Fouzel holds a double Masters, a MSc in Socio-Economic Community Health Development from the London School of Economics, a MPA-HSA from the University of San Francisco, and a BS degree in Organizational Development from San Francisco State University.