Bala Thara R
Department of Pediatrics, Section on Neurology, Baylor College of Medicine, Houston, TX.
Neurol Clin Pract. 2024 Apr;14(2):e200269. doi: 10.1212/CPJ.0000000000200269. Epub 2024 Mar 15.
Physicians strive to provide high-quality clinical care, yet after-visit patient telephone calls create extra demands on a clinician's time. Pediatric neurologists are particularly affected by this challenge given the number of patients with chronic illnesses they serve and the volume of worried parents they support. Added workload coupled with a busy office practice increases the likelihood of early physician burnout, which can have downstream effects on the quality of patient care and patient satisfaction. Using the IHI model for quality improvement (abbreviated QI moving forward), QI methodology was used to determine volume and key drivers of patient/family communications after a visit to a pediatric neurology clinic. Interventions aimed at reducing telephone messages by 15% over a 6-month period were put into place.
A baseline audit of clinic phone calls was completed in 2019 to develop an overview of after-visit communications. After-visit telephone calls and web-based portal messages were then tracked for 3-week periods in 2019, 2020, and 2021 to understand key trends. A key driver diagram of patient/family communications after a clinic visit was created, and interventions aimed at reducing telephone messages were discussed. These interventions included optimizing MD-RN workflows, synchronous and asynchronous educational initiatives, and changes to our clinic's voicemail phone tree. Our primary outcome measure was the average monthly telephone call volume, and this measure was tracked monthly from November 2020 through December 2022. Similarly, electronic portal message volume was tracked and served as our balancing measure.
Physicians, nurses, and patients were primary drivers of phone call volume. After interventions were in place, the average monthly call volume decreased by 30% from a baseline of 293 calls to 203 calls. This change was sustained for at least 1 year. The average monthly portal message volume remained consistent throughout the study period at 359 messages.
Both physicians and nurses agree that after-visit patient communication affects their workload. This study illustrates that QI methodology can be used to plan and implement interventions aimed at decreasing after-visit telephone calls.
医生努力提供高质量的临床护理，但诊后患者来电给临床医生的时间带来了额外的需求。鉴于儿科神经科医生所服务的慢性病患者数量以及他们所支持的忧心忡忡的家长数量，他们尤其受到这一挑战的影响。工作量的增加加上繁忙的门诊工作，增加了医生早期职业倦怠的可能性，这可能会对患者护理质量和患者满意度产生后续影响。使用医疗改进研究所（IHI）的质量改进模型（以下简称QI），采用QI方法来确定儿科神经科门诊就诊后患者/家属沟通的数量和关键驱动因素。实施了旨在在6个月内将电话留言减少15%的干预措施。
2019年完成了对门诊电话的基线审核，以全面了解诊后沟通情况。然后在2019年、2020年和2021年对诊后电话和基于网络的门户消息进行了为期3周的跟踪，以了解关键趋势。创建了门诊就诊后患者/家属沟通的关键驱动因素图，并讨论了旨在减少电话留言的干预措施。这些干预措施包括优化医生 - 护士工作流程、同步和异步教育举措，以及更改我们诊所的语音信箱电话导航。我们的主要结局指标是每月平均电话数量，从2020年11月到2022年12月每月对该指标进行跟踪。同样，对电子门户消息数量进行了跟踪，并将其作为我们的平衡指标。
医生、护士和患者是电话数量的主要驱动因素。干预措施实施后，每月平均电话数量从基线的293次下降了30%，降至203次。这一变化持续了至少1年。在整个研究期间，每月平均门户消息数量保持稳定，为359条。
医生和护士都认为诊后患者沟通会影响他们的工作量。本研究表明，QI方法可用于规划和实施旨在减少诊后电话的干预措施。
