Katherine A. Olson, MSN, RN; Genevieve L. Bautista Young, MBA/MHA; Therese A. Johnson, RN; Shabana F. Pasha, MD; Francisco C. Ramirez, MD; Ryan A. Fix, MHA; Ryan M. LeCheminant, MHA; Rob S. Platou, MHA; Donald R. Henney, LPN Department of Medicine, Division of Gastroenterology and Hepatology – Mayo Clinic in Arizona

Define

Patient Education Card: Improving Patient Communication and Expectations

©2017 Mayo Foundation for Medical Education and Research

• Mayo Clinic is a multi-disciplinary practice with patients often scheduled for multiple appointments and tests each day across various specialties.

– The Division of Gastroenterology and Hepatology manages communication with patients through a busy centralized call center.

• A gap in quality communication and expectations between patients and providers regarding care plans and next steps was identified.

– Staff observed a lack of patient portal use, incoming calls which needed to be further directed to more appropriate departments, and available resources and expectations not being discussed with patients.

• The team identified and collected information from key stakeholders – providers, RNs, LPNs, medical practice secretaries, call center staff and patients.

– GI providers were surveyed on what they told patients about the call center, specifically related to when to call and for what.

– It was found that providers’ responses varied greatly from “call for anything you need” to no instructions given at all.

• Objective: Reduce the volume of messages classified as “other” to the triage nursing staff from 38% to 30% and improve patient portal use from 18% to 25% by October 30, 2016 without impacting staff stress and satisfaction levels.

ControlImproveMeasure Analyze

GIH Practice Optimization Education Card Baseline

Impact/Effort Grid

GIH Education Card

Education Card

Baseline vs.

Intervention Results

• Calls to the GIH call center, calls routed to the triage RNs through the electronic health record message center, and messages received from patients through the online patient portal were categorized into five categories: portal, sick, results, prescriptions, and other (scheduling, billing, insurance, medical questions, prep issues and testing).

• The original sample size was 981 messages over a three week period in June and July 2016 (12 days total). One full business week of calls was separated out and analyzed as well, for a total of 437 calls.

• Any calls that could not be classified were excluded from the sample size. “Unknown” was defined as a message that did not have any information in the subject line to determine the category of the call.

• Factors contributing to the gap in quality included: – No expectation set for patients (who, when, what number to call) – Patients only have one phone number – Providers instructing patients to call triage for anything they need – Scheduling, insurance, primary care questions – Limited time to determine reason for call

• An impact analysis was completed and determined that if patients expectations were better set upfront and specific phone numbers were provided for other support services (e.g. scheduling, patient accounts, pharmacy), it would decrease calls and messages coming into the department and streamline communication for patients.

• Additional rationale for selecting the patient education card intervention included: – Easy to distribute to high volume of patients – Low cost ($30 for 1,000 cards) – Limited impact on workflow

• Lessons learned include:

– Patients appreciated the information on the education card.

– Division knowledge of the initiative was crucial to the process.

– Physician leaders were crucial to gain buy-in for the process.

• The GIH patient education card was presented to mulitple groups throughout Mayo Clinic in Arizona.

• Several departments have reached out in an effort to develop education cards for their patients.

• This project significantly improved service delivered to patients. Educating patients on the appropriate resources available directly to them has made navigating Mayo Clinic easier and more streamlined.

Patient calls for wrong Directions unclear of whenMultiple Physicains reason to call

Physicians provide different Nothing visual given to patientMultiple MAs and LPNs information

Inappropriate expectations of To broad for reasonsstaff set by patients to call

Different people answering phone calls Workflow for who should Patients don't have any

receive call is unclear other phone numbersCall Volumes and Types of Phone Calls

Busy call center Lack of phone numbers Patient portal

Physician Buisness card Transferred Calls(contains 1 phone

Different types of practice number)enviroments GI Call Center

Patient portalMultiple practice sites

People Process Information

Enviroment Supplies Call Route

Division of Gastroenterology and HepatologyYour care team consists of physicians, advanced practitioners, nurses, and medical practice secretaries.Please use this information to help address any questions related to your Gastroenterology and Hepatology appointment.

Patient Online Services (secure web portal) – www.mayoclinic.org/onlineservices• View your test results and summary of provider visits• Send or receive a message from your health care team• Request, cancel or reschedule an appointment• Renew your medications

Test Results:• Please use the Patient Online Services Web Portal to view your test results • If results require urgent or immediate follow-up, a member of the care team will contact you• Please allow five days after completion of your last test before requesting results

Insurance and Prior Authorization Questions:• Please contact 480-301-8363

Appointment Scheduling and Rescheduling:• Gastroenterology office appointment – 480-301-7722• Gastroenterology procedure – 480-301-8228• If you need to reschedule your appointment, please contact us at least 72 hours prior

Prescription Renewals:• When no more refills exist, contact your pharmacy or submit a request through the Patient Online Portal• Renewal request may require up to 72 hours

MCS7648-02

Incoming Calls Directed

to Other Departments/

Divisions

Allied Health Staff Job

Satisfaction (Likert

1-5 Scale)

Allied Health Staff Stress Levels

(Likert 1-5

Scale)

Other Calls for GIH

Portal Messages for GIH

• Elements of the education card include: Introduction of GIH care team members; instructions on how to use and sign up for the patient online portal; service expectations regarding test results; and instructions for appointment scheduling, insurance questions, and prescription renewals.

• Education cards were distributed to patients completing GIH consultations, evaluations and follow-up visits.

• Check-in desk and LPN staff were educated on reviewing the education cards with patients during the rooming process, including providing the patient with patient portal sign-up and usage instructions.

• Physicians were asked to encourage patients to use the education cards.

Results

• Data from calls and messages at 30 and 60 days post implementation was analyzed.

• Data at 30 days post implementation (401 calls) demonstrated a decrease in “other” phone calls, an increase in portal usage, and a decrease in the number of calls related to results.

• Data at 60 days post implementation (416 calls) demonstrated a continued increase in patient portal usage and a decrease in “other” phone calls.

• Final results included a 12% decrease in the number of “other” phone calls and a 16% increase in patient portal use.

• Additional metrics and patient satisfaction scores will be analyzed throughout Q1 2017 to determine long-term impact on patient satisfaction.

Fishbone Diagram of Phone Calls by Type

Phone Call and Visit Process Flows