By Geri Hammes and Lora Foreman-Krall
The new 2009 influenza strain, H1N1, brought more than one challenge to those of us in the healthcare industry. Vaccine producers dealt with slow growth of cultures that delayed vaccine development and distribution. Populations more susceptible to the H1N1 virus seemed to be younger than those usually affected with seasonal flu in past years, necessitating different guidelines for vaccine administration. These factors, combined with a strained healthcare system often strained by limited resources, made for an interesting test of our skills. At Franciscan Skemp Healthcare Call Center in La Crosse, Wisconsin, we saw the pandemic as an opportunity to demonstrate to both those within our facility and within the community we serve what an important role call centers provide. Call centers are capable of playing an indispensable role during times of healthcare crisis.
Preparation: While no one can be completely prepared for an emergency, the influenza pandemic did give us a bit of warning as its spread was followed closely by the media and by the CDC (Centers for Disease Control). Our facility had a pandemic command center that discussed possible scenarios and ways to respond. As the number of influenza-like illnesses increased in our area, so did the call volumes. While a steady increase would have been more manageable, we literally saw call numbers double and then triple in a matter of a few days. The clinic and emergency departments also saw an increase in their calls. We needed to address the concerns of our patients, manage the call volumes, and still utilize what resources we had available to us in a cost-effective way. We wanted to accomplish this while maintaining patient and staff satisfaction. As a team and working with other departments within our facility, we chose three primary areas in which to focus our efforts:
- Educate patients regarding the facts about the H1N1 virus and dispelling myths that were adding to fears. We wanted to offer them an opportunity to speak with a registered nurse, give them many opportunities to ask questions, and discuss their concerns with a real human voice.
- Prevent the spread of the illness. We wanted to keep patients who did not need to be seen home with reassurance and support 24 hours a day. This was vital to allow maximum use of healthcare resources and available personnel.
- Be mindful of containing costs and utilizing the resources available to us within the institution.
To accomplish this, our call center activated a reserve line, “Calls to Action” (CTA) that is used for time-limited marketing and educational events. We designated the CTA line as our flu hotline to specifically address calls regarding influenza and influenza-like illnesses.
Increasing Staffing: We increased our RN staff during regular business hours in order to offload calls from our clinic departments, as well as our after hours call center. By doing this, we were able to allow our dedicated call center staff the time to take the more complex calls that routinely presented after hours, in addition to the CTA/flu hotline calls. We assimilated the new call center staff members from our PRN (the nurse pool) group of hospital nurses and then trained them according to guidelines we helped to develop using the latest information from the CDC, our state and county health recommendations, and our medical directors. Guidelines were specific for pediatric, OB, and adult patients. The goal was to make them easy to read and use no matter what RN answered the phone.
A phone script was also developed so nurses not familiar with answering the phone could have a guide as to exactly what to say. It was easily documented in our Cerner electronic medical record (EMR) system. The dedicated call center staff used the McKesson system for documentation, also part of the EMR system. This allowed each staff nurse to use their documentation system of comfort and still meet documentation needs efficiently and correctly. With some hard work and quick thinking, all of this was put into effect within a few days of the increase in call volumes.
As vaccine for the H1N1 arrived in our area, we were able to further utilize our call center. We advertised vaccination clinics using our already operational CTA line for scheduling of target populations. Callers were screened by an RN who answered questions regarding vaccinations. Then, callers were forwarded to arrange their appointments. A secondary line dedicated to just patient scheduling of appointments was established. Those receptionists who took calls from this line knew patients had all their questions answered and were easily registered. By answering questions first and then scheduling appointments, we could assess patient needs and determine staffing and vaccine supply for all our vaccination clinics. We were able to adequately supply all our patients as the vaccine was made more available.
As the local influenza outbreak began to resolve, we were able to decrease PRN staff and return to our dedicated call center staff. While this may look easy on the surface, this process was not without its share of problems. First, all call center nurses needed to become subject matter experts very quickly. We had a core set of documents, and we all utilized the same approved websites. While our PRN nurses all had an extensive knowledge base of nursing skills, we had to provide education on phone use and how to follow guidelines, often with little or no training time. We utilized core staff as resource personnel, and they were instrumental in making PRN staff welcome into the department and call center routines.
Internal Communication: Another problem we encountered was related to effective communication. As new updates were made available, our staff had to make frequent changes, sometimes within minutes, based on the most up-to-date information. Communicating those changes to everyone in an efficient manner was difficult. We found direct face-to-face communications at shift change the most beneficial for staff within the department. However, we also encouraged staff to check the CDC and our state health department websites specific for influenza updates because information was changing so rapidly. In addition, daily emails were sent by our supervisor with highlights regarding changes to protocols, target populations, and vaccine availability. All new updates were stored on our call center department website for easy reference.
Working with our hospital public relations department, we found having one centralized location with a small number of staff for communication allowed us to create a method to constantly assess what was happening in the public to better meet patient needs and modify processes based on those needs. It also allowed us to quickly identify problems within the system and make adjustments. We could then disseminate that to our outlying providers, clinics, and the public.
Conclusion: The pandemic in our area could have been a real disaster for both our patients and our staff. However, because we quickly mobilized resources and utilized available staff – including our flexible call center nurses – we were able to educate our patients using the latest information, calm their fears, and provide them appropriate access to medical services. By including staff not familiar with the call center into our department, we educated them to the role of the triage nurse. They gained a valuable insight and appreciation for our role. We assisted other departments by taking the flu hotline calls and freeing them for patient care. To our entire facility, the call center became a resource for the latest information regarding the pandemic and vaccinations. The Franciscan Skemp Call Center, while not in the forefront, became a central information location for both the public and our staff. Ultimately, it was the adaptability of our call center staff and the willingness of our organization to work as one team that made this entire event a success.
Geri Hammes, RN, BSN, is a call center supervisor and Lora Krall, RN, BSN, is a call center staff nurse at Franciscan Skemp Healthcare Call Center in La Crosse, Wisconsin.
[From the April/May 2010 issue of AnswerStat magazine]