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Should We Worry about Physician Burnout?



How Telephone Triage Call Centers Can Help

By Shannon Bays-Crockett

When studying worrisome symptoms among physicians and mental health workers in the 1970s, Herbert Freudenberger, a German-American psychology, coined the term burnout. HHS described professional burnout in 2017 as an occupational hazard that could lead to high-quality healthcare professions leaving the practice of medicine. By 2017 physicians reporting frequent or constant feelings of burnout totaled 51 percent—up from 40 percent in 2013.

The Center for treatment of Anxiety and Mood Disorders reports that physician burnout is growing in the United States. One in three physicians experiences physician burnout at any point in time. Compared to other professions, physicians are fifteen times more likely to experience burnout. About 45 percent of physicians report that they would quit the profession if it weren’t for the money. Approximately 400 physicians commit suicide each year. Those numbers emphasize the need to quickly address the burnout issue.

Physician burnout symptoms seem to mirror indications of other stress disorders, but there are also distinct differences. Dr. Dike Drummond, author of the blog “The Happy MD,” talks about physician burnout in his article “Physician Burnout and the Four Phases of Compassion Fatigue” (blog post #297) when he says, “Losing the ability to feel empathy, sympathy, and compassion for your patients is a constant risk for all of us.” 

Nurse triage call centers help physicians achieve work/life balance by reducing or eliminating after-hours and on-call requirements. Click To Tweet

Physician burnout symptoms might include:

  • Physical and emotional exhaustion that leaves physicians worn out and unable to recover during downtime
  • The development of a cynical and negative attitude regarding work and patients
  • A reduced sense of purpose along with a feeling that what they’re doing has little to no meaning or value

Ashley Altus, a writer for The DO for the American Osteopathic Association (AOA), reported on Dr. Octavia Cannon’s talk to the January 25, 2018, AOA LEAD (Leadership, Education, Advocacy & Development) Conference in Austin, Texas. Dr. Cannon challenged physicians to teach students and residents about the importance of life outside of medicine. “Encourage them to take time for themselves,” Dr. Cannon said. 

Dr. Cannon continued to discuss how stress for young physicians is at its peak during training in medical school and residency, citing Medscape’s 2018 National Physician Burnout and Depression Report in which data suggested that 42 percent of physicians reported symptoms of burnout. Ms. Altus reported on five key takeaways.

1. The highest rates of burnout occurred in critical care medicine, neurology, family medicine, OB-GYN, and internal medicine. The lowest burnout rates appeared in the specialties of plastic surgery, dermatology, pathology, ophthalmology, and orthopedics.

2. More than 50 percent of physicians feeling burned out noted that a contributing factor was that they had too many bureaucratic tasks, such as charting and paperwork.

3. Patient care declines when physicians suffer from depression. Approximately one-third of physicians reported that they are easily exasperated, and 32 percent reported that they were less engaged with patients because of depression.

4. About 50 percent of physicians reported that they cope with burnout through exercise, while about 46 percent talked with family members and close friends, and about 42 percent coped by getting more sleep.

5. Physicians are split on possible solutions to burnout. About 35 percent favored reduced financial stress through increased compensation. About 31 percent favored a more manageable work schedule and on-call hours. And about 27 percent felt that decreased government regulation would be the most popular suggestion.

Senior news writer for the American Medical Association Sara Berg suggests that medical students might consider the inherent or potential stressors of a specialty as part of their decisions about the specialty they want to practice. In a recent survey about burnout and depression, more than 15,000 physicians from twenty-nine specialties provided responses that indicated 42 percent of respondents were burned out, which was down from 51 percent the prior year. 

The rates of burnout among medical specialties are:

  • Critical care: 48 percent
  • Neurology: 48 percent
  • Family medicine: 47 percent
  • Obstetrics and gynecology: 46 percent
  • Internal medicine: 46 percent
  • Emergency medicine: 45 percent

Addressing Physician Burnout 

Private practice physicians have similar issues. Imagine the pediatrician at a daughter’s dance recital or a son’s football game, and the phone rings. The caller is the worried parent of a child who is spiking a fever. The physician is torn away from the family activity to advise the child’s parent. The doctor becomes frustrated by missing his own child’s big moment in the spotlight and can’t get that back. Somebody loses out, and the choice between duty, frustration, and guilt is not an easy decision. 

Physicians list the top stressors to be bureaucratic tasks, heavy workloads, computerization, and working around the clock.

In their article, Adams and Loftus discuss steps that Emory University’s GME program, the seventh-largest GME program in the country, has taken to prepare future physicians. Highlights of the Emory program are.

Pay Attention: Stress often takes a silent toll. Physician wellness improvement programs can be implemented at worksites.

Fill the Tank: Stress is cumulative and must be managed early and continually. Ensure that staff takes time for meal breaks, makes priorities of time with family and vacations, exercise, eats properly, and sleeps enough hours to restore the body and mind. 

Boost Empathy: Ensure that psychological and/or spiritual support is available for physician and nursing staff when disasters, both big and small, happen. Adams and Loftus offered this from George Grant, a psychologist and theologian: “A major cause of physician stress and burnout is ‘empathic’ imbalance. Most clinicians, to devote the fullest attention to patient and program, are taught to suppress their own concerns and feelings.”

Champion Wellness: Just as physicians tell patients to eat better, exercise, quit smoking, and find healthy ways to relax, the message needs to be passed along to other physicians and medical colleagues.

Strengthen Compassion: Research has proven that compassion is not an inborn trait. It can be taught and strengthened through instruction.

Restore Joy: The Blue Ridge Academic Health Group report, an annual publication, stated in one of its recent issues: “We pay a staggering cost in lost productivity, risks to mental and physical health, eroding quality and safety, diminished patient satisfaction, staff turnover, and lost dollars. 

“At the extreme [is the] personal toll of depression and suicide…. When joy is lacking and burnout is present, the stakes are high.”

Healthcare Call Centers

One popular solution—after-hours telephone triage—works well to achieve all the above goals as well as serve the needs of anxious patients. Nurse triage call centers help physicians achieve work/life balance by reducing or eliminating after-hours and on-call requirements by offering patients telephone access to advice that is based on guidelines established according to preferences of each provider’s practice. All patient calls are triaged using evidence-based guidelines and are directed to the appropriate level of care. All call records are forwarded directly to the patient’s care provider so they are available the next business day.

By partnering with accredited health call centers for after-hours telephone triage, providers can enjoy their professional as well as their private lives. Other benefits of afterhours nurse triage are reflected in improved physician recruitment and retention, as well as a more satisfying patient/physician encounter when the physician is rested and refreshed. 

Shannon Bays-Crockett is a strategic communications specialist with AccessNurse.

Use Telehealth to Extend Healthcare and Save Money



By Nicole Limpert

Sometimes a simple visit to your doctor’s office can be more complicated than expected. Typical doctor office hours are 8:00 a.m. to 5 p.m., Monday through Friday. However, symptoms and complications from being sick don’t adhere to business hours.

It can be a challenge for people who live in rural areas just to have access to a local medical facility. Often going to a doctor appointment means time off work for travel to and from the medical office. Those with limited mobility experience similar obstacles, no matter where they live, because traveling is a time-consuming endeavor.

With the help of technology, telehealth makes healthcare more accessible by bringing medical services to the patient.

What is Telehealth?

The Health Resources Services Administration (HRSA) defines telehealth as, “The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”

One of the most common forms of telehealth is a Nurse Hotline. Most U.S. health insurance companies offer a toll-free nurse advice hotline to their customers. Other types of telehealth services include:

  • Virtual Appointments: Patients can visit a doctor or nurse via online videoconferencing or using a web-based question and answer portal.
  • Medical Staff Consults: Telehealth isn’t only for patient/doctor communication. Doctors, nurses, and specialists use virtual consultations to coordinate care for their patients.
  • Remote Health Monitoring: Communication between patient medical devices and doctors. Patients can use home monitoring equipment, wearable devices, or apps to wirelessly communicate various health readings to their doctor or medical care team.
  • Non-Clinical Services: Telehealth also refers to remote, non-clinical uses such as, administrative meetings and provider training and education.
With the help of technology, telehealth makes healthcare more accessible by bringing medical services to the patient. Click To Tweet

Removing Barriers to Healthcare

Telehealth not only makes access to healthcare easier for the public, it has also proven to be a necessity for both large organizations and niche markets.

Members of the United States military, and their families, are stationed all over the world. The Department of Defense’s (DOD) Military Health System (MHS) provides healthcare to more than 9.4 million people through a network of fifty-six hospitals, 365 clinics, and other facilities worldwide. Telehealth programs connect military patients to providers across the world to deliver direct access to quality healthcare, tele-radiology, and tele-pharmacy services.

The United States Department of Agriculture (USDA) is heavily involved with providing telehealth services to rural communities and administers telecommunications telehealth grants through two major programs: the DLT Program and the Community Connect Program. Similarly, the United States’ Indian Health Service uses telehealth to assist with accessing health services for American Indian and Alaska Natives populations who live in outlying communities.

Other isolated, niche markets use technology to improve healthcare. Alaska’s Maritime Industry uses a telehealth platform to enhance access to care for those who work in the dangerous waters off Alaska. Internet connections are unreliable, so they primarily use a phone-based system to instantly connect with doctors. The Federal Bureau of Prisons (FBOP) uses telehealth to expand their internal healthcare program by consulting with external healthcare providers via collaborative practice agreements.

Telehealth and Medical Call Centers

Regardless of where people are located, telehealth is a critical tool that brings the best possible care to patients. Medical call centers play a significant role by providing the technology and medical expertise needed to bring remote healthcare to patients.

Technology enables medical call centers to effectively become an extension of a hospital or medical center’s operation. The communication software used by medical call centers can securely access a patient’s electronic medical record (EMR), update EMRs with notes, and record calls needed for insurance claims and workmen’s compensation. Because everything is documented, detailed reports can be generated for reporting purposes.

Medical call center operators can coordinate care, make follow-up calls, schedule visits, contact on-call medical staff, and manage referrals. Some healthcare call centers staff licensed medical professionals who are qualified to make health assessments, give medical advice, and escalate critical concerns.

The services provided by medical call centers are available 24 hours a day, 7 days a week. Medical operators can work different hours and be located anywhere in the world, in any time zone. For example, if a medical center on the east coast of the United States is closed, operators on the west coast are still available.

Telehealth Benefits Hospitals

In the 2017 American College of Healthcare Executives’ (ACHE) annual survey, hospital CEOs ranked their ten biggest challenges for the year. Telehealth services can address six of these ten concerns. Specifically, financial challenges (first), personnel shortages (third), quality of care (fourth), patient satisfaction (fifth), access to care (seventh), and population health management (ninth).

Multiple small and large-scale studies cite the use of telehealth as a cost-effective method to deliver quality care, improve outcomes, enhance the patient experience, and expand access to healthcare. The patient’s experience with their healthcare team plays a critical role in their satisfaction. Patients are asked to provide information about their care experience via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Unacceptable survey results can result in hospitals losing some reimbursements. In 2017 alone, approximately 1.7 billion dollars in reimbursements were withheld from hospitals.

The cost savings are also passed along to patients. Call center data from Health Navigator cites the top five reasons for calling a nurse hotline are fever, vomiting, stomach pain, cough, and head pain. Less than 10 percent of the cases were high risk. On average, telehealth appointments for nonemergency reasons cost approximately 45 dollars, as opposed to 100 dollars for an in-person visit at a doctor’s office or 160 dollars at an urgent care clinic.

The Future of Telehealth

The population growth for the United States, from 2008-2030, is estimated at 20 percent, totaling 363 million people. This spike in population will exacerbate an already strained shortage of healthcare professionals. Telehealth services may become more of a healthcare necessity rather than a convenience.

As technology advances, telehealth can become more complex by not only connecting patients with expertise in real-time, but also enabling computer assisted medical procedures in remote locations by specialists thousands of miles away, creating global care teams for patients.

1Call, a division of Amtelco

Nicole Limpert is the marketing content writer for Amtelco and their 1Call Healthcare Division. Amtelco is a leading provider of innovative communication applications. 1Call develops software solutions and applications designed for the specific needs of healthcare organizations.

Vendor Spotlight: 1Call, a Division of Amtelco


Our mission: Working together to provide the very best communication product solutions, backed by the best support available.

Since 1976, Amtelco has provided innovative communication solutions to call centers around the world. In 1997, the 1Call Division was formed to offer enterprise-wide clinical communication solutions designed specifically for healthcare organizations. 1Call is dedicated to serving the unique call center and communication needs of healthcare organizations, helping improve communications between patients, physicians, and staff by connecting people and information. Amtelco has received twenty-eight patents, covering a wide range of communications processes.

Hospitals and healthcare organizations around the world turn to 1Call to solve their medical call center, answering service, on-call scheduling, call handling, secure messaging, voice processing, conference calling, and automated integration engine notification needs. In an independent survey, 100 percent of the respondents said they would highly recommend Amtelco and 1Call to another healthcare organization.

Five-Star Service and Support

AvvCustomer advocates, solutions architects, and product managers are available to help customers and answer questions before, during, and after the sale.

1Call has a reputation for complete, professional system support, offering training, installation, and technical support staff on call on a 24-hour basis. When customers need assistance for their call center solutions, 1Call’s customer support staff provides fast and reliable service.

1Call understands that every healthcare organization has unique needs. Click To Tweet

1Call’s customer support staff includes implementation specialists, installers, project managers, and technical support staff. The customer support staff has an average tenure of over fifteen years, which is virtually unheard of in technology and IT businesses. All support staff members are in the United States. While many of the staff members are in the Midwest home office, there are several regional offices around the United States.

Help When Needed

When help is needed, it’s just a phone call away. 1Call customers can also email the support team or access the exclusive online TechHelper tool, where documentation, manuals, videos, and many more training tools are available. TechHelper is available 24-hours a day, with unlimited access. Emergency assistance for 1Call systems is available 24-hours a day, 365-days a year.

Software upgrades are included with support agreements, helping ensure that 1Call customers always have access to the newest features.

In an independent customer satisfaction survey, 97 percent of the respondents said the Amtelco and 1Call service and support was excellent (Amtelco Satisfaction Research Study conducted by TMA+Peritus, February 2015). 1Call looks forward to partnering with more healthcare organizations to provide this same level of service.

Solutions That Work

1Call features a complete line of modular solutions specifically designed to streamline enterprise-wide communications, eliminate errors, and reduce training time for new hospital call center operators. All the specialized 1Call solutions save an organization’s limited resources, making each organization tremendously efficient, enhancing the patient experience, and improving their bottom line.

Each 1Call solution comes with the benefit of Amtelco’s forty plus years of experience in the field of call handling and messaging. Thousands of 1Call and Amtelco systems are in operation around the world, 24-hours each day.

Easily Customizable

1Call understands that every healthcare organization has unique needs and that they sometimes receive unusual requests from physicians and departments. That’s why 1Call offers powerful solutions that are easy to customize by the customer. Customers have access to a wide variety of administrative functions, including the ability to customize scripts for any department, with individual scripts for every physician, if needed. 1Call also has a scripting team that is available to assist customers with any specific requests.

Why Choose 1Call?

Hospitals continually recommend 1Call solutions to other healthcare organizations. So, more healthcare organizations continue to switch to 1Call. And it’s no wonder. With all the customizable hospital call center solutions available, the high levels of customer satisfaction and quality support services, 1Call is in a class by themselves.

What do customers say about moving to 1Call? Here’s one example: “It was a great decision switching to 1Call. The 1Call technology is innovative. It’s easy to learn, and it really seems to mold around what the particular needs of our hospital are. Everything runs so much more smoothly now. I think it’s also worth noting, the customer service: great. We couldn’t be happier.” Read more at www.1call.com/support/customer-service.

Strong Partner Relationships

Hospital CIOs and CTOs are under tremendous pressure to do more with smaller budgets and staff. It’s paramount that they have a reliable health communications IT partner. 1Call forms solid partnerships with their customers. Each organization is encouraged to work closely with the 1Call team of consultants and engineers through each phase of system planning, configuration, and implementation. This helps ensure that the 1Call systems are at their optimum performance levels to meet all the communication needs of their organizations.

1Call also works closely with key technology partners to provide organizations with the solutions that best fit their communication and technology requirements. 1Call’s partners integrate at a high level with the call center, on-call scheduling, HIPAA secure messaging, alarms management, and emergency notification solutions to produce a comprehensive solution that satisfies the needs of each organization.

The 1Call technology partnerships include:

  • American Messaging
  • Apple iOS Developer Program
  • Avaya DevConnect Community
  • Black Box
  • Bluestream
  • Cisco Solution Partner Program
  • Cisco Developers Network
  • Copia OEM Partner
  • GENBAND Partner Program
  • Google Play Developer

  • Health Level 7 International (HL7)
  • HISCALL
  • Interactive Intelligence Global Alliance
  • Interbit Data
  • Microsoft Developers Network
  • Mitel Solutions Alliance
  • NEC UNIVERGE Solutions Partner Program
  • ProScheduler
  • QGenda
  • SAP OEM Partnership Program
  • ShoreTel Innovation Network Alliance Partner
  • Spectralink Application Integration and Management Solvers Program
  • Unify (formerly Siemens) Technology Partners – Advanced Level Status
  • Vocera Solution Partner Program
  • Windows Development Center Member

One Company, One Solution

The development and customer support teams are in the “Innovation Way” hallway at the Amtelco and 1Call home office. These teams work together closely, and when a question arises, it’s a quick walk down the hallway to find the solution. One company, one solution, proudly located in the USA.

Recent Innovations

As customers have come to expect, Amtelco and 1Call continue creating innovative solutions. In addition to frequent enhancements to Intelligent Series, soft agent, and miSecureMessages, the newest innovations are MergeComm, Genesis, and miTeamWeb.

The MergeComm Integration Engine

MergeComm automates communications throughout an organization, speeding response times to help organizations provide better patient care. MergeComm takes an incoming message and uses a script to determine who needs to receive that information. MergeComm can receive a message from a wide variety of sources, including alarms, alerts, HL7 messages, nurse call, severe weather alerts, TCP, WCTP, and web services. Notifications can go to an individual, to an entire group, or to the current on-call personnel. Notification methods include email, miSecureMessages, IP phones, pagers, phones, smart devices, SMS, and Vocera badges.

The Genesis Software Switching Solution

Provides the Intelligent Series applications with advanced software-based telephony. Genesis provides an all-inclusive call center solution with ACD, call management, reporting, and call center applications based on the Intelligent Series. A few of the many benefits of Genesis include reducing the need for hardware, virtualization of the switching platform, integrating with SIP-enabled PBXs, connecting remote agents, and automating overhead paging.

MiTeamWeb is a Web Interface

Hospital staff uses miTeamWeb for fast online and mobile access to on-call schedules, messages, directories, and status. MiTeamWeb is available using secure browser access from a PC, smartphone, or tablet.

The Future

1Call, a division of Amtelco

As technology continues to evolve (and everyone knows it will) and as customers have new communication challenges, rest assured that 1Call and Amtelco will continue to develop new innovative solutions, as they have for over forty years.

Offer Learning Opportunities to Better Retain Staff



Everyone Wins When You Provide Strategic Training for Your Staff

By Peter Lyle DeHaan, Ph.D.

Author Peter Lyle DeHaan

We’ve looked at five tips to better retain call center staff. The first two addressed agent compensation and agent benefits. Now we’re going to look at learning opportunities.

Today’s entry-level workforce values jobs that allow them to grow mentally. Educational opportunities provided at work, or through work, help to better connect employees with the job they do, increase their job satisfaction, and lengthen their tenure.

Not only are learning opportunities a wise retention tactic, it’s also a smart recruitment tool. Many workers so value learning opportunities that they’ll take a lesser-paying job if it provides the chance to grow, versus a higher paying position that doesn’t.

Here are some learning opportunities that you can offer to your staff.

In-House Training

Delivering internally produced training to your staff is a cost-effective way to provide the learning opportunities they crave. This can be unstructured teaching offered as needed or more organized educational offerings. The best thing about developing in-house instruction is that you can tailor it to the specific needs of your call center.

Possibilities include one-on-one training, classroom scenarios, and management coaching. You don’t need to provide all these options or offer them to all employees, but the smart move is to offer some in-house training to those employees you want to keep or groom for promotion.

Local Seminars

More general business training is available in the form of local seminars. These are usually half-day or full-day events. And since they’re local, there’s little expense beyond the registration cost. Not only do these provide important skills your staff can apply to their work, it’s also a way to increase their job satisfaction and enhance their self-esteem.

Industry Events

Don’t forget industry conferences and conventions. These include both those that are healthcare related and those that are call center related. If they cover both, that’s a bonus. These opportunities, of course, are more expensive. Registration for conferences and conventions carry a higher fee then local seminars, plus there’s also travel costs involved, which can add up. Therefore, reserve attendance at industry events for employees in management or on a management track.

Formal Education

Next on our list is post-highschool education, usually through college courses. Though this can be towards degree fulfillment, a better solution is to pick specific classes that will directly benefit your call center. Be sure to look for opportunities to audit the class. Although this won’t result in any credentials for employees, it could reduce or eliminate the cost for the class.

For these last three options, formal seminars, industry events, and formal education, you may want to ask participants to report what they learned to their colleagues. This has three benefits. One is that it reinforces what they learned. The second is that it allows others in your organization to also benefit from it. Third it enhances the employees’ self-esteem.

Develop a Career Path

To further enhance the value of these learning opportunities, integrate them with a career path for employees who you feel have the potential to advance in the organization. This includes both those who you see in various future supervisory roles, as well as managerial positions and support staff functions. When employees see the potential that awaits them from these learning opportunities, they will stay with your organization longer and provide increased value while they’re there.

The Benefits of Providing Learning Opportunities for your Staff

Not only will these learning opportunities extend staff retention, they’ll also increase job satisfaction and improve performance. However, most importantly, as you train employees to do more, they become a more valued resource for your healthcare call center.

Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat. He’s a passionate wordsmith whose goal is to change the world one word at a time.

Five Tips for Hospitals When Purchasing a Secure Messaging App



By Tom Curtin

Hospital communication systems are complex. Yet, many hospitals select one communications method, secure messaging, in the hopes that a texting solution or an app is going to be their panacea.

When hospital staff research communications companies in the healthcare space, they may not realize that while these businesses offer texting products, that is all they offer. Having just that one part of a communication solution, which involve systems and software from other departments, will not support what hospital care teams need to deliver a great patient experience.

The goal of every hospital is to provide the best care in the most efficient way possible to their patients. Having a secure messaging app is important, but it is only part of an effective communication protocol. It is paramount for hospitals to have a holistic communication platform so that a secure messaging app can access EHR, integrate with other communication systems, and take advantage of known data to provide reports.

Hospital medical and IT staff should consider the following key questions before selecting a secure messaging app.

Having a secure messaging app is important, but it is only part of an effective communication protocol. Click To Tweet

1. Will the app deliver messages to the right people, at the right time?

Be certain the app can integrate with your hospital’s on-call schedules. Everyone needs to be able to find the staff or care team they need in an instant and contact each person how they prefer.

2. Is it easy to integrate the app with multiple systems?

Do your patient room systems, as well as your EHR, communicate with your care teams? Then your app should too. Does the app support API integration to your nurse call and alarm systems so it can send critical messages to the right staff? Maintaining multiple systems takes multiple people, which lead to working in silos. Therefore, the app needs to provide simple architecture so it’s easy to implement and maintain.

3. Is the app easy to use?

The app needs to have features that are easy to use so training is fast and simple. Losing time spent on training takes away from patient care.

4. Can staff easily manage the app?

What happens when hospital staff must add or remove users? How are app updates and new releases handled? Does the company offer reliable customer support and trouble-shooting help? Providing care for patients happens 24 hours a day, seven days a week. Hospital staff should be able to rely on customer support for the app 24/7 as well.

5. Does the app improve workflows?

Hospital staff use multiple communication tools and don’t need another tool that provides the same functions as other devices already in use. The app should integrate seamlessly with existing hospital systems, save staff time, enhance the patient experience, improve clinical communications, and support reporting functions.

Conclusion

A stand-alone secure messaging app, or messaging app company, will not be able to address all the communication pain points within a hospital. However, when used in combination with communications solutions that offer scripting, directories, on-call scheduling, emergency notifications, and other web-based applications, a secure mobile messaging app used by staff will help your patients in the timeliest way possible. This gives the patient the best service possible.

1Call, a division of Amtelco

Tom Curtin is the president of Amtelco and their 1Call Healthcare Division. Amtelco is a leading provider of innovative communication applications. 1Call develops software solutions and applications designed for the specific needs of healthcare organizations.

Using an Outsourced Telephone Triage Service for Suicide Prevention


TriageLogic

By Ravi K. Raheja, MD

Telephone triage nurses play a critical role in suicide prevention and serve as the first point of contact for callers in need of immediate assistance. According to the CDC, 123 Americans die by suicide every day, and for every person who dies from suicide every year, another 278 people think seriously about it but don’t kill themselves.

As the demand for mental health services grows, practices are turning to outsourced telephone triage call centers to support their practices. Call center triage nurses trained in treating patients with mental illnesses are better prepared to intervene and often alleviate lengthy interruptions to the normal call flow of a practice.

Common Warning Signs Of Suicide

  • Talking about wanting to die or to kill oneself.
  • Looking for a way to kill oneself.
  • Talking about feeling hopeless or having no purpose.
  • Talking about feeling trapped or being in unbearable pain.
  • Talking about being a burden to others.
  • Increasing the use of alcohol or drugs.
  • Acting anxious, agitated, or reckless.
  • Sleeping too little or too much.
  • Withdrawing or feeling isolated.
  • Showing rage or talking about seeking revenge.
  • Displaying extreme mood swings.

What Can Triage Nurses Do to Help?

Triage nurses need to find a connection with the patient. They combine both clinical judgment and emotional connections. Click To Tweet

In moments of crisis, connecting with a trained triage nurse can deescalate the suicidal crisis and provide immediate help. It is never easy to talk about suicide, but it is crucial for triage nurses to be comfortable talking about suicide in the same way they talk about chest pain. How they handle each call can be life-changing for the caller.

Triage nurses need to find a connection with the patient, find the patients local emergency assistance numbers, and be ready to involve all resources available to help prevent this patient from harming him/herself.

It is essential for the triage nurse to be sympathetic, non-judgmental, and accepting. The caller has done the right thing by getting in touch with another person. No matter how negative the call seems, the fact that it exists is a positive sign, a cry for help.

Triage nurses always have the caller’s safety in mind. They combine both clinical judgment and emotional connections to assess the patient’s situation to identify possible mental health issues.

Even though remote triage nurses typically can’t see their patient, they must develop that all-important trust quickly and by means other than visualization for the caller to open up and be honest with the nurse. Not all patients can accurately describe their condition, history, medical conditions, or other pertinent information. The telephone triage nurse must decipher this uncertainty.

Sometimes the patient needs emergency treatment, while other times they are reaching out for someone to talk with and work thru difficult situations like substance abuse, economic worries, relationships, sexual identity, getting over abuse, depression, mental and physical illness, and loneliness.

Just talking about their problems for a length of time gives some suicidal caller’s relief from loneliness and pent up feelings, an awareness that another person cares, and a sense of someone understanding them. Also, as they talk, they get tired and their body chemistry changes. These things take the edge off their agitated state and help them get through a bad night. Suicide calls can be difficult, but with proper training, protocols, and disposition, telephone triage nurses save lives, one call at a time.

TriageLogic

Ravi K. Raheja, MD is the CTO and medical director fo the TriageLogic Group. Founded in 2005, the TriageLogic Group is a URAC accredited, physician-lead provider of high quality telehealth services, nurse triage, triage education, and software for telephone medicine. Their comprehensive triage solution includes integrated mobile access and two-way video capability. The TriageLogic group assists their clients with value based care and serves over 7,000 physicians and covers over 18 million lives nationwide. For more information visit www.triagelogic.com. and www.continuwell.com.

Vendor Spotlight: TriageLogic


TriageLogic


Using Data Analytics to Improve Value-Based Care

As practices and organizations move to value-based care, medical call centers can play a crucial role in improving the patient experience and the quality of care while containing costs. An effective way to find a solution is to evaluate data from nurse triage call centers on patient concerns, caller demographics, nurse triage disposition and effectiveness, and other measures to improve the call center and the patient experience.

Value-based programs focus on the quality of the care given, rather than fee-for-service. Ensuring patients receive the right level of care for their symptoms is an important action to decrease healthcare waste. Providing a quality medical call center that patients can access 24/7 is a great first step in transitioning to value-based care. Providers and hospitals can then gather information from the patient callers to further improve their service while containing costs.

Studies show that incorporating data analytics into value-based care programs can reduce healthcare spending by $300 billion. Healthcare providers need to be able to gather, analyze, and report on patient data to show they are improving the quality of care. This quantitative method is especially important in medical call centers. Call center software should include a data portal to easily evaluate key metrics to spot trends or areas needing improvement.Value-based programs focus on the quality of the care given, rather than fee-for-service. Click To Tweet

Gather Data

For new call centers and those selecting a new platform, start by evaluating data you’ve already collected and what you need to know to help the patients and the practice. For example, TriageLogic’s data portal collects information on the number of calls per protocol, calls per nurse, dispositions, and disposition override. Call centers also get data on nurse performance, such as the number of calls per hour and percentage of patients told to seek emergency care. Information on nurse performance provides a valuable tool to evaluate nurses and determine the focus of further training.

Analyze Data

While gathering the data is a crucial first step, the platform also needs to have a simple dashboard for the manager to monitor the key metrics of patient calls and nurse performance. For example, the TriageLogic data dashboard allows the user to break down the data by date, location, nurse, and so forth. Reviewing the various data sets can help caregivers gather insight on the performance and find ways to improve care.

For example, with the data dashboard, users can see the percentage of the dispositions given to the patient callers. Users can also see the actual data as the number of calls and the percentage of the total, as well as graphs that illustrate any trends of the different disposition percentages.

Report on Data

After analyzing the data from medical call centers, physicians or organizations can better understand their patient population. Look for a quality call center platform that allows call center managers to easily export the information in various formats and then share it with their practices. This is an important feature to improve coordinated care between the office and the call center.

Physicians can see what concerns their patients have after-hours and make positive changes that can address those concerns ahead of time. For example, an increase in stomach pain related issues may mean that a virus is hitting their population.

Another important use of data is to compare the number of patients you prevented from going to the ER. The number of those patients shows how much value the call center is creating for the practices (ROI), and it may motivate hospitals and providers to continue encouraging patients to call a nurse line before going to the ER.

Secure Data

When collecting patient data, it is vital that all data from the call center software be fully secure and that products are evaluated and updated as technology and standards change. When evaluating call center software, make sure you understand how it stores and secures patient data. Also, ensure you can share the information with providers securely or without any PHI.

The goals of value-based care are to provide better care for patients, create a healthier population, and reduce healthcare costs. A nurse call center system armed with good data analytics allows you to identify the quality of the clinical call center and improve the efficiency of the nursing staff while helping patients at the same time. Having access to this data, analyzing it, and sharing the information with providers improves patient care, while at the same time showing the value of your call center service and saving valuable healthcare dollars.

TriageLogicFounded in 2006, TriageLogic is a URAC accredited, physician-led provider of high-quality services and software for telehealth. TriageLogic is a leading provider of top-quality triage technology, mobile applications, and call center solutions. The TriageLogic group serves over 9,000 physicians and covers over 18 million lives nationwide.

Healthcare Call Centers Help Bring Care to the Medically Underserved



By Nicole Limpert

A person medically underserved, is someone who does not have health insurance. Estimates from the Centers for Disease Control and the National Health Interview Survey cite that in 2017, 29.3 million, or 9.1 percent of the population were uninsured.

Vulnerable Populations: Multiple studies have found that vulnerable populations in the United States, including the elderly, low-income, ethnic minorities, migrants, and people who received limited education, are also medically underserved.

People with various life experiences may interpret symptoms differently, such as thinking a seizure is a spiritual issue rather than a medical complaint, or expressing concerns about depression as anger rather than sadness.

Poor Access to Healthcare: Living in a rural location and having inadequate transportation present challenges when trying to access healthcare. Rural areas are sparsely populated, resulting in a lack of available services. Rural communities comprise roughly 20 percent of the United States, yet less than 10 percent of doctors practice in these communities.

People in rural areas rely on their own transportation to and from health services. A report released in December 2018 from Pew Research Center, found the average travel time by car, to the nearest hospital for rural Americans, is about 17 minutes compared to 10 minutes in urban areas.

However, even people in urban areas have difficulty visiting their doctor’s office. Transportation can be a challenge for people with disabilities, those with chronic illnesses, the elderly, and people who are low-income. Approximately 3.6 million Americans, from both rural and urban areas, experience missed or delayed medical appointments due to transportation issues.

Medical call centers play a critical role in helping to serve the medically underserved. Click To Tweet

Support from Healthcare Call Centers

Technology enables medical call centers to effectively become an extension of a hospital or clinic’s operations. The communication software used by medical call centers can securely access a patient’s electronic medical record (EMR), update EMRs with notes, and record calls needed for insurance claims and workmen’s compensation. Because everything is documented, detailed reports can be generated for reporting purposes.

Medical call centers can provide or facilitate healthcare-related services 24 hours a day, 7 days a week. They play a critical role in helping to serve the medically underserved, by addressing two of the biggest barriers to healthcare: language and transportation.

Language: Healthcare staff work with an enormously diverse patient population. Understanding a person’s language leads to better healthcare. Multi-lingual call centers hire operators to assist non-English speaking patients or use confidential over-the-phone interpreting (OPI) services for access to hundreds of different languages.

Transportation: Patients with mobility challenges or who live in rural areas don’t have to leave home for some services. Operators can coordinate care, make follow-up calls, schedule visits, contact on-call medical staff, and manage referrals.

Some call centers staff nurses or multidisciplinary teams (such as a resident, pharmacist, and social worker) who are qualified to make health assessments, give medical advice, and escalate critical concerns. These call centers can offer nurse call helplines, emergency mental health counseling, and other critical support.

Helping Hospitals that Help the Underserved

Reduce Penalties: A recent study done by Harvard suggests that hospitals located in low-income areas are more likely to receive penalties due to Medicare and Medicaid’s survey-based reimbursement programs. Patients are asked to provide information about their healthcare experience via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Unacceptable survey outcomes can result in hospitals losing some reimbursements.

The American Medical Association Journal of Ethics reports that the Centers for Medicare and Medicaid Services (CMS) can currently withhold one percent of Medicare payments—30 percent of which are tied to HCAHPS scores. When Medicare and Medicaid account for more than 60 percent of all care provided by hospitals, the possible amount of dollars lost due to poor patient experience is a significant number. In 2017 alone, approximately 1.7 billion dollars in reimbursements were withheld from hospitals.

Healthcare call centers play a critical role in patient satisfaction surveys, because they function as a virtual lobby for a hospital and are often the first point of contact with a patient. The patient’s experience with coordinating their care via call center agents can positively affect their feedback on the survey.

Reduce Readmissions: The CMS reports that nearly one in five Medicare patients are readmitted to a hospital within 30-days of discharge, yet a recent study from the University of California San Francisco (UCSF) and published in JAMA Internal Medicine found that twenty-seven percent of all 30-days hospital readmissions are preventable.

Medicare’s Hospital Readmissions Reduction Program (HRRP) lowers payments to Inpatient Prospective Payment System (IPPS) hospitals who report too many readmissions. According to the CMS, 2,573 hospitals received penalties in 2018 and had around 564 million dollars in payments withheld.

Studies indicate that a post-discharge call program can help hospitals reduce their readmission rate. IPC Healthcare (IPC) tested the effect of post-discharge calls on readmission rates from October 2010 through September 2011. The IPC call center contacted 350,000 discharged patients to check symptoms, review medications and treatment plans, and remind patients of follow-up appointments. Successful contacts occurred with thirty percent of patients, with an estimated 1,782 avoidable readmissions prevented over that year.

1Call, a division of Amtelco

Nicole Limpert is the marketing content writer for Amtelco and their 1Call Healthcare Division. Amtelco is a leading provider of innovative communication applications. 1Call develops software solutions and applications designed for the specific needs of healthcare organizations.

Where Was the Call Center in Our Time of Need?


LVM Systems

By Mark Dwyer

This story hits close to home, because it involves my family members. I share it to illuminate where the call center is failing its customers. Today’s call center can offer supportive resources and referrals to patients and their caregivers and ensure that interventions are applied as needed. That is what coordinating care and managing transitions is all about. It is not necessarily about a specific disease, but it’s more about the patient’s and family’s needs.

If you ever had to move a loved one into a long-term care facility, you know how incredibly hard it can be. Especially when all your loved one really wants is to simply stay or go home. I’ve had to deal with this situation now three times in my life. First with my mom as she suffered with Lewy Body Disease, then dad with Alzheimer’s, and last week with my dear little brother as he is in the final stages of Early Onset, Frontal Lobe Dementia.

His is the cruelest of all. Not only was he afflicted with this terrible disease at such a young age, he’s now just fifty-eight years old, but it is a horrifying disease for all whose lives are touched by it. At this point, his disease causes him to rarely sit still. He paces the halls, head bent downward. His navigational skills are amazing. But what is he seeing, what is he processing? His vocalizations fluctuate between quiet utterances to loud vulgarities and heinous, hateful words spewed upon his loving wife. She does her very best to comfort him despite occasional punches, attempts to choke her, and comments more vile than one would say to their worst enemy.

What makes this even worse is that my brother was never an angry, nasty man. Quite the opposite. He was the life of the party, always the kidder, the storyteller, the embellisher. He never met someone he did not greet with a smile.

But that was then, and this is now. This past week, I saw everything from enormous amounts of love and compassion, to raw agony on the face of my sister-in-law. I saw complete confusion and despair on the face of my brother. If I had a mirror, I most certainly would have seen overwhelming sorrow on my own.

Where Was the Call Center?

I could not help but wonder as I was loading my brother into my sister-in-law’s SUV moving him from the psych ward to a supposedly “qualified” dementia nursing care facility 2.5 hours away, where was the call center?

Why had my sister-in-law never spoke with someone in the call center about how best to transfer him? How to get him into the car without a struggle or to distract him along the way? How to help him with the transition into new surroundings? Before we set off on our road trip, why hadn’t someone from the call center reached out to the new care facility and asked the hard questions to determine if they were qualified to accept and care for my brother? Why?

I have not spent over half my life in this industry to have it fail me now. Why had the hospital not taken the initiative to begin using the call center to support transitional care? Who better than skilled nurses trained to ask probative questions and educated to listen between the answers? Why hadn’t experienced call center staff been brought into the fold to offer this much needed service to the community? Surely, my sister-in-law or I would have paid for such a service. We cannot be the only ones who would.

Unfortunately, there was no call center support. My sister-in-law and I loaded my brother into the car and began our 2.5-hour transition to the dementia nursing care facility without educational or emotional support.

Fortunately, after years of caring for my brother, his wife smartly knew to bring a few items to distract him along the way. For the most part, he was content to play with a stuffed animal that reminded him of his cat. The trip progressed uneventfully.

When we arrived at the facility, there was no one to greet us. Instead, a kind young lady led us to an area where patients were eating lunch. Not the best way for my brother to start his new life. Too much confusion, too many people all looking at him. Too many strangers.

Eventually, they showed us his room. My sister-in-law had brought many of his toys, pictures, wall hangings, blankets, etc. As she made up his room, I joined my brother in his thousand-step trek around the facility. Not only does he like to walk, he likes to walk fast, a challenge for an older brother with a bad hip. We walked, and we walked, and we walked, occasionally setting off door alarms if I failed to redirect him in time. Meanwhile, my sister-in-law completed all the needed paperwork. Again, why didn’t the call center complete this prior to our arrival?

After an inordinate amount of walking, all the paperwork was completed (again paperwork that should have been coordinated and completed in advance of our arrival) and we were able to get my brother to settle down in his room.

Or so we thought.

We had been with him for most of the day, so we decided to head home before dark set in. We made one last stop at the nurses’ station to confirm they felt comfortable caring for my brother. That they felt they had adequate staff and resources to provide him with the care we expected.

Leaving Too Soon

With their assurances, we headed home. As we began our 2.5-hour return trip, my sister-in-law and I discussed how we felt my brother would do. As we began to convince ourselves that he’d be fine, the phone rang. It was the dementia care facility. We had travelled for less than thirty minutes and already the nurse was calling us to come back and get my brother. He was scared and agitated in his new surroundings, and when they tried to calm him, he swung at one of the staff. That’s all it took.

We turned around, reloaded his things, and headed back to the psych ward from whence he had come, feeling totally defeated. There had clearly been inadequate transitional care support. Not enough questions had been asked. My brother’s specific needs and issues were either not communicated or were not fully understood by the care facility agreeing to take him.

To add to our frustration, when we arrived back at the hospital, the less than friendly security guard informed us that the hospital could not, and would not, admit my brother unless he was willing to choose to admit himself. Mind you, we are talking about a man who has only fleeting moments of cognitive lucidity, and this guard wanted him to state he desired to be checked back in. Again, a perfect place for someone in the call center to have assisted in his transition back to the psych ward.

My sister-in-law lost it. She returned to the car, violently sobbing, determined to simply take her husband home and care for him herself. As she pulled away from the hospital, I reasoned with her explaining that there was no way we could take care of my brother at home by ourselves, and that with me leaving town the next day, there certainly was no way she could do it herself.

When it finally dawned on her that she had no medicines for my brother, she realized we had to return to the hospital. Fortunately, at her request, this time nurses from the psych department came down to the ED bay and facilitated getting him checked in and back to the same room he had left merely ten hours earlier.

Ten hours I will never forget.

LVM Systems

Mark Dwyer is a thirty-three-year veteran of the healthcare call center industry. He currently serves as COO of LVM Systems.

“Transitional care is defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location. Representative locations include (but are not limited to) hospitals, sub-acute and post-acute nursing facilities, the patient’s home, primary and specialty care offices, and long-term care facilities” (Coleman & Boult, 2003, p. 556).

a.   Transitional care is based on a comprehensive plan of care and the availability of health care practitioners who are well-trained in chronic care and have current information about the individual’s goals, preferences, and clinical status.

b.   It includes logistical arrangements, education of the individual and family, and coordination among the health professionals involved in the transition.

c.   Transitional care, which encompasses both the sending and the receiving aspects of the transfer, is essential for persons with complex care needs (Coleman & Boult, 2003).

Homelessness in America: How Can Your Contact Center Help?


LVM Systems-homeless population

By Traci Haynes MSN, RN, BA, CEN, CCCTM

Homelessness in America occurs in every state and has many causes. According to the January 2017 Point-in-Time (PIT) count by the National Alliance to End Homelessness, the most recent national estimate of homelessness in the United States identified 553,742 people experiencing homelessness. The PIT count is acount of sheltered and unsheltered homeless persons on a single night in January. Like all surveys, the PIT count has limitations. Results are influenced by the weather, availability of overflow shelter beds, the nature of the volunteers, and the level of engagement of the people being interviewed.

Most of this population lives in some form of shelter or transitional housing. However, approximately 35 percent live in places not meant for human habitation. The nature of homelessness makes it difficult to quantify the true size of the homeless population, not to mention the Point-in-Time methodology (although generally acknowledged to be the most accurate way to establish valid trend data). It is challenging to calculate the exact number of individuals who are homeless, because many live in hidden areas in parks, vehicles, or abandoned houses, and because numbers fluctuate, based on weather.

Homeless individuals are at a relatively high risk for a range of acute and chronic physical and mental illnesses. Click To Tweet

Health Problems Faced by the Homeless

Homeless individuals are at a relatively high risk for a range of acute and chronic physical and mental illnesses. Some health problems precede and may contribute to homelessness, while others are often a consequence of being homeless. And homelessness complicates treatment of many illnesses.

One example of a health problem that can cause homelessness is a major mental illness, such as schizophrenia. Without therapeutic interventions and supportive housing arrangements, such an individual may become homeless.

Another example is an accidental injury, including job-related injuries. Even with benefits under employer programs, these individuals may experience major economic costs leading to loss of housing.

Diseases of the extremities, skin disorders, malnutrition, degenerative joint diseases, dental and periodontal disease, communicable diseases, and the possibility of trauma are other health problems that may result from, or frequently occur in, the homeless population. Medical care and treatment for acute or chronic illness can be extremely difficult.

Bed rest may be non-existent for a homeless individual who has no bed or only has a bed in a shelter at night. Special diets and medication adherence are impossible to maintain for a person who is homeless.

Contact centers have long been known for assisting their organizations in offering triage, coaching, remote patient monitoring, and care management for an identified population. Some contact centers have also assisted other community agencies or services in filling a need or gap.

Triage Call Centers Can Help Address Health Concerns of the Homeless

So we all know homelessness exists, and it is a tremendous problem, but what does that have to do with triage call centers?

A community triage contact center at EvergreenHealth in Kirkland, Washington implemented a program around 2000, in which they began to offer low-level acuity triage for their regional 911 dispatch centers. The dispatchers would go through their algorithms with the caller, and once they ruled out any emergent or urgent issue, the caller was offered the option of speaking with a nurse. If the caller preferred, she or he could be connected with an appropriate unit or the individual could be transported to the Emergency Department (ED). This program proved a huge success in both caller/patient satisfaction and dollars saved.

A study was published in 2015 for a comparable 911 program in two cities with similar outcomes. Fort Worth, Texas (MedStar) provided nine months of 911 call data, and Louisville, Kentucky (LMEMS) provided thirty-four months of 911 data. The study reported that the 911 program had a significant reduction in callers routed to the Emergency Department (ED) at a cost savings of 1.2 million dollars in payments, as well as a decrease in emergency ambulance transports resulting in a cost savings of 450,000 dollars, and a resultant increase in access to alternative care. Overall, patient satisfaction was 91.2 percent.

As a result of the involvement with the regional 911 dispatch centers, the contact center was asked to become involved with yet another identified need: The growing population of homeless individuals. County shelters and housing facilities for the homeless population needed a resource for individuals with low to moderate acuity symptoms, when medical/nursing personnel were not on site. The fire department was handling 90,000 incidents per year, which resulted in overuse or misuse of the emergency medical response (EMR) system. And while the county shelters were not the majority of the calls, they were a contributor.

Addressing the Concerns of the Homeless

A very important concern to the homeless individual is whether they will lose their shelter bed for the night, if they are transported. The fire department is not authorized to make a medical diagnosis on the scene, to provide advice or guidance about disease management, to make a referral to other medical resources, such as a primary care doctor, or to provide transportation anywhere except an ED.

The contact center had the system and tools in place to assist the RN with the individual at the county shelter’s assessment and make recommendations of care. “Right care, right place, right time,” which is the fundamental premise of contact center RN triage. Their service provided a much-needed solution to an ongoing gap in care. They currently support five dispatch centers in providing contact center RN triage for thirteen shelters.

The contact center educated the staff at the shelters and facilities. They provided training on when to call 911 (a red flag list), and when to call the contact center’s health line. Each homeless individual received HIPAA information that included “understanding and agreement that a copy of the information discussed during the call interaction would be shared with the residence so that they may further assist the individual with their care.”

The workflow included one number for all facilities to dial into the Healthline contact center. The case manager and the resident had to be available at the time of the call. The RN in the contact center triaged the individual, and then the case manager determined the best non-EMR transportation based on the disposition. The triage note was then faxed to that facility.

Challenges included the individual wishing to remain anonymous, the individual being a vague or poor historian, individuals declining triage or the recommendation, availability of OTC meds, and their psych/social needs.

The Results

Eighteen months after the start of the program, the facility staff was queried, and all were either very or somewhat comfortable in knowing what situations required 911. Over 85 percent of the staff felt the service was very important to the facility.

By far, the majority felt the nurses at Healthline were very knowledgeable (83.33 percent). Beyond 85 percent also felt the nurse line process was easy-to-use, and felt the residents were satisfied with the service. Most of the staff felt very satisfied once the resident had talked with the nurse, and 100 percent indicated the importance of having the service available 24/7, adding that it was practical and helpful to the residents in the facility.

LVM Systems

Traci Haynes MSN, RN, BA, CEN, CCCTM is the director, clinical services at LVM Systems, Inc. and has been involved in the contact center industry for over twenty-five years. (Traci thanks Cheryl Patterson, BSN, RNC—TNP, clinical manager—quality and education, Healthline, for her contributions to this article.)