World Congress at ACG2017

Simultaneous Plenary Session 4C: IBD

79 - Workflow Algorithm Changes for Triaging IBD Outpatient Calls Can Improve Patient Experience and Reduce Physician Burden

Wednesday, October 18
9:30 AM - 9:40 AM
Location: W414 (Level 4)



Category: Practice Management       

Tenzin Choden, MD1, Anand Nath, MD2, Melissa O'Hara, RN1, Aimee LeStrange, CRNP1, Tamira Sanni-Sanoussi, MD1, Mark C. Mattar, MD, FACG1
1MedStar Georgetown University Hospital, Washington, DC; 2MedStar Washington Hospital Center, Washington, DC
Introduction: Inflammatory bowel disease (IBD) is a chronic disease of the gastrointestinal system that affects more than 1.6 million patients in the United States. Providers, nurses, support staff, and patients face the complexity of diagnosis and treatment of IBD, particularly patient literacy in understanding their disease and adherence to treatment. These issues contribute significantly to the workflow of daily clinical practice. Providers continue to observe a large volume of daily patient inquiries at the IBD Call Center, resulting in an average of 5 hours of follow up. The effort devoted to addressing these issues leads to a significant investment of time from the provider and support staff, as well as re-routing of clinical workflow. We aim to identify the major types of inquiries made by patients, with hopes to implement changes in delivery of care and streamlining provider workflows while expediting solutions to patient inquiries.

Methods: During one month, patient calls and secure messages taken by the IBD nurse coordinator were recorded by providers via the electronic health records system and categorized by type of concern. Patient-specific data recorded were gender and diagnosis. Quantitative analysis was performed to delineate the top ten patient concerns, as well as the frequent caller patient demographic.

Results: A total of 507 phone calls were recorded during a one-month period. More calls were attributed from females (60.0%) compared to males (40.0%). Patients with diagnosis of ulcerative colitis (UC) and Crohn’s disease (CD) comprised 72.6% of all calls made; of these, 47.5% of calls were attributed to patients with CD and 25.0% with UC. The top ten patient concerns and the average amount of time spent addressing them are shown in Figure 1/Table 1, which comprised 77% of total calls made. Multiple “top ten” patient inquiries (scheduling next infusion dose, insurance inquiry, medication refill, rescheduling appointments, and medical record requests) did not necessitate direct clinician input, and comprised 37% of all calls.

Discussion: A significant amount of the patient inquiries were related to medication dose scheduling, insurance inquiries, and other administrative tasks that do not need a clinician’s direct input. A new workflow algorithm should be designed to redirect these calls through alternative non-clinician dependent pathways in order to minimize clinician burden as well as to expedite patient care and enhance the patient experience.

Supported by Industry Grant: No


Table 1. The estimated average amount of time spent on each type of patient concern




























































Rank



Patient Concern (Percentage of phone calls) 



Estimated Average time spent (minutes)



1



Scheduling next infusion dose (16%)



2



2



Symptoms update (15%)



15



3



Insurance inquiry (8%)



30



4



Plan of care (7%)



30



5



Medication refill (6%)



5



6



Medication & clinical questions (6%)



15



7



Scheduling or rescheduling appointment (6%)



1



8



Request clinician call (5%)



2



9



Results & Next steps (5%)



15



10



Medical Record request (2%)



1





Figure 1. Top 10 Reasons for Patient Phone Calls.

Citation: . WORKFLOW ALGORITHM CHANGES FOR TRIAGING IBD OUTPATIENT CALLS CAN IMPROVE PATIENT EXPERIENCE AND REDUCE PHYSICIAN BURDEN. Program No. 79. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Tenzin Choden

Resident Physician
MedStar Georgetown University Hospital
Washington, DC

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