Dataset Information

Reducing calls missed by the hospital telephone exchange from 26% to less than 10.

ABSTRACT: A hospital's telephone exchange is the first point of contact for patients and their attendants to take appointments, to collect healthcare related information and to connect to the hospital in case of emergencies. At Sitaram Bhartia Institute of Science and Research the doctors, patients, and attendants often complained about the inefficiency of the hospital exchange. In February 2012, a doctor raised her concern of calls not being picked up at the exchange with the senior management and a QI project was initiated to tackle the problem. Baseline data showed that about 26% of incoming calls to the hospital during 8am to 8pm were not being picked up. On the basis of the baseline data, call audits, staff interviews, and observations the project team identified the defects. These defects were categorized under four headings - manpower, equipment, processes, and environment. The team proposed several change ideas. Some of these change ideas were implemented immediately. Three proposed change ideas were tested through individual PDSA cycles. The percentage of missed calls dropped from 26% to 18.1% after the first cycle and then to 9.6% and 6.5% after the subsequent cycles which involved testing of two other additional change ideas. These changes were implemented and a benchmark of no more than 10% calls to be missed was set. For nearly three years we have held the gains and have met the benchmark of missing not more than 10% calls coming to the hospital exchange between 8am to 8pm. The contributing factors to the success have been the involvement of frontline workers, an expert and engaged head of department, and senior leadership support.

SUBMITTER: Bhartia S

PROVIDER: S-EPMC4752711 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Reducing calls missed by the hospital telephone exchange from 26% to less than 10.

Bhartia Saru S Bahlvi Zorba Z Sharma Irina I

BMJ quality improvement reports 20160114 1

A hospital's telephone exchange is the first point of contact for patients and their attendants to take appointments, to collect healthcare related information and to connect to the hospital in case of emergencies. At Sitaram Bhartia Institute of Science and Research the doctors, patients, and attendants often complained about the inefficiency of the hospital exchange. In February 2012, a doctor raised her concern of calls not being picked up at the exchange with the senior management and a QI p ...[more]

PMID: 26893896

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Project description:BackgroundSeveral care transition interventions propose that post-discharge phone calls can reduce adverse events and decrease costly return visits to the hospital. However, given the multi-faceted nature of most care transitions interventions, the true relationship between post-discharge phone calls and readmissions in a real world setting is uncertain.ObjectiveTo determine the effect of receiving a post-discharge telephone call on all-cause 30-day readmission in a general medicine population.DesignRetrospective observational study.ParticipantsPatients discharged home from the Medicine Service at a tertiary care academic medical center between November 2010 and May 2012.InterventionPatients received two telephone call attempts by a nurse within 72 h of discharge. Nurses followed a standard script to address issues associated with readmission.Main outcome and measuresBilling data captured readmissions. We used logistic regression-adjusted patient and clinical covariates as well as a propensity score representing likelihood of being called to determine the association between call receipt and risk for readmission.Key resultsThere were 5,507 eligible patients. In unadjusted analyses, patients who received a call and completed the intervention were significantly less likely to be readmitted compared to those who did not [155 (5.8 %) vs 123 (8.6 %), p < 0.01]. In multivariable models adjusting for socio-demographic and clinical covariates alone, completing a post-discharge telephone call intervention was associated with lower odds for readmission (AOR 0.71; 95 % CI: 0.55-0.91). However, when models adjusted for the likelihood of receiving the phone call using the propensity score, no association between call receipt and readmission was observed (AOR 0.91; 95%CI: 0.69-1.20).ConclusionsEffectiveness of post-discharge phone call programs may be more related to whether patients are able to answer a phone call than to the care delivered by the phone call. Programs would benefit from improving their ability to perform phone outreach while simultaneously improving on the care delivered during the calls.

Project description:BACKGROUND:Recent studies have thoughtfully and convincingly demonstrated the possibility of estimating the circadian rhythms of young adults' social activity by analyzing their telephone call-detail records (CDRs). In the field of health monitoring, this development may offer new opportunities for supervising a patient's health status by collecting objective, unobtrusive data about their daily social interactions. However, before considering this future perspective, whether and how similar results could be observed in other populations, including older ones, should be established. OBJECTIVE:This study was designed specifically to address the circadian rhythms in the telephone calls of older adults. METHODS:A longitudinal, 12-month dataset combining CDRs and questionnaire data from 26 volunteers aged 65 years or older was used to examine individual differences in the daily rhythms of telephone call activity. The study used outgoing CDRs only and worked with three specific telecommunication parameters: (1) call recipient (alter), (2) time of day, and (3) call duration. As did the studies involving young adults, we analyzed three issues: (1) the existence of circadian rhythms in the telephone call activity of older adults, (2) their persistence over time, and (3) the alter-specificity of calls by calculating relative entropy. RESULTS:We discovered that older adults had their own specific circadian rhythms of outgoing telephone call activity whose salient features and preferences varied across individuals, from morning until night. We demonstrated that rhythms were consistent, as reflected by their persistence over time. Finally, results suggested that the circadian rhythms of outgoing telephone call activity were partly structured by how older adults allocated their communication time across their social network. CONCLUSIONS:Overall, these results are the first to have demonstrated the existence, persistence, and alter-specificity of the circadian rhythms of the outgoing telephone call activity of older adults. These findings suggest an opportunity to consider modern telephone technologies as potential sensors of daily activity. From a health care perspective, these sensors could be harnessed for unobtrusive monitoring purposes.

Project description:BackgroundA spontaneous subarachnoid haemorrhage (SAH) is one of the most critical neurological emergencies a dispatcher can face in an emergency telephone call. No study has yet investigated which symptoms are presented in emergency telephone calls for these patients. We aimed to identify symptoms indicative of SAH and to determine the sensitivity of these and their association (odds ratio, OR) with SAH.MethodsThis was a nested case-control study based on all telephone calls to the medical dispatch center of Copenhagen Emergency Medical Services in a 4-year time period. Patients with SAH were identified in the Danish National Patient Register; diagnoses were verified by medical record review and their emergency telephone call audio files were extracted. Audio files were replayed, and symptoms extracted in a standardized manner. Audio files of a control group were replayed and assessed as well.ResultsWe included 224 SAH patients and 609 controls. Cardiac arrest and persisting unconsciousness were reported in 5.8% and 14.7% of SAH patients, respectively. The highest sensitivity was found for headache (58.9%), nausea/vomiting (46.9%) and neck pain (32.6%). Among conscious SAH patients these symptoms were found to have the strongest association with SAH (OR 27.0, 8.41 and 34.0, respectively). Inability to stand up, speech difficulty, or sweating were reported in 24.6%, 24.2%, and 22.8%. The most frequent combination of symptoms was headache and nausea/vomiting, which was reported in 41.6% of SAH patients. More than 90% of headaches were severe, but headache was not reported in 29.7% of conscious SAH patients. In these, syncope was described by 49.1% and nausea/vomiting by 37.7%.ConclusionHeadache, nausea/vomiting, and neck pain had the highest sensitivity and strongest association with SAH in emergency telephone calls. Unspecific symptoms such as inability to stand up, speech difficulty or sweating were reported in 1 out of 5 calls. Interestingly, 1 in 3 conscious SAH patients did not report headache. Trial registration NCT03980613 ( www.clinicaltrials.gov ).

Project description:BackgroundFood insecurity is a social determinant of health that impacts more than 10% of U.S. households every year. Many unexpected events make food-insecure people and those with unmet food needs seek information and help from both formal (e.g., community organizations) and informal (e.g., family/friends) resources. Food-related information seeking through telephone calls to a community referral system-211 network-has been used as a proxy for food insecurity but the context of these calls has not been characterized and the validity of this proxy measure is unknown.ObjectiveTo investigate the content of food-related telephone calls to 211 and explore the indications of food insecurity during these calls.MethodsWe conducted a secondary qualitative analysis on the transcripts of food-related calls to Utah's 211. From February to March 2022, 25 calls were sampled based on the location of callers to ensure the representation of rural residents. 13 calls from metropolitan and 12 calls from nonmetropolitan ZIP Codes were included. Using a purposive sampling approach, we also made sure that the sample varied with regard to race and ethnicity. Calls were transcribed and de-identified by our community partner-Utah's 211 and were analyzed using a thematic analysis approach by our research team.ResultsThree themes emerged from the qualitative analysis including referral to 211, reasons for food-related calls, and reasons for unmet food needs. Results highlight the complex social environment around 211 food-related callers, lack of knowledge about available food resources, and indications of food insecurity in calls.ConclusionInformation seeking for food-related resources through 211 is a problem-solving source for people living in a complex social environment. Indications of food insecurity through these calls validate the use of these calls as a proxy measure for food insecurity. Interventions should be designed to increase awareness about the available resources and address the co-existing social needs with food insecurity.

Dataset Information

Reducing calls missed by the hospital telephone exchange from 26% to less than 10.

Publications

Reducing calls missed by the hospital telephone exchange from 26% to less than 10.

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