A strategy for engaging community physicians and improving outcomes

Nov. 8, 2013

With new payment models that reward quality and penalize readmissions, getting the right information at the right time can significantly improve patient outcomes and the financial health of a hospital. Ingalls Memorial Hospital has 560 beds and is located in Chicago’s south suburbs. It is a leading regional health and the area’s only independent not-for-profit system. As a community hospital, the vast majority of Ingalls’ 450 physicians own independent practices. While this model has its benefits, it comes with challenges. Rapid communication of critical radiology results, for example, had become an area of physician concern.Ingalls’ historical reliance on manual processes to communicate critical messages with physicians began to reveal gaps in information and time delays. To streamline the notification process and take advantage of workflow efficiencies, Ingalls made the decision to implement an intelligent communication engine with a proven track record in critical test results management (CTRM).

Improving radiology workflow with CTRM

Despite the benefits of Ingalls’ independent physician model, hospital staff found it difficult to efficiently keep community practices informed of significant and critical test results (CTRs) in a timely manner. This workflow issue came to a head in the hospital’s radiology department in 2010 as it prepared to deploy a new Siemens radiology information system (RIS). The RIS improved many processes, such as streamlining imaging and report distribution within the department, but it still required staff to manually alert ordering physicians of CTRs. In addition, the new system lacked a voice recognition feature that would allow radiologists to post preliminary dictated notes to the telephony server as audio files that referring doctors could access in advance of the final report. Ultimately, Ingalls’ chose to implement Notifi, an intelligent hospital communication engine developed by HIT Application Solutions.

Knowing the importance of having a voice recognition feature, both teams worked closely to answer the telephony challenge and had the enterprise-wide alerting system up and running in less than three months – in time for the go-live of the RIS. The radiology applications were fully integrated, allowing radiologists to continue dictating notes through voice recognition software and tailor notifications to established key words. The system is able to read the text-based results and understands the presence of an abnormal or critical value depending on the set rules defined by Ingalls. When time-sensitive results are present, they are sent to the appropriate members of the care team. In addition, the system supports multiple communication devices so notifications can be sent to the recipient’s preferred contact number or device. Consistently aware of their patients’ progress, Ingalls’ unaffiliated physicians felt a stronger tie to the health system and were able to be more collaborative with patient care from outside the organization walls.

With the new system in place, the radiology department reduced the time needed to deliver abnormal test results by 50 percent and was able to reallocate staff resources for improved workflows.

Enhancing quality, expanding outreach

As word of the successes in the radiology department spread, caregivers at Ingalls Stroke Center took an active interest in the CTRM as a way to gain Joint Commission certification as a Primary Stroke Center. As part of its endeavor to be certified, Ingalls developed and implemented a protocol according to American Stroke Association guidelines and recommendations to ensure that patients are diagnosed and treated as quickly as possible. The protocol includes the immediate availability of a CT scan within minutes of a patient's arrival at the emergency department and administration of clot-busting drugs in selected individuals. Radiology was able to quickly route critical findings to ED staff and other caregivers for follow up and case management, enabling prompt and seamless coordinated care. Ingalls improved patient outcomes, gained national recognition for its exceptionally low mortality and complication rates, and earned accreditation.

Ingalls’ leadership looked at other ways the CTRM system could be used to streamline communications across their enterprise and increase quality of care. Missed appointments have a direct affect on patient outcomes, especially those with chronic diseases. Recognizing that one of the best ways to improve outcomes and costs is to close gaps in care, Ingalls implemented an automated appointment reminders system across 15 departments, generating time-sensitive communications to patients and their caregivers. And, because the system was controlled within the organization, staff was able to customize messages, and alter dates and times to accommodate changing schedules. As a result, Ingalls reduced its number of no-shows by 85 percent. According to the developer of Notifi, by reducing no-shows by only 10 percent, smaller hospitals (150-200 beds) could increase revenue by nearly $400,000 per year, and larger hospitals (500 beds) by more than one million per year. The benefit to Ingalls is not only the increased revenue but improved care coordination and relations with referring physicians.

Ingalls is now determining how it will use the communications platform in the future. It is currently looking to expand the use of it into other departments and workflows, such as its orthopedic center and in EKG studies. The hospital is also piloting a mobile version of the system, which will be rolled out to medical staff members later this year, and plans to introduce it to other specialist groups as well as its business development department.

Moving forward as a team

By implementing an enterprise communications platform that not only mitigates alert fatigue but gives busy, independent providers the information they need in a timely way, Ingalls is able to maintain its commitment to serving the community through superior patient care. The health system has strengthened the relationship between the hospital and its doctors, whose needs and schedules are accommodated, leading to greater engagement and collaboration.

About the author

Sue Bjork is Manager of Information Technology at Ingalls Memorial Hospital.

For more information on Notifi by HIT Application Solutions, go to www.healthitservices.com/solutions/.

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