Melissa Kline's Profile

We recently opened online scheduling to Primary Care (Internal medicine and Med/Peds). It can be done through our website or via MyChart. It has had great feedback. Previously, you could only schedule via MyChart and only with a Primary Care physician that you had previously seen.

If you would like, I can connect you with our some of the team that worked on this. Let me know at class next week!

How did the discharge lounge work for you? We have attempted this twice without success (about 4 years ago and again at the end of 2015/beginning of 2016). Physicians and nurses had excuses as to why a patient could go there. The few patients that went there, didn’t like it. We even put a large screen TV, comfy couches, recliners and a stocked refrigerator and gave the patient a $10 voucher to the coffee/snack shop near it.

We have implemented a very similar program at my organization. All employees completed a 4 hour course and then managers did additional 1 hour programs each month in 2016 to keep the program going. Along the way, it was recognized that physician communication scores were not where they should be and additional training is being provided in the form of a mandatory 8 hour course.

To gain buy-in, the facilitators presented to the service line leaders, Medical Executive Council, Council of Chairs, Medical Staff, and Advanced Practice Provider Council. They focused on the plan for all providers to attend and the content that would be covered. They provided their own patient experience scores and demonstrated how they improved after implementing the techniques learned in the course. As providers have gone thru the course, successes have been shared and data shared.

To create sustainability, the organization adopted a goal this year to have the overall score for “recommend this provider” in the 90th percentile. Individual scores are provided monthly to each provider and Chairs and Service Line leaders are charged with ensuring that providers review these. They are also built into the provider’s quarterly quality incentive so there is some monetary incentive for individuals. Each Chair and Service Line leader have the goal as one of their goals for their department/service line.

Wee Joo-

I like your approach. Be up front with AB regarding expectations-and hold her accountable. Focus on the positives and offer opportunities to expand on AB’s expertise. And as Joanna said below-maybe these opportunities may be in a lab further away from the dept!

We have similar issues in our ED, along with a lack of psychiatric beds in the region. Our psych unit is 20 beds, with very strict admission criteria and can only accept insured patients. Even with this rules, they are always full, with increasingly complex and sometimes violent patients. We have had psych patients in the ED for more than 5 days.

Psych consults on all psych patients in the ED and we have a full-time psych social worker. We use Mobile Crisis (which has 72 hours to respond) to aid in assessing patients. We implemented Team STEPPS across the organization over the past two years. ED was an early adopter. After everyone went thru training, Team STEPPS action council was formed by interdisciplinary team members. We extended the psych area in the ED, made some cosmetic changes (it was looking pretty bad), and implemented routine care for the patients such as offering a shower and change of clothes every 24 hours (this is done early in the morning prior to the ED getting busy as these patients often need close monitoring and cannot be left alone). We also worked with Dietary to have menus available and trays delivered to the ED for this population (they had been getting the standard ED turkey sandwich and ginger ale for 5 days!). All of this is a band-aid and doesn’t solve the real problem, of course, but the staff recognized that we could do better for the psych patients and provide them more dignity and a better environment.

We have looked at opening a short stay/observation psych unit also but many of the modification we would need to make to a vacant unit are somewhat cost prohibitive as we are building a new hospital to be completed by 2021-ish.

A similar topic was just on a CNO Listserve that I am on. One of the options proposed was to add screening questions for either the MD or the RN to answer, with an automatic referral triggered if certain criteria are met. To ensure that it is completed, it could be a hard stop in the EHR (admission screening/in-patient) or be required to be completed every X months (ambulatory) in certain populations. Another potential option is to allow the nurse to “order” the consult.

We also touched on this topic at our Medical Executive Council this morning. The physicians were very opposed to a nurse “ordering” this type of consult, even on the in-patient setting. They were slightly more open to screening questions.