The chief wellness officer at one Delaware health system asked the question: Were specialists at his health system who were fielding calls from community physicians spending their time wisely, or was the telephone consultation model creating more of a burden for infectious disease physicians?
The “Physician Priority Line” had been around for about eight years and gave primary care physicians in the community immediate phone access to specialists at Nemours Children’s Health in Delaware. The goal was to get patients the right care quickly and generate appropriate referrals for follow-up care from the health system’s specialists.
But no one had ever looked at whether those initial goals were being met.
“From a well-being perspective, it actually can be quite burdensome because it’s not that I’m just sitting in my office checking my email ... waiting for people to call me. I’m on call, I’m working. I’m invariably seeing patients in the clinic. I’m seeing patients in the emergency room. I’m doing surgeries,” said orthopaedic surgeon Alfred Atanda, MD.
Dr. Atanda directs clinician well-being and is surgical director for the Center for Sports Medicine at Nemours Children’s Health, and he explored how to reduce this burden for infectious disease physicians during an episode of the “AMA STEPS Forward® Podcast.” You can listen on Apple Podcasts and Spotify.
“I would feel the stress, but I think this was much more stressful for a lot of our nonsurgical colleagues because a lot of these calls would be long—10 to 15 minutes of listening to lab results and studies,” he said.
During the pandemic, infectious disease physicians at Nemours Children’s Health had seen these calls from outside physicians skyrocket. Dr Atanda worked with the specialists to figure out how the Physician Priority Line could be structured so it wasn’t so burdensome on the physicians.
Call in nursing to help take calls
The biggest and most effective change turned out to be adding a nurse to triage the calls coming in. The health system dedicated a nurse to take calls coming into infectious disease physicians from outside physicians. The RN would let the caller know they work with the infectious disease physician, listen to the facts from the primary care physicians calling in for the consultations, categorize the calls and list what was needed to respond.
The nurse could then go to infectious disease physicians with a quick blurb and package it in a way that the physician could look at it in a few minutes.
“Our specialists were still calling those outside physicians, but they were doing it already preemptively prepared with information,” Dr. Atanda said.
The results: About 25% of the time, the call could be handled entirely by the nurse and the time infectious diseases specialists spent on these calls dropped by 50%.
The data also showed that over the first three to four months of their pilot, outside physicians only had a patient follow up with the specialists about 7% of the time.
“We were providing very valuable free advice under the guise that it would be good for business development and good for referrals. But there were no referrals actually happening to the level that we thought. So, it really opened up our eyes and you know, this was a small little microcosm of what we envision is happening, happening pervasively through our organization,” Dr. Atanda said. “We’re looking towards cardiology and gastroenterology next as our pilot program subjects.”
Rooting out system burdens
Dr. Atanda encouraged leaders to talk to those on the front line and listen and prioritize the pain points that are the most important to address and to establish metrics to review programs over time to make sure you are accomplishing what you set out to do.
“If you don't recheck in every so often ... you're not even going to realize that you're doing something that's burdening the front-line specialist physicians.”
Learn more about reducing physicians’ burdens with the AMA STEPS Forward “De-implementation checklist” (PDF) and the “Listen-Sort-Empower” toolkit.
