Decreasing non-urgent parent overnight and weekend phone calls to pediatric urology providers: a quality improvement study
Amanda Raines, MD, Jennifer Ahn, MD, Mark Cain, MD, Julie Cheng, MD, Nicolas Fernandez, MD, Byron Joyner, MD, Kathleen Kieran, MD, Paul Merguerian, MD, Margarett Shnorhavorian, MD.
Seattle Children's Hospital, Seattle, WA, USA.
Background: Parent and caregiver phone calls are an important part of caring for pediatric patients. At our institution, residents respond to night and weekend parent calls. While it is critical for families to be able to reach us for urgent concerns, the ease of access has led to overutilization with many phone calls not meeting the urgent nature that is intended for these calls. The primary aim of this quality improvement project was to decrease the number of non-urgent parent calls on nights and weekends. Our secondary aim was to improve compliance with telephone encounter documentation and to standardize the documentation content. Methods: A multiphase quality improvement project was launched on November 1, 2021. We began with evaluation of our current state, identifying that most calls were for post-operative patients and that our discharge instructions inadequately detailed when parents should call. Notes were inconsistently documented with no standard format. The first phase included creation of a parent call note template to accurately and thoroughly document the telephone encounter. The other intervention during phase one was the addition of the pediatric urology fellow to the parent call pool. The second phase began on January 1, 2022 and included updates to our post op instructions with explicit instructions detailing when to call on nights and weekends. We reviewed call data from September 2021 to February 2022 including variables such as caller demographics, reason for call, and operative details. Our primary outcomes were proportion of post-operative calls within 30 days and non-urgent calls. Secondary outcome was proportion of calls documented appropriately. Phases were categorized as pre-intervention (Sep/Oct 2021), phase 1 (Nov/Dec 2021), phase 2 (Jan/Feb 2022). Results: In our preintervention period the majority of the calls were for post-operative patients (66%) and 41% of all calls during this period were urgent. The proportion of post-operative phone calls stayed stable at 67% during phase 1, but decreased to 38% with phase 2 with implementation of updated post-operative instructions (p<0.001) (Figure 2). The proportion of urgent calls was similar (pre-intervention 41%, phase 1 33%, phase 2 31%, p = 0.39) (Figure 2). Call documentation was also similar with a documentation rate of 79% preintervention and 87% post intervention (p=0.21) (Figure 2). Between the study phases, there was no difference in patient ethnicity, insurance status, type of surgery, reason for the call, time from surgery to call, mean number of weeknight calls, or mean number of weekend calls. Conclusions:
With interventions focused on post-operative parental instructions, the number of post-operative phone calls decreased. Standardization of documentation and compliance with documentation improved. However, the overall call volume did not change, nor the proportion of nonurgent calls, which will be a focus of the next phase.
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