Frontline Physicians

During the normal stress of being admitted to the hospital, it's not always clear to patients and their families who does what.

And if a nurse or clerk can’t answer a question on admissions, the patient can get frustrated.

So it was in the admitting department at Fremont Medical Center in Northern California, where patients gave low satisfaction scores regarding the process.

“Many different staff use the word ‘admitting,’ so we needed to make sure we stood out, and that patients knew when their admission officially began and ended,” says labor co-lead and admitting representative Joanna Nelson.

Team members thought one of their biggest challenges was making sure patients knew when they were dealing with admitting staff versus other employees.

They first tried using scripted language, the “Right Words at Right Time” (RWRT) approach to let patients know when the actual admission process had started and the representative’s role.

When that failed, the UBT added another level of patient service and rounding, which included a small gift and card.

The gifts were mostly Kaiser Permanente brand items including cups, tablets, aprons, vases or plants. Admitting representatives also gave personal cards to each patient.

“We came up with an extra-special plan for our new admissions. Once the patient was admitted, the Admitting rep went back up to the room—either later that same day or the next day—and gave our patients a welcome gift,” shop steward and OPEIU Local 29 member Nelson says, describing the gesture as a “thank you for choosing our hospital.”

And it worked.

In four quarters, polite and professional customer service scores improved 21 points, and efficient and easy customer service scores picked up three points.

The team also helped by letting patients know how all the pieces fit together.

“Personalize your admitting process,” says Fonda Faye Carlisle, manager, Admitting and Patient Financial Services. “Since the admitting department is not the only voice that says, ‘I will be admitting you,’ admitting needs to personalize so the patient can differentiate between them and others, such as nursing.”

There were team benefits, as well, beyond the scores. Department morale and attendance also increased.

“Our satisfaction is seeing our patients happy and watching our scores improve,” Nelson says.

An accurate list of a patient’s prescriptions is critical to maintaining continuity of care.

It also helps to decrease medication errors, and one of the Joint Commission’s national patient safety goals requires medication reconciliation at hospitals and clinics.

So, in order to protect patient safety, it's crucial caregivers compare the medications a patient is taking (and should be taking) with newly ordered medications.

The Infectious Disease/Oncology team at Cumberland Medical Office Building in Atlanta had a high percentage of patient records in KP HealthConnect that listed duplicate medications.

To improve medication reconciliation, the team did a manual cleanup of patient charts over a period of several weeks. Then it instituted a new process for checking medication. They had the licensed practical nurses (LPNs) and medical assistants (MAs) call patients and ask them to bring their bottles of medication to their office visit.

During the initial workup, the MAs and LPNs reviewed patient medications, and checked off in the members’ charts which medications the patients were and were not taking.

The providers then confirmed medications once again with the member and removed all possible duplicate oncology meds from the patient’s record.

In collaboration with the clinical pharmacist, the MAs printed out a snapshot of the patient’s medications and gave it to the nurse practitioner for review and removal of any expired medication.

As they found success, the team included more medications in the process.

For instance, the team members reviewed patient records for infusion medications and one-time-only meds a patient might need to take before a procedure. Infectious disease pharmacists also began removing duplicate medications for their overlapping oncology patients.

Team members reviewed statistics for duplicate medications from KP’s National Reporting Portal, analyzed the data at huddles and posted it in the department.

They also monitored whether providers increased the number of times they had to reorder medications (which would indicate they were too aggressive in deleting prescriptions). As it turned out, the reorder rate was unaffected by the project.

The percentage of duplicate medications fell to 15 percent, far exceeding the team’s goal. And by avoiding hospital admissions due to inadequate medication reconciliation, the team saved $90,000 in three months.

It also created better communication with patients.

“Knowledge is power,” says Gwendolyn Brown, the team’s management co-lead. “It helped patients and their families ask more questions.”

And a full team effort helped the project succeed, as they moved from Level 2 to 4 in Path to Performance.

“It is tiring and frustrating when you are the only person doing the work,” says Brown. “Here, everyone is involved.”