Putting Patients First to Ensure Appropriate Utilization of Resources

Posted by Christina Gurnari on Apr 24, 2019 9:25:04 AM

iStock-1034254290 (web)It seems like it should go without saying that patients should be a healthcare provider’s primary focus. According to a recent national survey of NEJM Catalyst’s Insights Council, the current provider environment makes delivery of high-value, compassionate care a challenge. According to the survey, the biggest part of that challenge involves finding more time with patients so that clinical staff can spend the right amount of time to provide the right care. This time can greatly impact patient experience and satisfaction which are also driving factors in creating a high value compassionate care environment.

Dealing with high patient volumes efficiently starts with ensuring you get the right patient to the right resource at the right time. By expanding access to care outside of regular office hours, you can reduce unnecessary and often costly ED visits. When patients know they have access to speak with a clinical professional anytime, day or night, regardless of the severity of the symptoms, you yield higher patient satisfaction rates and patients who are more engaged in their wellness.

Over the past decade, we’ve tracked a wide variety of clients who have implemented our Nurse Line services in order to help guide patients to the appropriate level of care. In the process, we’ve identified best practices common among clients with the lowest levels of unnecessary utilization. Since triage is a top-down process, it all starts with ensuring patients with emergent conditions get the right care promptly. Having a central Nurse Advice Line that offers clinical triage to patients and gives advice on whether to treat a minor symptom with home care or head to the Emergency Department (ED) is only the first step in the process. By employing secondary triage, providers can help drive patients to the most appropriate level of care, ensuring those cases don’t fall through the cracks and develop into emergent situations down the road.

Here are additional best practices employed by provider organizations that successfully manage utilization:

  • Have a well-established Emergency Department (ED) management plan in place
  • Require group offices to have ED pre-authorization between 7 PM and 10 PM
  • Extended after-hours clinical and non-clinical support
  • Use secondary triage to ensure patients are routed to the most appropriate level of care for their condition
  • Coordinate triage services so that they align with the additional services available to the patient (such as urgent care clinics or telehealth visits)
  • Promote the Nurse Advice Line to ensure patients know they have 24/7 access to care (This step alone can prompt a 300% increase in utilization and reduce unnecessary ED visits!)
  • Offer a range of resources, such as mental health resources, same-day appointments, and urgent care clinics

Download Value of a Nurse Advice Line Paper:

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Christina Gurnari

Written by Christina Gurnari

Christina brings experience focused on selling into highly complex client relationships with large national and regional Health Plans, Academic Medical Centers, Healthcare Systems, Universities and Provider Groups. Prior to joining Citra, she was responsible for market share growth for Forest Pharamaceuticals as a Sr Specialty Sales Manager and began in healthcare with Shire Pharamceuticals as a Specialty Sales Representative in the Behavioral Health division.

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