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Case Study: Georgetown University Hospital

One Call Does It All. Georgetown University Hospital’s Sharp Focus^® referral center helps outlying physicians refer critically ill patients after hours.

Georgetown Univ. Hospital Contact Center Staff
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Organization

Georgetown University Hospital (Georgetown) is Washington D.C.’s oldest and most recognized academic teaching hospital that has been dedicated to promoting health through education, research and patient care since 1898. With 609 licensed beds, Georgetown’s scope of clinical services represents one of the largest, most geographically diverse and fully integrated healthcare delivery networks in the area.

Challenge

The patient was stabilized at a community hospital’s Emergency Department for cerebral bleeding. There was one problem: the hospital that this patient was receiving care from did not have the neurosurgical support for his condition. The patient needed to be transferred to a specialist at another facility as soon as possible. Although Georgetown University Hospital maintains a fully staffed neurosurgical department, it was losing many of these referrals.

Georgetown’s referring physicians were frustrated because they were unable to have their critically ill patients admitted to Georgetown after hours. "Referring physicians didn’t like all the phone calls they had to make to get their patients admitted to Georgetown. The patients that they want admitted are unstable and may require surgery, so they need care quickly. Because care in this instance is so time critical, the referring physician would default to a hospital that could quickly assist them with an appropriate on-call physician," says Vivian Winter, Director of Georgetown’s referral center. How could Georgetown create a "one phone call" solution for referring hospitals and physicians to transfer a patient to Georgetown after hours?

Solution

"Our main challenge was to supply a 24/7 response to accommodate after-hours emergency referrals, transfers and admissions," says Winter. She researched how to continue the daytime referral service to an after-hours "One Call Does It All" program. She looked at various technologies that could help with program implementation.

"The person taking the call needed to be a clinical person, so an answering service wouldn’t work. The logical step was to expand the referral center. However, implementing a 24/7 referral center on site is an expensive process, and the call volume was unknown to support this extra cost. After careful review, we selected wireless technology, since a cellular telephone was portable, offered an immediate response and proved economical. We could forward a call to the cellular telephone, program telephone numbers, and have three way conference calling. It was definitely more cost effective for us to pay a nurse to be available on-call who could use the cellular telephone to complete the process without having to be in the office," explains Winter.

With a wireless solution in hand, the outlying physician could call Georgetown’s contact center phone number and be connected to an on-call nurse counselor immediately, even if it was 3:30 in the morning. The on-call nurse could use the cellular telephone anywhere and complete the after-hour, referral and transfer process in approximately fifty minutes. Within this period, the proper specialist would be assigned, an appropriate bed reserved, and emergency transportation arranged.

During the call, the nurse takes manual notes regarding the patient, transfer, physicians and facilitation, and then enters this information into the Sharp Focus® Consult Module the following day. An assigned user-defined code is entered into the program to identify the consultation and referral call in the database. This step provides complete documentation of the referral and the ability to generate future activity reports.

Benefits of Sharp Focus

"We use the Consult Module because there are ways of tagging the after-hours referrals as admissions. The benefit of identifying the action type with codes is to use them for custom reports and consult logs. We can easily see all the patients that were admitted during this time, find out what hospitals referred the patients, provide useful physician and hospital data and track the services most used," states Winter.

She continues; "The Notes Area in the caller log allows us to input status of patient, the name of people notified, the actions taken, and the estimated time of arrival. If something didn’t go right during a transfer, we have the documentation. We can go back and check on the quality of our process. Sharp Focus gives us the confidence that everything on our end was appropriately completed."

"I am a huge fan of the Sharp Focus Custom Reporter because it is flexible, allowing you to easily pull up the information you need without having to sort through unnecessary data. I provide reports which track revenue, services rendered and other metrics to administration each month," comments Winter.

Lessons Learned:

1. Starting with a small pilot seems appropriate. However, once you open the line you can’t limit what comes in. "You’re not going to turn down an admission just because it’s not from your targeted specialty."
2. Build very strong alliances with clinical departments because they quickly understand the advantage of how much easier it is to facilitate referrals through this process.
3. You build strong alliances with referring hospitals because of the ease of transferring their patients. They learn that we take care of the acute cases referred and return the patients to the referring physician for follow-up care.
4. A contact center software with robust reporting capability such as Sharp Focus represents perhaps the only opportunity to document the financial benefit of marketing efforts.
5. It makes sense to have nurses on these calls, and it is much more cost effective to have them provide this service from their homes.
6. Physician-to-physician referral represents a significant opportunity to refer a substantial percentage of incremental patients to the institution.

Sharp Focus with Consult Module helps Georgetown University Hospital:

• Make regional physician referrals for critically ill patients easier, more efficient
• Create a seamless 24/7 off-site referral center
• Increase incremental inpatient admissions by an average of 85 per month
• Create incremental revenue averaging $4.34 million per month

Results

• Seamless 24/7 off-site referral center
• Incremental inpatient admissions increased by an average of 145 per month*
• Incremental revenue averages $9.37 million per month*
• Program to date since 2001:
  $446.43 million inpatient charges (7,410 admissions)
• Referrals received from over 191 hospitals, 21 states and 7 foreign countries *(updated 1/07 for previous 18 months)

For more information, contact Vivian Winter, Director Referral Center at (202) 444-4003
or e-mail winterv@gunet.georgetown.edu.

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