Case Study: Central Kentucky Anesthesia
Central Kentucky Anesthesia Improves Outcomes, Reduces Length of Stay with On Call Central
Summary
Central Kentucky Anesthesia has become one of Lexington, Kentucky’s premier anesthesia practices. While the practice offers a variety of services, they specialize in providing anesthesia and pain management services for patients undergoing orthopaedic procedures, everything from fractures to total joint replacements. Central Kentucky Anesthesia boasts 13 anesthesiologists and 25 certified registered nurse anesthetists. If you live in central Kentucky and need an orthopaedic procedure, chances are that one of the professionals at Central Kentucky Anesthesia will expertly provide anesthesia and post-operative pain-management.
The use of peripheral nerve catheters and disposable infusion pumps presented the possibility of at home, postoperative pain management. Providing a continuous nerve block reduces the need for opioid medications, which prevents patients from developing opioid side effects and, more importantly, opioid dependence. However, for this medical device to be safely used by patients in their own homes, close communication with providers is essential. Providers need a way to reliably contact patients at least once a day, and patients need to be able to contact a provider, day or night. When Central Kentucky Anesthesia started this program in 2013, they kept in contact with patients by providing them with their personal cell phone numbers. While personal cell phones did provide a means of communication, they certainly were not professional and may not have been the safest option.
At A Glance
Overview
- Central Kentucky Anesthesia
- Located in Lexington, KY
- Number of Anesthesiologists: 13
- Number of CRNAs: 25
Problem
- Providers were using their personal cell phones to communicate with pain management outpatients, which was unprofessional at best and risked patient health at worst
Solution
- On Call Central created a custom call management system with a single number for incoming and outgoing calls with communication documentation and call scheduling
Results
- Helped increase the number of outpatient nerve catheter patients by nearly six-fold in two years
- Provides a highly professional communication system that providers and patients love
- Creates a digital recording of each answered and unanswered call that can be used in the medical record and to coordinate care
Problem
“Cell phones worked, but I didn’t feel comfortable using them,” explains John Edwards, MS, CRNA with Central Kentucky Anesthesia, “we didn’t have a fool proof way of tracking who called, or what was discussed. Did someone reach out to Mr. Smith today?” Central Kentucky Anesthesia’s Acute Pain Service needed a centralized system to make and receive calls, ideally through a single phone number that patients could call 24 hours a day. They were looking for a way to organize daily patient follow-up calls and improve documentation.
Solution
On Call Central is a secure, automated call management system that uses web-based technologies to directly connect patients and providers. Patients are given one number that is routed to the appropriate provider on call. Before they go home, all patients get a wristband with the On Call Central phone number. Every peripheral nerve catheter also has a sticker with this number right on the side. There is an instant record and digital recording of each secure phone consultation, which can become part of the medical record. If a provider cannot reach a patient on the number they provided, there is also a record of that attempt.
On Call Central has become the centerpiece of communication for Central Kentucky Anesthesia’s Acute Pain Service. It has helped them expand their practice as well. The practice had just 15 patients go home with disposable infusion pumps in 2013 and supplied 140 patients with these pumps in 2014. The practice added On Call Central in May 2015, which coincided with a fourfold increase in patients on their Acute Pain Service. They had 575 patients on this system in 2015 and 691 in 2016. These numbers do not even include the over 3000 nerve block patients that the Central Kentucky Anesthesia’s Acute Pain Services manages on a yearly basis. Mr. Edwards adds, “We would have kept expanding the program, but it would have been a nightmare to manage without On Call Central.”
The full implementation of at home, postoperative pain management services using nerve catheters has had a profound impact on patient care at Central Kentucky Anesthesia. Perhaps the biggest difference has been on the time a patient has to stay in a hospital after a procedure, referred to as length of stay or LOS. Before patients could be sent out after procedures with a nerve catheter and disposable infusion pump, pain management had to be done as an inpatient. This hospital stay can increase health care costs considerably and is a burden for patients and caregivers. Since starting the outpatient acute pain service, patient satisfaction had dramatically increased and LOS has decreased consistently. “Patients love the freedom to return home sooner. With the disposable infusion pump, patients can be virtually pain-free while they recover at home. The amount of opioids that our patients require now has dramatically decreased. With On Call Central, we can ensure the level of monitoring required to safely manage our acute pain patients at home,” says Edwards.
Results
The providers at Central Kentucky Anesthesia’s Acute Pain Service are extremely pleased with what they have received from On Call Central. Patients have been very pleased with their care and with their service. Here are just a few of the results that Central Kentucky Anesthesia enjoys now that they have made the switch to On Call Central:
- Provider numbers remain private. The providers at Central Kentucky Anesthesia didn’t necessarily mind that patients had their personal cell phone numbers, but it was far from ideal. A single business number was strongly preferable. “I don’t think any patient used one of our personal cell phone numbers inappropriately, but as our service grew, you just never know,” Edwards states. Patients who call the centralized number provided by On Call Central are greeted with a professional call management system and are promptly forwarded to someone who can actually help them. “I love the fact that On Call Central has allowed us to have over 4000 phone interactions with patients at home. We hear time and time again how much they appreciate our compassionate care and excellent follow up,” added Edwards.
- Closed gaps to improve patient safety. The providers at Central Kentucky Anesthesia have a very collaborative system of care, especially in regards to the acute pain service. Since every patient with a peripheral nerve catheter and disposable infusion pump needs to be called every day, providers share this responsibility. Providers can quickly find a list of patients who were called or need to be called on a given day. With On Call Central there is a record of every call, which helps to ensure that every patient is called, every day.
- Medicolegal documentation. On Call Central provides a record of each incoming and outgoing phone call. Not only is each completed call recorded, but so is each message. That means if a patient fails to return phone calls from the providers daily follow-up call, Central Kentucky Anesthesia has documentation that they tried to reach the patient.
- Improved practice organization. One On Call Central feature allows users to set up a call schedule for the daily provider on call. Edwards said, “I had an extra hour after the new year to work on the dashboard. Now our call schedule is setup for the whole year.” After minimal screen time on On Call Central’s dashboard, the practice has a call schedule for a whole year. If someone needs to change their schedule, the changes can be made on the dashboard quickly and easily.
- Rapid setup. “I was amazed by how fast the setup went,” Mr. Edwards mentioned. The time between hearing about the product and full, integrated setup was no more than 2 or 3 weeks. On Call Central provides hassle-free setup for every client.
- Fully customizable. Central Kentucky Anesthesia was able to set up their own rules for how calls would be handled. This includes rules for call routing, missed calls, and callback reminders. This service is available to all On Call Central clients.