Pennsylvania Hospital Leans on Change Healthcare for Nurse Triage Services During the Pandemic
“The volume of calls and requests for information exceeded our internal resources, information on the virus was changing quickly, and we needed to expand to assure the needs of our community were being met safely, correctly, and efficiently.”
- Heidi Aubertin
Quality Improvement Lead for Medical Practices, Grand View Health
Grand View Health, an independent community health system serving Bucks and Montgomery counties in eastern Pennsylvania
Calls to a COVID-19 hotline launched early in the pandemic were overwhelming internal staff, and concerns were increasing about the sustainability of Grand View’s COVID-19 population health strategy.
Technology Enabled Services: Nurse Triage
Change Healthcare quickly stood up a dedicated registered nurse triage team to handle more than 4,000 hotline calls per month. The RNs provided guidance around COVID-19 symptoms, testing, quarantine, and treatment, and were later responsible for sched
Based in Sellersville, PA, Grand View Health provides primary and specialty care to tens of thousands of patients annually through Grand View Hospital, a 168-bed acute care facility, as well as six outpatient centers. The hospital is a Level 2 Trauma Center and is accredited by the Joint Commission as a Primary Stroke Center.
The Challenge: Creating Clean Claims
After the pandemic exploded in March 2020, Grand View Health launched a hotline to address patient-care needs regarding COVID-19 symptoms, testing, isolation, and treatment.
The primary objective was patient triage: The sickest callers were instructed to go to the emergency room, while those who were mildly symptomatic were asked to isolate or seek care from their primary care physician. The process was designed to funnel patients to the appropriate level of care, improve access to treatment, and protect staff and patients from further infection from the virus.
Because many hospital services had been curtailed due to the pandemic, the hotline was initially staffed by clinical personnel from a variety of internal departments, But as 2020 wore on and the facility began to reopen, clinicians increasingly needed to return to their primary duties.
Hotline call volume, however, continued to grow. With the hospital’s approval, area public health departments had been directing the general public to the hotline for timely and reliable COVID-19 information. Even nonaffiliated clinicians were including the hotline number on their recorded, patient-directed messages.
To keep pace, administrators, managers, and clinicians from the care management team manned the phones seven days a week. Heidi Aubertin, Grand View’s quality improvement lead for medical practices, took calls herself every weekend—but the effort eventually became unsustainable.
“We reached a point where we were burned out and no longer able to fulfill our roles,” Aubertin said. “I talked to my vice president, and we agreed that the hotline was something the hospital needed to continue. So that’s when we made contact with Change Healthcare.”
For several years, Change Healthcare had provided scheduling for the hospital’s laboratory and radiology departments, so the company was not unknown to Grand View. In late 2020, hospital leaders reached out to discuss their hotline/triage needs.
The clinical guidelines and protocols staff had been using were shared with Change Healthcare, along with details about the hotline’s required hours of operation and anticipated call volume.
Beyond identifying a vendor that could duplicate the level of service provided by internal staff, Grand View was committed to selecting an organization that would seamlessly integrate as a virtual extension of the hospital.
“What we really tried to emphasize to Change was that we were a small community hospital and we were looking for someone that could help us maintain that genuine sense of community and, as much as possible, adapt to our environment,” Aubertin said.
“Change was very responsive to those conversations,” she added. “That was encouraging for us and gave us the confidence to move forward.”
Change Healthcare agreed to create a team of registered nurses that would be exclusively dedicated to handling Grand View’s hotline calls. After extensive planning, the triage service was ready to launch within 30 days.
Change Healthcare’s team took over the hotline on Jan. 4, 2021. Along with providing Centers for Disease Control (CDC) guidance regarding symptomatic and asymptomatic infection, the RNs directed callers to area treatment and testing sites, helped them determine exposure risk, and provided guidance on isolation and quarantine.
The nurses followed detailed, technology-enabled algorithms customized to Grand View’s patient population to help ensure a consistent and appropriate response to each call.
By February, call volume had rapidly increased to 4,000 calls per month. Even so, average time-to-answer quickly fell to less than 30 seconds and remained there through the rest of 2021, thanks to collaborative process-improvement initiatives.
Aubertin said that when issues or concerns occasionally arose based on patient or provider feedback, “I never hesitated in taking it to the Change Healthcare team, and we would iron it out and move forward. It was an extremely collaborative relationship, and I think that was critical to the hotline’s success.”
By the spring, the public’s attention was shifting to the emerging COVID-19 vaccines, so hotline call volume was dropping. As a result, a decision was made to add to the scope of hotline services with the inclusion of a dedicated vaccine-scheduling outlet. Going forward, the Change Healthcare RNs would rely on hospital scheduling software to set up all vaccination appointments for system-affiliated patients.
Over the next nine months, the Change Healthcare RN team was responsible for scheduling more than 17,000 vaccinations, including appointments for a majority of all of Grand View’s 1,800 employees.
The process helped ensure appropriate vaccine distribution to the most vulnerable patient populations early on, when vaccines were in short supply.
After vaccine scheduling began to ease, the triage team was next tasked with reviewing the medical records of high-risk Medicare patients to schedule their annual wellness visits, since many of these patients had missed appointments through the initial phase of the pandemic. It was therefore important to get them in to be assessed as quickly as possible, Aubertin said.
“We try to be very proactive with our highest-risk patients, so we thought this was a really good way to continue our partnership with Change Healthcare and draw on the clinical expertise of the nurse team they’d put together,” she said.
Aubertin said the evolving relationship with Change Healthcare has exceeded the hospital’s expectations.
“Change Healthcare was an excellent partner through the pandemic,” Aubertin said. “They were thorough in their planning, collaborative and professional in their operations, and flexible in adjusting to our evolving needs. We’re very proud of the work we did together to deliver a vital service to our community.”