Quality Improvement Initiative to Improve Uptake of an Alternative Call Management Strategy for Home-Based Hospice Care.

Abstract

Background: In home-based hospice care, frontline nurses frequently need to take unscheduled incoming calls while out in the field. This interrupts critical tasks and disrupts patient rapport, potentially lowering care quality for patients. At HCA Hospice in Singapore, the 30 frontline nurses could receive up to 135 calls/day. In mitigation, a telemedicine call-center system (MediHELP) was conceived in September 2023 for frontline nurses to divert incoming calls to a dedicated team for timely management remotely. However, call diversion to MediHELP remained low. A Quality Improvement project (December 2023-July 2024) was designed to catalyze the process change.

Methods: Using the plan-do-study-act (PDSA) model, we aimed to increase call diversion rates to MediHELP by 50%. Initial root cause analysis, corroborated with surveys and focus groups, revealed key challenges: inconsistent processes, inconvenient diversion procedures, and lack of awareness. The first PDSA cycle focused on developing a standardized communication protocol with nurse input, while the second cycle broadened operational hours and improved outreach efforts. Outcomes were evaluated by examining call diversion rates and conducting feedback surveys among stakeholders to assess confidence in the MediHELP team and perception of its effectiveness.

Results: Implementations led to a significant increase in call diversions (from 11% to 65%), achieving 600 calls per month within six months, passing the targeted diversion rate of 50%. Home care nurses reported increased confidence with the MediHELP team, improvement in its perceived effectiveness, and acknowledged that call diversion had led to less stress and greater focus at work.

Conclusion: Successful implementation of a new initiative that reduced nurse burden was achieved by addressing workflow barriers. This initiative could support the future expansion of home care capacity. Additionally, MediHELP services would be extended to patients under day-hospice support within the organization.