Callback Program Boosts Patient Experience Scores

Nurses and others follow up on 60,000+ ED patients

Improving patient experience may be as simple as making a two-minute phone call.

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Nurses and other caregivers at Cleveland Clinic are on track to make follow-up phone calls to every patient discharged from a Cleveland Clinic emergency department (ED). During the calls, caregivers verify that patients are stable after their ED visits. They answer questions and address any continuing concerns.

Since the effort began in January 2017, Cleveland Clinic caregivers have made more than 60,000 phone calls. As of August 2017, they have been contacting about 40 percent of discharged ED patients throughout the health system’s Greater Cleveland locations. That percentage continues to rise, with one ED already calling nearly 100 percent of its discharged patients.

Nurses make the majority of calls, but physicians, physician assistants, clinical technicians, paramedics and other caregivers call patients as well.

“We looked at using a robocall service, but there’s value in personal interaction — especially with a patient you served in the ED,” says James Bryant, DNP, RN, CEN, Associate Chief Nursing Officer of Emergency Services at Cleveland Clinic.

The whole purpose is to find new ways to increase patient engagement and satisfaction, Dr. Bryant explains.

“We all strive to put our patients first and deliver high quality care,” he says. “What it comes down to is going the extra mile to express genuine concern and empathy. Restaurants might give you a free appetizer. Mechanics might give you a discount on an oil change. Callbacks are our way of creating that unexpected ‘wow’ experience for ED patients.”

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Tied to the EMR

On Cleveland Clinic’s electronic medical record (EMR), caregivers can see a list of all patients discharged from their ED in the past 72 hours. The list excludes patients who were admitted, placed in observation or transferred, or who expired.

Each caregiver is encouraged to call at least two patients per day, ideally those they personally cared for.

“Some love doing it and end up calling 10 or more each day,” says Dr. Bryant.

During a call, the EMR prompts caregivers to ask how the patient is doing and if they have any questions about their discharge instructions or follow-up care. They also ask if anything could have improved their visit.

“We want to be proactive at addressing their concerns,” says Dr. Bryant. “Did they get their prescription filled? Were they able to schedule a follow-up with their doctor? Callbacks just let them know we care about them, even after they’ve left the ED.”

Calls also provide an opportunity for service recovery. If the patient had an unanswered question, the caller can seek out an answer. If care wasn’t satisfactory, the caller can apologize and take steps to correct it, when possible.

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When the call is completed, the caller records the patient’s responses, and the patient’s name is removed from the callback list. Caregivers also can record if there was no answer, they left a message, the patient was not available or the phone number was incorrect.

Calls linked to higher experience scores

Callbacks are making a difference, says Dr. Bryant, pointing to rising patient experience scores.

“Our scores have gone up since we started callbacks,” he says. “It’s another thing that we can do as caregivers that makes a real impact on how patients perceive their care. It creates loyalty to our hospital and services.”

For example, patient experience scores at Cleveland Clinic Fairview Hospital’s ED, where callback rates are about 75 percent, show significant year-over-year improvement. Overall experience was rated “very good” by 62 percent of patients surveyed from January to June 2017. That’s up from 49 percent for the same period last year. Most notably, provider communication was rated “very good” by 68 percent of respondents — up from 39 percent last year.

Many surveyed patients commented specifically on the phone calls.

“It’s all about connecting with our patients,” says Dr. Bryant. “We truly do care and want them to have good outcomes. To ensure we’re doing the best for them, there’s nothing better than hearing from them firsthand.”