Call centers have key role to play in pandemic planning
Non-clinical staff would handle 'education' calls
Call centers will be the first line of defense for the hospitals they serve if a pandemic such as an outbreak of avian flu should hit the United States, say a variety of health care professionals working to prepare for such an eventuality.
The message to patient access directors and other hospital leaders is "your phones will be crazy" if a pandemic occurs, says Pat Pollert, RN, call center manager for MeritCare Ask-A-Nurse in Fargo, ND. "If there isn't an existing call center, [people] will call the hospital switchboard and clinics.
"You need to anticipate that and make sure you are involved in any community discussion," adds Pollert, whose call center works with the state health department to identify spikes in symptoms that could give early warning of a pandemic.
"You need to know what the plan is, because if you're not informed you could make things worse," she points out. "It may not be the best time to say, 'Just go to the emergency department,' because that could make someone sicker. If people are not experiencing flu symptoms, you don't want them exposed."
For those on the non-clinical side of this kind of disaster, says Pollert, one of the most crucial things to remember is that everyone in the organization should be providing consistent information to the public.
"[Inquiries] will be coming in through lots of different phone numbers," she notes. "Whatever the entry point, there must be the same message." In some cases, Pollert adds, the best plan will be to simply funnel calls to a central pandemic call center.
"In a true pandemic, the message going out could change by the hour," she says. "That's when you need the least number of people possible relaying that message."
It's important in a pandemic to try to isolate the caller's problem, Pollert says, "and call centers are involved because you don't want people to present on their own. There could be mandated quarantines, so the phone link is critical."
North Dakota's health department established 15 work groups to facilitate its pandemic planning, covering such topics as logistics, finance, security, and patient care. Pollert served on the patient care subgroup, which looked at, among other things, how call volumes would increase as people started getting sick and what the triggers would be for taking various steps.
"When we get X number of calls, we would bump up to this level [of response], we would set up a dedicated line at this point," she says. As patient volume increases, Pollert explains, the criteria for directing people to come in for care would get tougher.
"Unless people are exhibiting [a specified] group of symptoms, we want them to stay home," she adds. "We even worked out what places in the hospital people with different sets of symptoms would be directed to based on acuity level and on what the capacity is at the moment."
Through the McKesson software used at the call center Pollert manages, data sought by the state health department are compiled seamlessly, she notes, "as our nurses go through the day and do their work."
"There may be certain symptoms the [callers] say they have, and we [select] those, providing automatic documentation," Pollert explains. At the end of the day, using a program created by the software vendor's technicians, she says, "somebody downloads the information, takes out the patient identifiers, and dumps [the data] into syndrome surveillance software."
"It's all done in terms of how the software is programmed," Pollert adds. "Say 'fever and vomiting' or 'fever and cough and abdominal pain' are the groups of symptoms we're looking for. [Technicians] are able to extract that."
Health officials have been able to correlate spikes in certain clusters of symptoms with confirmed cases of influenza, she says. "The report of the clinical data we are able to pull out of our software is a very good early predictor of potential outbreaks."
Typically, ZIP codes are included in the data in order to look for clustering, but information identifying patients is removed, Pollert says. However, she adds, if a cluster indicative of, say, an anthrax outbreak, were identified, technicians could "drill down" to that level of specificity in the interest of public safety.
Proactive approach taken
Evergreen Healthline, a 24-hour nurse and information call center at Evergreen Hospital in Kirkland, WA, became actively engaged in emergency preparedness several years ago, says call center manager Vickie Cundy, RNC, realizing that "we are going to be the front line for information" should a pandemic occur.
"We have a plan specific to our department as well as being involved with the emergency planning groups for the entire organization," she adds. "We also became involved with the community in a variety of breakout groups formed by the local health department's coalition for pandemic awareness."
A regional telecommunication group, started about a year ago, Cundy says, is addressing such issues as how call centers would access the resources of their counterparts in the area "if we need to quadruple our call volume."
There are plans in place for having Evergreen call center staff handle low-level 911 calls in the event of a pandemic, she notes. "If a large part of the community is ill in a pandemic, emergency response services will be totally overwhelmed, so they are determining how to delegate the non-emergent calls to us."
Taking education calls
Under the Healthline's own departmental pandemic plan, the call center's clinical staff would continue to take triage calls from people who are symptomatic while non-clinical employees would be called upon to handle "education" calls, Cundy says.
"If people are calling and saying, 'I've heard about avian flu. What should I know?'" she adds, non-clinical staff using scripted material would inform callers of what to do under various circumstances.
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'Linked network' in planning stages Technology 'looks promising' Business-oriented, non-clinical call centers such as those under the direction of many in the patient access field will be an important component of the response to a large-scale public health emergency, suggests Joe Cropley, project manager for the Puget Sound Call Center Coordination Project. Such call centers "might be called to participate in a linked network" should a pandemic or similar situation arise, says Cropley, who is employed by the Washington Poison Center, which is under contract to Seattle-King County Public Health. That region, he adds, "is the only one in the country right now actively trying to put something together" in terms of a call center network for public health emergencies. While one component of the planned call center response will be medical triage, he says, the other in which non-clinical centers will be involved "will be what we are calling 'the provision of scripted general health information.'" For those concerned because their facilities use proprietary software and might not be able to connect with a network of call centers, Cropley notes that a variety of technologies that would take care of that issue are being explored. "It looks promising," he adds. Cropley says he welcomes feedback from health care professionals interested in working toward this kind of call center solution in their own areas. Non-clinical call centers' participation in such a network would be activated only in the event of a wide-spread public emergency such as a pandemic, he emphasizes. "This would not be day-to-day business." The goal, as others have pointed out, will be "to keep as many people at home as possible" and provide relief to hospitals, clinics, and 911 services that are being overwhelmed by calls, he says. (Editor's note: Joe Cropley can be reached at [email protected].) |
In addition to clinical functions such as a 24-hour nurse triage line and after-hours coverage for physician clinics, Evergreen call center staff perform non-clinical tasks including scheduling diagnostic imaging and respiratory therapy procedures, physician referrals, registration for community education classes, and absence reporting (employee sick calls), Cundy notes.
"Our call center is one of the key communication links for any event that occurs at the hospital," she says. "Once the primary event team makes the decision to declare an emergency or another internal or external event with the potential to disrupt daily operations, they notify us."
The call center recently has taken responsibility for an organization-wide phone tree that covers a variety of in-house and off-campus departments it is charged with notifying in case of an event, Cundy says. "There are overhead announcements, but some staff that are off-campus don't hear. The hospital-owned clinics, for example, also need prompt notification."
The effectiveness of the phone tree has been confirmed, she notes, through two recent practice scenarios one a region-wide test. "We didn't have 24-7 notification of all key staff and departments, and since the Healthline call center is a 24-7 operation, we realized we could support this effort effectively."
There is also a Healthline department-specific phone tree, she says, that lists all employees and the distance of their homes from the hospital whether 15, 30, or 45 minutes away. "That allows us to quickly ramp up our staffing based on the employee's proximity to our worksite.
"We have also shared what our department did to educate our team on pandemic [preparedness] with the organization's planning team," Cundy adds. "They decided there was a need for an education tool for the entire organization."
Other departments have asked for copies of the call center plan, Cundy says, in order to develop something similar.
A learning tool containing emergency preparedness information is in development for organization-wide continuing education use that shows employees how to be prepared at home in the event of a disaster or pandemic. "If they're prepared at home, they're more willing to come to work," Cundy says.
Remote work force deployed
One of the primary components of the call center's emergency preparedness program, she continues, is a remote force of employees who are able to work entirely from their homes with full access to the call center's software system.
The development of a remote work force began three years ago with a small group, Cundy explains, and now several employees participate.
Initially, land lines were installed in four user homes, and those employees could make outbound calls for the center, she adds. The recent advent of Voice over Internet Phone (VoIP) technology, however, now allows home-based staff to handle both incoming and outbound calls, Cundy says, which greatly increases call efficiency.
"Our department also has back-up plans on how to rapidly mobilize additional remote staff if necessary," she notes "In addition, arrangements have been made for ramping up the call center's software licensing to handle one-, two- or three-month high-volume scenarios should a pandemic occur."
As the severity of a pandemic increased, call centers would go from providing information and referrals to also having their own level of preparedness, notes Marlene Grasser, RN, a Seattle-based regional sales director for contact center software vendor LVM Systems, of Mesa, AZ.
"The function would start to change," adds Grasser, a former call center manager who spent 20 years working for Evergreen Healthline, and would include such steps as beginning to screen call center employees and keep records of those results.
Services available at the hospital would gradually be reduced as the pandemic level goes higher, she suggests, and there would be occurrences such as, for example, running out of ventilators. In those instances, Grasser says, the call center would begin referring people to surrounding clinics and trying to keep the ED volume as low as possible.
"There would be designated fever clinics, sick clinics, and immunization clinics," she notes. Schools and other facilities would not be operating and would be used to provide patient care, Grasser says. "The call center would be tracking information [to identify] resources in the community and delegate people to those facilities."
At Evergreen's call center, notes Cundy, there will be a screening process for any employees entering the work site during a pandemic. The person's temperature will be taken, and an assessment will be done to determine whether any family member at home is sick with symptoms of avian flu, she adds. "If so, the employee will not be allowed in the call center.
"We have masks and food preparation [capabilities] so people can stay on-site if necessary," Cundy says. "During a pandemic we can expect to be working long hours so being prepared at the call center and at home is essential. Because our software is complex, it would be difficult to bring in outside people to do triage, which is why a remote user staff is advantageous in emergency planning."
To patient access directors and others who might face this kind of health care crisis, Grasser says, "the best thing I can say is to network. Every demographic area has different needs, different issues. For example, we estimate the pandemic will hit where birds migrate not the Midwest, but coastal areas so network with others in that demographic, or in the 'opposite' areas, which might bring up things you haven't considered."
Evergreen call center personnel had conversations with their counterparts in Nevada, she notes, on how to use software differently to maximize its usefulness.
"Not everyone can be fully prepared, so know how to deal with excessive volume, know how to refer out," Grasser advises. "Things in the software area are constantly changing. Be as automated as possible. Be able to send blast e-mails and blast faxes.
"You don't want your staff to have to stop and think about where to go for information," she says. "Make it easier for them [with] automated pop-ups. Make sure the software fits the process and not the other way around."
When U.S. health officials speak of a pandemic, Grasser notes, they're talking about the potential outbreak of a very aggressive influenza virus with the markers H5N1 or some mutation of that virus.
"There is human-to-human transmission, but [the virus] is not spread rapidly," she notes. "It is predicted that it will in the future. When we see that virus pop up, that is when our level of alertness goes up. The virus just needs to mutate a little and we would have a major pandemic."
(Editor's note: Vickie Cundy can be reached at [email protected]. Marlene Grasser can be reached at [email protected]. Pat Pollert can be reached at [email protected].)
Call centers will be the first line of defense for the hospitals they serve if a pandemic — such as an outbreak of avian flu — should hit the United States, say a variety of health care professionals working to prepare for such an eventuality.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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