Children's Hospitals Today - Summer 2022 - 20

FEATURE / MESSAGING
workflow when replying to messages.
Additionally,
the survey
pool or the provider inbox.
The team also added a feature to
asked about their level of burnout
and their urgency to respond
to messages.
From the survey results, interviews
and process map, the team
found that most caregivers had
unclear routing instructions,
used non-standardized messaging,
missed urgent messages, and
lacked time to complete them on
top of a busy workday.
Developing solutions
With this data in hand, the
team convened an educational
session with pediatric providers
to outline solutions. During the
session, the project team clarified
the workflow and provided
clear instructions on when a
message should be triaged, using
specific examples.
The team also introduced standardized
responses, called smart
phrases, for different scenarios-
requests for prescription refills,
billing information and appointments,
and messages routed to
the provider or the nurse. For
example, nurse triage messages
always use the smart phrase,
" Thank you for your request. Your
message has been forwarded to
Nurse Triage who will be contacting
you by phone so we can better
understand your concern. "
These smart phrases ensured
consistent responses no matter
who answered the message or
what the request was. The team
also placed a reminder card at each
workstation displaying instructions
for the smart phrases based
on the patient's message. After the
educational session, medical assistants
were able to identify which
messages they could reply to with
smart phrases and which should
be escalated to the nurse triage
20
BY THE NUMBERS
Survey results
A multidisciplinary team at
Cleveland Clinic's Children's
Hospital improved the hospital's
portal messaging workflow.
After the changes, there was
less burnout with messages,
increased comfort in responding
to messages, and higher use of
smart phrases to ensure consistent
messaging. Here are the numbers.
70%
60%
50%
40%
30%
20%
10%
0%
Burnout
70%
60%
50%
40%
30%
20%
10%
0%
Comfort with
messages
Use of smart
phrases
Before intervention
After intervention
Maria Tang, M.D., is associate staff
of pediatrics; Adam Keating, M.D.,
is an ambulatory pediatrics quality
improvement officer; Valerie Solar,
RN, is a physician specialist; Lynda
Paskonis, RN, is a triage nurse; and
Alexandra Gaye, M.A., is a medical
assistant at Cleveland Clinic
Children's Hospital.
Send questions or comments to
magazine@childrenshospitals.org.
Late responses
ity of the new workflow, the
team used EHR data to measure
the time to respond to messages
six months after changes were
implemented. They found that the
percentage of messages without a
timely response decreased from
20% to 2.5%.
In the open-ended section of the
post-survey, many respondents
commented on the consistency
and ease of the new process. One
shared, " This was exactly what
needed to be done, and it assured
successful use by staff. This was a
painless way to obtain staff buyin,
and now we love it. "
the system that automatically returns
messages to the pool if they
have not been routed within a
certain time frame, ensuring messages
no longer go unanswered.
Long-term results
Eight weeks later, the team
sent out the survey again to
evaluate the effectiveness of the
interventions. Sixty percent of
staff surveyed responded. When
the team compared pre-results
to post-results, they found less
burnout with messages, higher
use of smart phrases, and
increased comfort in responding
to messages.
To evaluate the sustainabilCHILDREN'S
HOSPITALS TODAY Summer 2022
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