SF General’s transitions team gives patients a number they can call when they need help navigating the healthcare system.
Collaborator (Non-Members)Larissa Thomas, Michelle Schneidermann
Many of our patients had small, simple questions that could be answered quickly but, since they didn’t know how to get them answered, they would just go back to the emergency room. If they did try to call the hospital, they’d get “Press 1 for this, press 2 for this, press 3 for that.” It was very frustrating.
San Francisco General is a non-profit hospital and level 1 trauma center in San Francisco, CA. It has 598 beds and serves a diverse population, the majority of whom are lower income and do not speak English as their first language. Many are also illiterate in English as well as their preferred language. The hospital also serves individuals who may not have health coverage, housing or access to food. They enroll the most difficult to engage patients who have a history of substance abuse and poor health outcomes. Their transitions program began in 2009 and is influenced by the Care Transitions Program and Project RED.
What We Tried
We created a “warm line” that patients could call from 8:00–4:30. When they call, they receive a clear message, “Please leave your name, speak slowly, tell us what your concern is and a number we can reach you. We’ll call you back today or tomorrow.” Any of our nurses can access this line and will call patients back. That’s a really big thing, for patients to actually get a call back from the hospital.
The warm line is less about giving medical advice and more about helping patients navigate the health system. Patients may call because they’re out of pills and I’ll coach them to call their clinic or their pharmacy and remind them to count their pills regularly. In the past this is something they would have come into the ER for, but now I can help them over the phone.
Patients aren’t coming back to the ER for the same reasons anymore. We’re coaching them at the bedside and letting them know that they should call the warm line if they have any questions instead of just coming back. They prefer that because no one wants to come back and wait in the ER for hours.
The warm line is also a way to support patients who aren’t receptive to our help. They may not want home visits or follow up calls, but at least they have this number they can call if they realize they need help.
Primary care physicians can also use the warm line if they have questions about a patient. This gives them a single point of contact instead of having to figure out who the patient’s care team was.
Whoever is answering the phone needs to understand the scope of coaching. For example, if a patient complains of shortness of breath, we are obligated to recommend that they call 911 or come into the emergency room. Some people might think that the warm line failed if patients come back to the hospital after calling, but I see it as a patient actively managing their condition.