The Challenge:

One goal among health care organizations is to appropriate level of care treatment for patients. For a large pediatric TeamHealth client in California, one aspect of consistent care is appropriate level of care when care is needed and to allow their physicians to service those needs whenever possible.

To achieve this goal, the following objectives needed to be met:

  1. Reserve Emergency Department referrals exclusively for patients who require that level of care.
  2. Direct parents/caregivers to follow up with their child’s physician network PCP in cases where waiting until the office re-opens is a clinically viable solution.
  3. Utilize existing client facilities staffed with pediatric resources whenever possible, if imminent care was required after hours.

The Solution:

The client’s after-hours children’s clinic is considered a hybrid urgent care facility with ‘ED-type’ capabilities. The facility is staffed weeknights, weekends and holidays. TeamHealth worked closely with the client to refine referral directives related to specific patient conditions and outcomes and this facility’s ability to deal with more clinically complex cases. TeamHealth met with the client’s business and clinical leaders regularly to review clinical cases and discuss refocusing the ‘post-triage’ process as it related to the appropriate referral of the patient depending on the care needed. These meetings resulted in:

  • The creation of an actively managed “Exceptions List” to the guide the RN’s to refer to the after-hours children’s clinic or defer to another client location, depending on the care needed
  • Refinement of TeamHealth internal system processes
  • Backline communication established between TeamHealth RN’s and client staff in the after-hours children’s clinic for appointment purposes.

The Results:

  • During the next 12 months, 91% of all referred callers were directed to a client facility. The other 9% of referred callers were comprised of parents and caregivers that refused a referral or were undecided (6%), or decided to go to a different non-client facility (3%).
  • The number of ED referrals also dropped significantly.

“We look forward to continuing our partnership with TeamHealth to provide excellent after hours care to our pediatric patient population.”
– Client Manager of Clinical Operation

High Level Detail

Detailed Breakdown