When COVID-19 caught hold of the U.S. in early 2020, provider systems everywhere began to implement strategies to control patient volume, clinician capacities, and PPE usage. With the increasing availability of COVID-19 testing, systems were again challenged to balance patient and supply volumes – effectively screening the community while ensuring the availability of tests for those who desperately needed them. After establishing a set of eligibility guidelines for COVID-19 tests, the Operations team at Cleveland Clinic created a workflow to ensure said guidelines were met for all caregivers and patients of the enterprise. Adoption of this workflow, however, would require the establishment of a headquarters – a task Innovations was proud to take on. Director, Product & Business Development, Chip Steiner was one of the first on-site to work alongside project lead, Purva Grover, MD, to establish the center at Cleveland Clinic’s Administrative Campus in Beachwood, Ohio.
Upon arrival in Beachwood, Steiner and the team from Operations, nurse practitioners, and physician assistants routed Cleveland Clinic’s existing hotline number to their location and enabled Epic logins on the available computer terminals. With access to the Epic context created for COVID-19, these caregivers were able to receive calls and place orders for the Hotline. The operation became known as the COVID-19 Call Center, and its purpose was twofold: easy access to testing for caregivers and the assurance that all patients who called on their provider for COVID-19 had a consistent care path. After the establishment of the call center, only those orders and phone calls that flowed through the hotline would result in an ordered test. Serving as an interface between the clinician visit and patient arrival at the testing center, the new workflow screened and organized orders for manageable distribution of COVID-19 tests.
Said Steiner, “16 hours-a-day, seven days-a-week, phones were ringing off the hook.” Founded with only eight providers, Steiner organized a push to get more caregivers involved. But as the operation grew, so did a need for an efficient team management tool. In conjunction with Cleveland-based software company, OnShift, Steiner was able to implement a scheduling system for the call center staff. Making their product available to the center, OnShift played a huge role in the team’s ability to log staff hours, fill upcoming shifts, and get care providers paid for their service. Implementation of a scheduling system made the sailing smoother, but with rotating clinicians, running the center effectively required some consistent faces to bring newcomers up to speed. Several Innovations team members volunteered their time to maintain a presence that would be familiar to those passing through. Working into the night and on weekends, Innovations facilitated newcomer training by veteran provider staff so as to keep the operation running as smooth and swift as possible.
At its most basic function, the call center helped establish that any order for a COVID-19 test was based in medical need. Alongside most optimal distribution of testing supplies, building a barrier to control testing ensured that any change to the screening criteria could be controlled and implemented immediately – rather than non-uniform adoption across the system. At peak, the center was authorizing as many as 250 tests a day and minimizing testing of the “worried well” with the organization’s limited supplies. Before screening encounters and requiring at least one symptom, the hit rate for positive patients was around 3%. After implementing a symptom requirement as part of the call center workflow, Cleveland Clinic saw its hit rate go up into the teens – an indicator that tests were being used for those in need.
As of June 1, Steiner and the Innovations team members ramped down their involvement, and management of the center was turned over to the advanced practice providers. A heavy lift, Steiner credits the clinicians chipping in time to control the surge. Said Steiner, “Every two weeks we would open shifts in the scheduling system. With four to five clinicians per shift and shifts 16 hours-a-day for two weeks, we’d unlock nearly 200 slots. Yet, in four minutes, all the shifts were taken.” Eager to help those with COVID-19 concerns in a time of high anxiety and flex outside typical roles to better help patients, the call center efforts showcase the compassion and devotion known of Cleveland Clinic caregivers.