Implementation of an Automated Phone Call Distribution System in an Inpatient Pharmacy Setting
Background: Inpatient pharmacies receive numerous phone calls from health care professionals and patients. This uncaptured workload poses potential staffing concerns for pharmacy administrators as unequal distribution or misdirected calls to the pharmacy team can lead to accountability and patient safety concerns. We aimed to implement and evaluate the effectiveness of an automated call distribution (ACD) system in an inpatient pharmacy setting at a US Department of Veterans Affairs hospital.
Observations: A new inpatient pharmacy service phone line extension was implemented at the Edward Hines, Jr. Veterans Affairs Hospital in Illinois. The ACD phone system yielded positive performance metrics, including ≤ 30 seconds mean speed to answer and ≤ 5% abandonment rate in the 12 months after implementation.
Conclusions: The ACD phone system is a promising, new application of available technology implemented in a nontraditional setting. The ACD system provides more actionable information and quality metrics data to pharmacy leadership. The implementation of the ACD system has improved accountability, efficiency, work distribution, and the allocation of resources.
ACD data also allow pharmacy leadership to assess staffing needs, depending on the call volume. Based on ACD data, the busiest time of day was 8:00 AM to 4:00 PM. Based on this information, pharmacy leadership plans to staff more appropriately to have more pharmacy technicians working during the first shift to attend to phone calls.
The mean call abandonment rate was 4.7% for both CPs and pharmacy technicians, which met the ≤ 5% goal. The highest call abandonment rate was from midnight to 8
Pharmacy technicians handled a higher total call volume, which may be attributed to more phone calls related to missing doses or unit stock requests compared with clinical questions or order verifications. This information may be beneficial to identify opportunities to improve pharmacy operations.
The main challenges encountered in the ACD implementation process were hardware installation and communication with hospital staff about the changes in the inpatient pharmacy phone system. To implement the new inpatient pharmacy ACD phone system, previous telephones and hardware were removed and replaced. Initially, hardware and installation delays made it difficult for the ACD phone system to operate efficiently in the early months of its implementation. The inpatient pharmacy team depends on the telecommunications system and computers for their daily activities. Delays and issues with the hardware and ACD phone system made it more difficult to provide patient care.
Communication is a continuous challenge to ensure that hospital staff are notified of the new inpatient pharmacy ACD phone number. Over time, the understanding and use of the new ACD phone system have increased dramatically, but there are still opportunities to capture any misdirected calls. Informal feedback was obtained at pharmacy huddles and 1-on-1 discussions with pharmacy staff, and the opinions were mixed. Members of the pharmacy staff expressed that the ACD phone system set up an effective way to triage phone calls. Another positive comment was that the system created a means of accountability for pharmacy phone calls. Critical feedback included challenges with triaging phone calls to appropriate pharmacists, because calls are assigned based on an algorithm, whereas clinical coverage is determined by designated unit daily assignments.
Limitations
There are potential limitations to this quality improvement project. This phone system may not apply to all inpatient hospital pharmacy settings. Potential limitations for implementation at other institutions may include but are not limited to, differing pharmacy practice models (centralized vs decentralized), implementation costs, and internal resources.
Future Goals
To improve the quality of service provided to patients and other hospital staff, the pharmacy leadership team can use the data to ensure that inpatient pharmacy technician resources are being used effectively during times of day with the greatest number of incoming ACD calls. The ACD phone system helps determine whether current resources are being used most efficiently and if they are not, can help identify areas of improvement.
