Lost in a Sea of Calls: Getting a Better Handle on MS Patient Phone Calls

Background: Tele-health is a key component of Multiple Sclerosis (MS) specialist nursing practice.   Patients with a chronic and neurodegenerative illness such as MS value having rapid access to a nurse who can provide advice, guidance, and support in between clinic visits when health concerns arise.  However, MS nurses often struggle to manage the seemingly endless flow of calls from patients with increasingly complex health issues while attending to competing job demands.  

Objectives: In order to develop efficient, patient-responsive care delivery systems, there is a need to better understand MS patient phone call patterns. The aim of this quality improvement project was to systematically evaluate who the callers are, why they are calling, and the practitioner input required to assist the caller. 

Methods: A phone log was developed to track nursing phone calls. Data categories captured by the log included call volumes, the reason for the call, practitioner expertise required in resolving the health issue, and nurse impressions of the factors related to call complexity.  These categories were based on expert clinical opinion and a literature review of factors influencing patient and/or call complexity.  The two nurse clinicians in the MS clinic completed the phone log on a daily basis for 9 months.

Results: MS Nurses play a significant role in resolving health issues of patients via phone, independent of other healthcare professionals.  Medication/treatment-related questions constitute almost half of all calls received by the clinic. Complex call features include callers with high psychological distress, insufficient resources to manage illness demands, and those with a perceived high dependence on clinic staff for support.

Conclusions: Phone call data analysis: (1) informed a quality improvement project aimed at improving phone access with the development of a nursing phone helpline; (2) inspired the creation of group teaching sessions for patients changing disease modifying therapies; (3) confirmed the need for standardized guidelines and tracking systems for the safety monitoring  of patients on complex drug therapies. Future directions include a need to: (1) further evaluate the defining characteristics of frequent callers to understand their unique needs and how best to meet these needs; (2)  address, clarify, and ensure balance between patients’ expectations of tele-health services and those which clinic staff can realistically, safely, and effectively provide via telephone.