Service evaluation of the nurse-led telephoneadvice line in the wake of COVID-19: A report of auditand staff satisfaction

ABSTRACT

Background/AimsThe Rheumatology nurse advice line (NAL) at the Royal NationalHospital for Rheumatic Diseases (RNHRD, Bath) provides a vitalservice for direct patient access to specialist advice via a designatedvoicemail system. Increasing numbers and difficulty connecting callreturns have increased staff workload, reduced efficiency andimpacted on staff satisfaction. An audit was therefore undertaken toevaluate service use and efficiency, paired with formal assessment ofstaff satisfaction in order to identify areas for improvement.MethodsThe total number of monthly calls through the NAL during 2020 werecounted. A subset of consecutive calls were audited in detail, documenting temporal parameters in relation to the call beinglogged, returned and concluded. The number of clinicians andattempts required to contact the patient was noted. An anonymisedstaff satisfaction questionnaire was completed by NAL nurses andadministrators. Data was analysed using Excel.ResultsAn average 653 calls per month (range 340-894) came through theNAL between January and September 2020. 97 consecutive patientcontacts were audited from August 2020. Multiple attempts wererequired to successfully return the call in 19.6% of cases (n = 19/97).Of those, 68.4% (n = 13/19) of calls needed 2 nurses to contact thepatient. In general, the first attempt to return the call was prompt(average 7.6 hours, range 0.1-27.7). However, the time to conclude thecall from the patient's first call log ranged from 0.1 - 142.6 hours(average 12.7 hours) with increased time associated with difficultiescontacting the patient or when further advice was required from aRheumatology doctor (18.5%, n = 18/97).Staff surveys revealed 67% of staff felt that the NAL is a good serviceto offer patients. However, 67% of staff did not feel the NAL in itscurrent format was easy to manage. Specific comments included thatthe lack of rota'd responsibility, unpredictable workload and timeinefficiencies were barriers to managing the service.ConclusionFrom this data, we conclude that patient calls are returned promptly, but utilising a system of voicemail and unscheduled call returns isinefficient and contributes to staff dissatisfaction. This data has drivenchange for service improvement. To improve efficiency, calls will beanswered live by an administrator during working hours and patientsgiven a call-back time. A doctor will be named as a single point ofcontact for the nurses to seek additional advice and a nurse rota willdesignate responsibility for NAL calls to reduce work-load uncertainty.Follow up service evaluation will include staff and patient satisfactionquestionnaires, and repeat audit, with consideration of ways tosupport frequent service users.