Jan 29, 2015Dial an ATC
When patients call this athletic trainer, she helps get them the appointment they need and makes sure they know how to care for their injury until they see a physician.
By Elyse Putorti
Elyse Putorti, ATC, is the Orthopedic Patient Navigator at the Cayuga Center for Orthopedics and Sports Medicine in Ithaca, N.Y. She can be reached at: [email protected].
Like most athletic training students, I imagined myself working at a school or physical therapy clinic after graduation. But during my job search a very different position caught my eye. The Cayuga Center for Orthopedics and Sports Medicine, a division of Cayuga Medical Center in Ithaca, N.Y., was looking for an athletic trainer to provide care in a more behind-the-scenes role: Answering its new orthopedic service line.
The Orthopedic Patient Navigator (OPN) position called for a certified athletic trainer to help patients coordinate appropriate care with Cayuga Medical Center-affiliated sports medicine, orthopedic, physical therapy, and physiatry offices over the phone. The OPN is also responsible for advising patients on self-care until their appointment.
There are three types of callers: Primary care offices that set up appointments for patients needing specialized orthopedic care, patients who call after they have been discharged from the emergency room or our hospital’s urgent care facility, and self-referring patients who have seen or heard our advertisements about the service line. I help all three get the right appointment with the right provider, and if warranted, give the caller general advice on how to care for their injury until they see a doctor.
This type of job was not on my radar at all. But I wanted to explore the idea more, and I was eventually offered the position. Over the past year, I’ve had the opportunity to help hundreds of patients navigate the medical system as the OPN. It’s been a really interesting way to be involved in patient care as an athletic trainer.
DEVELOPING THE OPN
My position as OPN, and the orthopedic service line itself, was created by the Cayuga Center for Orthopedics and Sports Medicine as a way to ensure that our patients receive the highest quality care and customer service by assisting them through the healthcare process. The position is modeled after the Cayuga Medical Center’s oncology nurse navigation system in which cancer patients are assisted by a navigator who works as a liaison between the patient and their caregivers/providers.
The idea for the service line came after the hospital analyzed the number of orthopedic patients seen at the hospital and urgent care centers compared to the number of patients seen at the hospital’s off-campus orthopedic care offices. The data showed that a lot of patients did not follow the recommendation that they visit an orthopedic, sports medicine, or physical therapy office after being seen in the emergency room or at the urgent care facility.
Having and advertising one central phone number for patients to call allows for improved lateral integration of care and better communication so that more patients receive the treatment they need. The hospital has the resources to provide its patients with these services, it was just a matter of better aligning all the orthopedic care services we offer and then educating patients and providers about the service line.
My primary responsibility is to answer the service line from 8:30 a.m. to 5 p.m., Monday through Friday. If someone calls outside those hours they are prompted to leave a voicemail, and I return their call the following business day. Patients are guaranteed to be seen by a physician as quickly as possible after speaking with me, almost always within 48 hours.
Having a 48-hour guarantee for appointments is a key component of the service. The faster a patient can be seen, the sooner he or she can get the necessary treatment or care recommendations from our team of orthopedic specialists.
The number of calls I field per day varies based on the time of year. For example, the fall tends to be busier than the summer months. In my first year, we helped more than 800 patients secure appointments with an appropriate provider within 48 hours.
When a primary care office or self-referring patient calls with an orthopedic injury, I ask about the injury and based on that information, schedule an appointment for the patient following a rotating schedule that includes three different orthopedic offices in town. If it’s important that a patient see an orthopedist right away after discharge from the emergency room or urgent care, I follow an on-call schedule.
If based on the description of the injury–and their insurance policy allows–I can also schedule the patient for physical therapy at two different office locations. I typically get calls from patients who have had acute injuries, but when a patient has a chronic issue like tendonitis or a specific weakness that would benefit more from physical therapy, I can schedule it for them. This is where my clinical background and judgment are put to use. Regardless of the injury, we don’t conclude our conversation until I have scheduled an appointment for the patient.
Callers don’t typically request a specific doctor, but if they do, I try to accommodate them. It’s part of our dialogue on the phone: “Have you seen anyone in the area before for orthopedics or would you like me to schedule you at a particular office?” If they say yes, I call that office to set something up. If not, I follow the rotating or on-call schedule. This works the other way around, too. If a patient has seen a physician in the past and does not want to see them again, we will offer appointments at other offices.
Sometimes challenges arise when time is a factor, especially with pediatric patients. A primary care office may request a same day appointment or one before the school day begins because the patient needs clearance for a big soccer game that afternoon. Callers may also be in a crunch due to business travel schedules or vacations, so our orthopedic and sports medicine offices try to be as helpful as possible.
One of the major challenges being the OPN is that few callers are knowledgeable about the medical system or fully understand their insurance policy. I have learned more about insurance and billing than I ever could have imagined. Before coming into this position, I had no idea there are so many different components to each plan.
Because I talk to a lot of different people each day, my communication skills have had a workout over the past year. It is especially important to show compassion and understanding when speaking to the patients. I think the most important quality I have honed as the OPN is patience. Sometimes I have to explain every detail, or repeat myself multiple times because the patient is writing down everything I say. Other times there is a language barrier. (Though I haven’t had to use it yet, the hospital does have a translation service.)
One of the oddest conversations I had was with a patient who had suffered an abdominal muscle strain while on the job. He was seen at the hospital’s urgent care facility and referred to the service line when he was discharged. When he called, he described pain “in his stomach” that started while he was walking at work and occurred without any trauma. I was worried it was an internal medicine concern because his description didn’t fit any common abdominal strain criteria. Thankfully, I was able to pull up his visit notes on the hospital computer system, confirm that the urgent care doctor had ruled out internal injuries, and get him an appointment with a sports medicine physician for follow up the next day.
The other part of my job is helping callers with self-care until their appointment. Although the physician or physical therapist they eventually see will give them an official diagnosis and treatment plan, I often provide the patient advice on handling the injury until their appointment.
Obviously, an accurate diagnosis starts with taking a good history. Since I can’t perform a physical exam over the phone, I try to find a balance where I can obtain enough information from the patient to provide appropriate care, but not waste my time–or theirs–with an extremely detailed history. The challenge is to keep the patient focused on the injury they are calling about and not let them go through a 20-year play-by-play of non-related injuries they sustained when they were in high school and college. A lot of my recommendations include explaining RICE to the patient and giving them some pain-free range of motion exercises. For example, if someone calls with an ankle injury I might say, “With your foot elevated, try spelling your name or drawing the alphabet with your toes. Afterwards, replace your bandage and apply ice for 20 minutes. Try to stay off of it as much as you can before your appointment.”
Even when someone thinks they need to go back to the emergency room and I’m almost positive they don’t, I still need to be sensitive to their concerns. Whether it’s a mild ankle sprain or chronic back pain, I make sure each person knows they are my first priority at that time.
Giving self-care instructions over the phone has made me appreciate my education and prior clinical background in the field. A lot of athletic trainers get used to working with athletes, who understand that injuries happen, know what it takes to get back to activity, and are clear on our role as clinicians. In my position, I get to apply my knowledge and provide important patient education to different groups of people–all just via a phone conversation.
Because the OPN position is so new, the hospital wants to continually evaluate its effectiveness. Therefore, about a week after every patient’s appointment, I call to follow up and ensure they had a pleasant experience with the service line and do not need further assistance. I ask how their appointment went and if they need help scheduling any further appointments. Before hanging up, I ask if they have any questions or concerns about their experience with the service line and their resulting visit.
Almost all the people I speak with are satisfied and the most common response is gratitude. But any negative feedback is recorded and if it is related to a specific office, I call the practice manager to address the issue raised.
I also monitor patient feedback left on our Web site survey. This is important information that paints a picture of how the service line is helping to serve patients. The 15-question survey asks patients to rate the facility, physician they saw, reception staff, other staff members like nurses and athletic trainers, the scheduling process, and wait time in the office. There is also space for comments at the end of the survey.
I regularly distribute the results to the office managers so that they can see the customer satisfaction ratings and fix any issues. Every other month, we have an orthopedic service line meeting that all providers and office staff attend. During this meeting, we review statistics from the previous two months and address any questions or concerns regarding the service line. For example, after a patient said that the x-ray room in one of our offices was very cold, the office bought extra blankets to have on hand to ensure that patients are comfortable during exams.
Finally, my own performance is evaluated by both the Director and Coordinator of the hospital’s Center for Orthopedics and Sports Medicine. I also work closely with these two individuals when preparing for our bi-monthly meetings and other events.
I get a lot of different calls from a lot of different people, but the callers who stick with me are the ones who genuinely had no idea what to expect from the service line. These callers often say, “I went to Cayuga Medical Center and they told me to call you.” They don’t fully understand what I can do for them at first, but by the end of our conversation, they have a timely appointment that fits their schedule, advice on how to manage their injury until the appointment, and a number to call back in case they have any questions. It’s a good feeling to know that I helped them manage their care.
Athletic training is a unique and growing profession. Though this job wasn’t part of my master plan, it’s proven to be a great choice. I think that more and more athletic trainers will soon be working in different settings such as this one.
To learn more about the orthopedic service line, visit the Cayuga Center for Orthopedics and Sports Medicine Web site at: www.everyonesanathlete.org.
Sidebar: AWAY FROM THE DESK
One of the perks of being an Orthopedic Patient Navigator is that it is a “9 to 5” job. I arrive at and leave the office at the same time every day. There are no early morning practices or night games to cover, which has been great. But on the other hand, I do miss working with teams and getting to know a group of athletes throughout a season.
So I’ve made sure to continue practicing my hands-on skills as well. I work as a physician extender at Cayuga Medical Center’s sports medicine and athletic performance facility two half-days per week and work at our local high school on Wednesdays. (There are other athletic trainers employed by the hospital who cover the phone for me when I’m away from my desk.) And I help with football coverage in the fall and with other competitive events like a local triathlon held every summer.
I am also involved with teaching a monthly preoperative lecture for the hospital’s patients. The lecture is a chance for joint replacement patients to learn more about what to expect before, during, and after their upcoming surgery. They hear more about the surgery itself, inpatient and outpatient physical therapy, occupational therapy, nursing services, and how to obtain durable medical equipment. All of the different roles and responsibilities I’ve been able to take on outside of the service line have been great for making me still feel like part of the “traditional” athletic training world.