Optum National On-Call Team
Funmi A. Aiyegbo, DNP, FNP-BC, CRNP, Senior Director of Clinical Operations, Optum® National On-Call Team
The Optum National On-Call Team acts as an extension of primary care for over 14,000 residents of long-term care facilities and community-based members. Our services are provided by Advanced Practice Clinicians (APCs) after office hours and on weekends.
Using telemedicine technology, we manage highly complex chronic conditions, address acute changes in conditions and stabilize people to prevent unnecessary transfers to higher-level care.
We keep the patient at the center of all decisions and respect the goals of the patient and their family.
Need clinician expertise late at night?
During office hours, a provider is easy to reach. However, as health problems don’t mind the time, Optum Complex Care Management (CCM) uses telemedicine to stay in touch with patients around the clock.
For patients with complex needs who live in a long-term care facility, a sudden change in health requires immediate access to an informed provider.
Their timely assessment and care may be the difference between an ambulance ride to the emergency department and prompt, patient-centered treatment where they live.
The On-Call Team vision
Optum CCM has years of experience meeting the needs of patients and caregivers by staffing Advanced Practice Clinicians (APCs) in long-term care facilities.
However, if a patient’s condition suddenly worsened in the hours between 5 o’clock in the evening and 8 o’clock in the morning, they were left with a gap —no prescribing provider was available to assess the change.
This circumstance sent many long-term care facility residents to the hospital by ambulance. However, if a provider were on hand at their facility they may have been easily treated in place.
APCs took note of this gap, and in the interest of providing high-quality continuity of care, created the On-Call Team as a valuable night-and-holiday resource.
The On-Call Team has been serving patients and facilities for 2 years. In 2017 on-call APCs and Triaging Registered Nurses took 400,000 phone calls, successfully treating the majority of the calls without moving the patient to a higher-acuity facility.
The role is unique in the world of clinical APCs, in that the clinicians practice from home using the tools of telemedicine to complete their work.
Through access to the facility’s shared EMR, and using the assessment skills that are specially tuned to interpret nuanced medical findings over the phone, the providers plan the best course of treatment.
Case study in continuity
On a typical overnight, a facility nurse may be checking on a resident when he or she finds them wheezing and complaining of shortness of breath. The nurse documents the assessment and picks up the phone to reach out to the On-Call Team.
The call is routed to the nearest on-call hub where APC answers. The nurse identifies the patient and the reason for the call: shortness of breath.
The APC reviews the patient EMR checking medical history, medications, current plan of care, and as important, the patient’s stated goals of care. Does the patient want aggressive intervention?
Are they in late stages of illness and do they stress that comfort is their most important goal? Taking a holistic view of the patient picture, the APC prescribes a dose of intravenous diuretic to remove excess fluid from the lungs.
While the facility nurse carries out the orders of the care plan, the on-call APC contacts the patient’s listed family member to inform them of the change in condition, advise them of the course of action, and explain what is expected as far as the stabilization of their loved one.
Once the family is given the information, the APC asks them their wishes if the patient is not stabilized by the current plan. Options may include further treatment in place, taking the patient to the hospital or providing comfort measures.
The APC will also call the patient’s primary care provider with an update, and then circle back to the nursing facility nurse to relay the conversation with the family and get a patient status update.
The process of planning changes in care as symptoms present and resolve, in accordance with patient and family desires, continues uninterrupted through the night.
Until the patient is stable, requires transfer, or the daytime provider returns, they are in the capable hands of the On-Call Team.
Value for patient and facility
Continuity of patient care from day to night aligns with the goals of the care facilities using On-Call Team services. Wraparound care focused on the wishes of the patient and family brings value to the patients served.
Close attention to detail and the expertise of the APC equipped with high-tech tools optimizes patient outcomes. Fewer trips to the hospital emergency department keep patients comfortable and free the beds and providers in the ED for high-acuity cases.
Ultimately this unique role for APCs leverages their great potential to focus on serving the needs of a diverse and varied patient population. With experience, skill and technology, on-call teammates give patients and care facilities superior service and best possible outcomes.
This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice.