RELIABILITY Speak Up for Safety

Great Catch of the Month July

Kristen Lutz

Safety Coach and Diagnostic Coordinator, Cancer Services, Vineland

Submitter: Jami DeNigris, Director of Cancer Services

This Great Catch highlights the importance of embodying our Mission, Vision, Values (I.C.R.E.A.T.E.) and system goal of Teamwork, as well as our High Reliability Tones, Tools and Behaviors.

A patient reached out to Vineland Oncology with a concern. A computerized tomography (CT) scan had been ordered by Dr. Ahmad and scheduled at Delsea Imaging. However, the patient received a call from Delsea Imaging stating that there was no authorization, leading the patient to consider canceling the appointment. Amanda Morales, medical assistant of surgical oncology, took the initiative to contact Kristen Lutz, safety coach and diagnostic coordinator of Vineland Cancer Services, seeking guidance on how to proceed and whether the patient should cancel.

Kristen promptly engaged with the pre-service team and spoke with Carmen Rosario, pre-service pre-cert representative of patient registration, to address the issue. Carmen successfully attached the authorization to the appointment and contacted Delsea Imaging to confirm that the CT scan was indeed authorized, assuring the patient could keep their appointment. Amanda then reached out to the patient, providing reassurance regarding the authorization and instructing them to proceed with the scheduled appointment.

Seeking to understand the root cause of the authorization issue, Kristen initiated a discussion with Carmen. It was revealed that the authorizations were not being completed for Dr. Ahmad's patients because their team only handled authorizations for Inspira providers, and Dr. Ahmad was listed as a non-Inspira provider in Soarian Financials. Recognizing the need for improvement, Kristen and Carmen collaborated and discovered that tests ordered by Dr. Ahmad were automatically placed on a non-Inspira worklist for pre-service based on a setting in Soarian Financials. They agreed that pre-service should take responsibility for completing authorizations for Dr. Ahmad's Inspira patients.

Kristen and Carmen worked together with Maryanne D'Agostino, supervisor of patient registration, and supervisor of patient registration, to implement changes to either the setting or the process, aiming to enhance the system moving forward. The entire pre-service team was informed and instructed to cross-check Dr. Ahmad's patients on the worklist with PowerChart to confirm their status as Inspira patients and ensure their authorizations were completed.

This Safety Story exemplifies how a Safety Coach is empowered to Speak Up for Safety and collaborate with various departments to improve our systems, all in the pursuit of providing safer and more reliable care for our patients, staff and community.

Kristen shared her experience using our High Reliability Tool, ARCC (Ask a question, Request a change, Communicate a concern and Chain of command), with the system goal of Teamwork at the core:

• Ask a Question: Kristen asked why authorizations were not completed for Dr. Ahmad's Inspira patients.

• Request a Change: She requested a change to the pre-service process to help identify Dr. Ahmad's Inspira patients who require authorization.

• Communicate a Concern: Kristen effectively communicated her concern that authorizations were not being completed for patients in need of timely testing to treat or rule out cancer, putting their appointments at risk of cancellation.

• Chain of Command: Kristen and Carmen elevated this concern up the chain of command within Patient Access. As a result, the supervisor implemented a cross-check process for all pre-service representatives to identify Dr. Ahmad's Inspira patients and ensure their authorizations are completed.

This collaborative effort and commitment to safety and teamwork are truly commendable and contribute to the continuous improvement of our care delivery system.

Thank you, Kristen, for embodying our Mission, Vision, Values (I.C.R.E.A.T.E.) and system goal of Teamwork, as well as our High Reliability Tones, Tools and Behaviors