In-Basket Management: Empowering Nurses to be First Responders for Patient Messages, Providing The Right Care at The Right Time


Dones M Trojillo, MSN, RN; Maia M Patel, MD, ScM

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Mid-Atlantic States

Background: Patients increasingly send email messages regarding their health care, but not all messages require physician input. Our prior state routed all incoming messages through the bottleneck of overloaded physician in-baskets, increasing response times and lowering both physician and patient satisfaction. Launching our project in August 2017 helped us meet the needs of our rapidly growing membership and achieve our operations goal to “deliver exceptional care” and “deliver an extraordinary consumer experience” in the Mid-Atlantic Region.
Methods: Over 10 months, high-touch in-basket message management training was provided to 205 nurses in adult and family medicine. Patient vignettes were used to train each new functionality, including the use of standardized SmartPhrases and QuickActions created specifically for patient message replies. We continue to follow weekly and monthly metrics, tracking “hours to first touch” for each incoming message, the percentage of messages “screened out” by nurses (messages handled to completion without any physician input), and the percentage of messages researched and staged by nurses well enough that only “one touch” is required by physicians to complete the message.
Results: We saw an 83% decrease in the time to first touch for all incoming messages, cutting our regional response time from an average of 22.3 hours at baseline to 3.8 hours. Addressing the goal to have all health care team members working at the top of their licenses, we saw a 207% increase in the number of messages able to be handled entirely by nurses, moving from a baseline screened-out rate of 14%, to an average of 43% of all incoming messages screened out by nurses. Anecdotally, nurses are happier being empowered to triage and to manage patient requests from the outset, and our data confirmed that some of our top-performing nurses have truly taken ownership, screening out 70% of all incoming messages.
Discussion: Although we already had an optimal message pool design within Kaiser Permanente HealthConnect, we relied on physicians to “edit in” to those pools to manage incoming messages. By redefining our regional workflows, we are better leveraging the skills of our highly trained nurses in providing more timely responses to patient inquiries. In Adult Family Medicine, we are continuously monitoring outcomes, and evaluating the staffing model to sustain this success. We have extended our in-basket message management to the Pediatric and Obstetrics/Gynecology Departments, and will expand to specialty services in the Mid-Atlantic Region in 2019.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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