• By Dana Sparks

Mayo Medical Laboratories Receives Top Call Center Award From BenchmarkPortal

June 3, 2014

Woman with glasses on computer at call center

Mayo Medical Laboratories placed second in the Top 100 Call Center award for 2013 from BenchmarkPortal. The Top 100 competition compares the performance of contact centers throughout North America by evaluating their key metrics against other call centers, which range from 5-100 agents. Entries are all cross-checked, validated and approved by certified call center experts, and the resulting submissions are scored on the basis of both quality and cost efficiency.Second Place Award Logo for Benchmark Portal

"Ranking in the Top 100 Call Center contest is a notable achievement for our hardworking call center staff," said Franklin Cockerill, M.D., chair of Mayo Clinic Department of Laboratory Medicine & Pathology. "In balancing efficiency, effectiveness and quality, Mayo Medical Laboratories' call center is committed to providing personalized and timely service to each and every customer."

Benchmark Portal's Top 100 process is based entirely on statistical comparison to the world’s largest and most respected database of call center metrics, which allows this competition to objectively identify centers who are achieving superior results both in financial and qualitative terms.

“Mayo Medical Laboratories’ placement among the top 100 call centers is a direct result of its leadership’s commitment to balancing cost-effective service solutions with best-in-class service performance,” said Bruce Belfiore, CEO, BenchmarkPortal.

The Top 100 contest grouped submissions into three categories according to size for this awards program. Each center was compared within a wide variety of industries and assigned numerical ratings. As a result, Mayo Medical Laboratories was determined to be second in North America for small-size centers.

Additionally, the customer service center was also certified as a Center of Excellence by BenchmarkPortal for the third straight year. The Center of Excellence recognition is one of the most prestigious awards in the customer service and support industry. To achieve the distinction of a Center of Excellence, Mayo Medical Laboratories’ call center underwent an extensive review by a team from BenchmarkPortal, which audited and verified the center’s key performance indicators and compared that data with other peer organizations. The Center of Excellence is awarded to the top ten percent of the hundreds of call centers surveyed.

BenchmarkPortal is a global leader in the contact center industry, providing benchmarking, certification, training, industry reports and consulting. 

I would like to bring up a serious concern I have as both a Mayo patient and Mayo employee. I am hoping my concerns are addressed and my questions satisfactorily answered. * I am alarmed by the exploding use of anti-psychotic drugs such as Haldol and Seroquel in the care and treatment of patients in the general medical population. Drugs like Seroquel and Haldol were developed and designed to be taken by people with a major psychosis, to help modify the symptoms of schizophrenia, for example. These drugs are heavy duty anti- psychotics that are not without serious side effects. When taken these drugs do not just make a person sleepy. It troubles me greatly that some of the patients who receive these drugs are in such medical predicaments that they are not even able to report what these drugs make them feel like. In my opinion, as a lay person, when we use these drugs as chemical restraints and not for the purpose they were intended–to treat the symptoms of a psychosis– we raise some serious moral and ethical issues. Over and over again I have seen these drugs being prescribed for sleep and other behavioral issues, which, admittedly, may be troublesome to the nursing staff attending to them on the nursing floor, but in and of themselves are not diagnostic of a psychosis. In effect, we have patients in the Mayo system, in hospital beds right now, who have not and have never been diagnosed with any psychosis, who are in spite of this fact, being given anti-psychotic drugs which are being physician prescribed for off- the -label uses. It is this off the label use of these anti-psychotic drugs that so concerns me. At Mayo, everything we do is based upon the basic tenet that The Needs of The Patient Come First. With that in mind, keeping a close and watchful eye on any and all situations in hospital that allow or encourage the unnecessary administration of ANY drug, let alone an anti- psychotic which has direct chemical actions on both the patients mind and body, should be considered to be of the utmost importance with regard to delivering and ensuring patient centered quality patient care. I would like to know what Mayo's Policy is regarding the prescribing of anti-psychotic drugs for the general population in off- the -label uses, and whether Mayo either encourages or condones such off the label uses of these drugs. I am also interested in knowing whether anyone at Mayo is tracking the number of prescriptions now being written in hospital for anti-psychotic drugs and whether anyone is tracking their off -the- label use among the general patient population. If such an oversight program is not now in place I would hope that one soon will be. * Patricia Allende de Jung Unit Secretary Float Nursing Department

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Wonderful meeting. Thank you to Terry Norton for sharing his family's journey with the audience and for Megan Gill and her colleagues who have provided such great care for Chris.

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If you are able, I highly recommend you attend or tune in to this meeting. Lots of valuable Mayo business information, and it's guaranteed that Megan and Terry's message will help you better understand your role in providing solutions and hope for our patients. Great stuff!

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i totally agree with Patricia 100%, well said. Something needs to be said or done about it.

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As a Mayo employee and the parent of an adolescent patient who was prescribed Seroquel I am also troubled by Mayo's overuse of these medications for "off-label" purposes. Patricia's concern deserves a thoughtful response from Mayo consultants.

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I am a new employee and it has surprised me that why only so few credentials ( including JD) are recognized to be used albeit on your name tag or even in emails/cards. There is possibly no other place on the planet where healthcare is more “patient centered” and when you walk into a patient area you automatically are transformed and are conscious to look for someone needing help . That’s a truly unique feeling! In my opinion it increases the motivation of anyone to be acknowledged for their education or achievements. And in some direct or indirect way we are all serving the patient’s needs. I am also basing my opinion on two points: “There are no inferior jobs in any organization; no matter what the assigned task… if it is done well and with dignity it contributes to the function of everything around it and should be valued accordingly by all. ” Dr. Charles.W.Mayo Also if I were a patient I would be duly (may be more) impressed if I am helped by someone who is not directly related to patient care and is well credentialed.

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Terry Norton told a great story about a care provider named Georgia who gave them so much hope when Chris was first brought to Mayo. She sounded like a real spitfire. Curious who she was.

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@Alex. You should understand that there are so many positions here for which one's credentials may have no bearing. I mean that I know many PhDs who are currently holding positions for which there is no PhD requirement. These individuals, rightly in

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Posted on behalf of Tim Lineberry, M.D., psychiatrist and vice-chair of Hospital Practice: Great question, and one of interest to many readers. After diagnosing a patient, Mayo providers develop a patient-specific treatment plan. We are guided by order sets that ensure the safe use of antipsychotic medications for patients who need this class of medication. Antipsychotic medications are effective for a number of medical conditions – including delirium – and general information about these medications is available at http://www.mayoclinic.com/health/delirium/DS01064/DSECTION=treatments-and-drugs. Patients and family members with questions or concerns about the use of antipsychotic medications are encouraged to speak directly with a member of the patient’s care team.

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Re. Greg on behalf of Dr Lineberry. I am assuming this is not a response to my comments and questions about the off-the-label use of anti-psychotics at Mayo. Since my questions and their answers have moral, ethical, and even, frankly, legal aspects I am hoping that there is a serious review and response to my comments re the in-house off-the-label use of anti-psychotics. I am of course,in this post, referring to the use of these drugs within the general medical population, those people that are admitted with other than psychiatric diagnoses. The Individual patient care plans Greg refers to are one thing, official Mayo policy is another. There has been a veritable explosion in the off-the-label use of these drugs –in great part because these hugely profitable anti-psychotic drugs have been marketed to physicians and hospitals and blatantly promoted for uses other than they were devoloped and intended, and for that matter, other uses than are FDA approved. I would think that Mayo where the needs of the patient come first would have a clearly outlined policy in force especially given the potential for conflict of interest. That is, if the same people writing the prescriptions hold stock in the drug companies and even write the policy that allows or encourages the off-the-label use of these drugs then I for one would see this as a direct conflict of interest. I don't think I am alone on this. I agree with Greg that the prescribing and use of anti-psychotic drugs should be addressed at the patient to physician/care plan level. That is one half of the situation. The prescribing and off-the-label use of anti-psychotic drugs should also dealt with through clearly written Hospital Policy that outlines and assiduously defines the appropriate, safe, legitmate use of these powerful drugs. As a patient of Mayo, I want to know what Mayo Policy is regarding anti-psychotic drugs and whether anyone at Mayo is providing oversight to the use of these drugs in hospital. That is the other half of the equation. As an individual patient I can advocate for myself. That works for one half of this problem. Clearly written Mayo Policy that advocates to ensure the needs and welfare of the patient come first with regard to these drugs–that is what we depend upon for addressing the second part of this problem.

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October 29,2011. *This is my third and hopefully final post on this subject at least until I am at the point where I get a serious substantive answer and then I will be thrilled to post a Thank You.* * Again, what I am talking about is the off-the-label use of anti-psychotic drugs in the general medical setting, not the use of anti -psychotics by Mayo psychiatrists treating patients suffering with major psychoses. This is the patient population for which anti-psychotic drugs were developed and the psychiatrists who prescribe these drugs are the specialists who are trained and educated in the diagnosis and treatment of these patients. Not what I am talking about here.* * What I am talking about is the practice of physicians who are not themselves psychiatrists freely prescribing anti-psychotics for medical patients who do not have a history of psychosis. * *What I am talking about is the use of anti-psychotic drugs in hospital for purposes that are not approved of by the FDA and for which there is inadequate or no medical evidence of their efficacy. * *I am talking about the use of anti-psychotics as a chemical restraint. I am talking about the use of anti-psychotics for children and adolescents. I am talking about the use of anti-psychotics as a sleep aid. These are off-the-label uses of these drugs: either the patient is not age appropriate or the patient has no previous history of psychosis or the drugs are being used for something other than managing the symptoms of a major psychosis.* *It is because there are presently too many physicians who are not in fact psychiatrists prescribing these drugs in each of the situations I have mentioned, that the abuse of these powerful anti-psychotic drugs has become epidemic.* *I am trying to shine light on this serious matter because I am a patient at Mayo, because I work at Mayo, and because Mayo is recognized as the standard bearer in Healthcare and as such has enormous influence. Mayo because of its position and prestige Mayo has the power to be pro-active with this matter. That is why I bring my concerns to their attention. * *I see the off-the-label use of these drugs practically every day I am at work. Anti- psychotics prescribed for sleep. Anti-psychotics prescribed for chemical restraint. Anti-psychotics prescribed for delirium.* *I am so alarmed by how common this practice has become. Twenty years ago it would never have crossed my mind that I should have to worry about being given anti-psychotic drugs in the event I should for example, fall and hit my head and end up in the hospital in a general medical ward. * *I have to confess that I know from personal experience what these drugs can do. In the past I was once given Haldol,and the only thing I can compare it to is the way people describe an acid trip. Now maybe that is an unusual reaction, but I don't care, it is definitely an experience I would never want to repeat. Like an acid trip I had to have somebody be there for me reassuring me constantly that I would be all right, it's just the drug, this will be over when its out of your system.* *I can tell you that if I woke up in a hospital room today, a room filled with bright lights and strangers, and I didn't know how I got there because maybe I was hit by a car, or maybe I fell and hit my head and I was unconscious when someone found me and took me to the hospital where I now find myself an elderly woman lying in a bed in a place I don't recognize, and to make matters worse I can even hear a television set with a football game going in the background, and now I see some guy I don't know at all sitting in a chair next to my bed and he's watching that football game, and I hate the sound of the television and football games, and at home I would never have anyone sitting next to my bed watching television like this so that makes no sense. Topping it off there is this other person that I don't know from Adam coming in and out, looking down at me as I lay there still not having pulled it all together yet as to where I am and what I am doing here and this other person who comes in and out and in and out is also asking me repeatedly if I know who I am and where I am and who is the president of the United States– I think I'd be delirious too.* *I'd be delirious and the last thing I'd need is a dose of Haldol. Personally, I think all doctors who think Haldol is such a great drug for delirium should try it themselves first before prescribing it for anyone else. * *Sure, me as the little old lady who by now has gotten so upset because of these screwy circumstances that, maybe I start getting belligerent because no one around me in this vast fluid group of people I don't recognize, seems sensitive at all to the fact that this environment is incredibly stressful and I am basically captive at this point in time and rather than calm reassuring voices and the muted sensory environment my poor head requires I get bright lights, strange people asking stupid questions that when I can't at first seem to pull the answer out of my foggy head my inability to do so results in further frustrating me. * *So this time when the person I don't know from Adam comes in and gets in my face and asks me do you know who I am? I holler as best I can in my elderly lady voice which even isn't that clear now because when I fell and hit my head before I came into the hospital it knocked out a couple of me teeth and my lips are swollen so my speech distorts "Leave me alone, damn it! " comes out as "Lumphmiphdimbpfthdum!" and now things just escalate from there since no one in this place except me seems to appreciate how crazy it is with all the lights and noise and rude people coming in and out my "leave me alone damn it!" has convinced them by spouting such babble I must really be out to lunch.* "Please," the lady on one side of me says. "Calm down or you'll pull your IV out. Calm down," she says. * *She looks and sounds sweet enough, but what planet is she living on? I wonder. How can I feel calm when no one seems to get what its like for me to find myself here like this in this place that is becoming more a madhouse by the minute.* *Now I see that there are two nurses one on each side of me and I notice a guy in a white coat has come in and is standing there with another nurse or someone–how can I know since nurses don't wear white anymore and that makes really hard with all the people around here, to keep everyone straight, so anyway, at the end of my bed there is this guy in a white coat, and although he looks to me to be the same age as my paperboy, at least he's wearing a white coat which makes me feel a little better. This guy must be the one who knows what's going on," I think to myself. "He'll sort this out." * *The next thing I know is that the nurse on one side of my bed takes my hands and holds it while the nurse on the other takes my other arm and holds it, and then I see they have a shot of some kind, and yes, into my arm it goes.* *Now I am no longer 'delirious.' I am lying in this place, physically quiet, making no ruckus, being no bother. The television is still on and another uniformed stranger is watching not football, but Dancing With the Stars. * *As for me, while I am no longer a problem to the nursing floor, I lay there hanging somewhere in some limbo- purgatory in my mind, half awake half asleep I am experiencing the worst nightmares of my life. They are so bad and being half awake and half asleep I am not even sure they are only nightmares. Add to my discomfort the physical creeping sensations that make my skin crawl and my mouth so dry I can't even whisper if I could. I can't do anything except lay there helpless and wait till it is over. * * The thing about most of the anti-psychotic drugs is that while a patient might become quiet on the outside (and sometimes that doesn't even happen instead of real calm some patients get more wildly agitated) the patient who is now quiet on the outside may be in turmoil and torment on the inside (the chemical effects of these drugs target the brain). What the observer expereinces and what the patient taking the drugs expereinces can be two radically different things. * *An observer might look at the patitnt who is now immoblized and quiet and think, oh now that's good, that drug has worked, the patient is calm now. This however,is only one side of the equation. Anti-psychotic drugs change brain chemistry. If I need my brain chemistry changed that's one thing. If I don't need my brain chemistry changed then I should never ever be given these drugs. That is how I see it as a patient. Being knocked to another planet might also be perceived by an observer as being a handy dandy sedating experience that makes a difficult patient less difficult, but I perceive it as chemical/drug abuse.* *No one at Mayo wants to employ practices that sacrifice putting the needs of the patients first. * *What I am hoping to do through my comments is to open up a vigorous debate about the use of these drugs in hospital as well as highlight what I believe is the need for Mayo to develop and articulate well written thoughtful Policy regarding the use of these drugs not just on the psychiatric wards but throughout the Mayo Campus. * *There is enough literature out there right now, enough controversy, enough questions about the hows whys and wherefores of when and if these drugs should be used and for whom and for what. I urge anyone concerned as a patient or caregiver to not only talk to your provider on the care plan level but also to become proactive, read and review the current research, encourage Mayo to develop a formal in-house patient centered policy for practice that eliminates the inappropriate off-the-label use of these drugs, a policy that clearly sets the standard in defining and carefully restricting the use of these powerful anti-psychotic drugs in our patient population. * ——————————————————————————– patricia allende de jung <bluespanishlady@gmail.com> Sat, Oct 29, 2011 at 1:24 PM To: bluespanishlady@gmail.com [Quoted text hidden] ——————————————————————————–

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Posted on behalf of Tim Lineberry, M.D., psychiatrist and vice-chair of Hospital Practice: Mayo Clinic does not have a specific policy that addresses the off-label use of any medication. As health care providers we often use medications in off-label indications. This is found in many clinical practice areas and not limited to psychiatric medications. An example is a cancer medication used to treat a different type of tumor than what is officially approved for. To obtain FDA approval for a specific indication for a medication, the manufacturer provides an application with supporting research data to the FDA. This can be challenging with medications that are now generic. These generic medications may be found to provide new effective treatments for other problems outside their original scope of use. Many off-label medication uses are actually the result of researched and well established practices. Broad class names of medications can create confusion about their uses. The "antidepressant" class, initially derived from medications used to treat tuberculosis, also have FDA indications for treatment of panic disorder, bulimia, and chronic pain among others. “Antipsychotic" medications have many mechanisms of actions and other indications also. Antipsychotic medications are not limited to the treatment of schizophrenia. There are other FDA approved indications for this class of medications including bipolar disorder, depression and autism. The most common reason for new use of antipsychotics in the hospital is to treat delirium. Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. The onset of delirium is often sudden, within hours or a few days. Delirium can usually be traced to one or more contributing factors, such as a severe or chronic medical illness, medication, surgery, or sleep deprivation. Often, it is due to a combination of those factors. Without prompt recognition and treatment of delirium along with its underlying causes, patients are at high risk to develop medical and surgical complications. Delirium is a threat to patient's lives and their safety. The magnitude of the problem is reflected in its cost in the United States – an estimated $38 billion to $152 billion annually per a 2008 Archives of Internal Medicine study. The antipsychotics are important tools for treatment of delirium. They are not used for "chemical restraint," but to target specific problems associated with delirium including agitation and confusion. Because delirium is a significant and common medical problem requiring a standardized multidisciplinary team approach, Mayo Clinic Rochester developed an order set to improve treatment and outcomes. This order set helps guide the prescriber and the nurse administering the antipsychotic medication on the appropriate dose based on individual patient symptoms and provides monitoring recommendations. This order set is an important safety measure to insure the safe use of these medications in this patient population. Concerns about the individual patient use of antipsychotic medications in the hospitalized patient, similar to any other medications, is the responsibility of multiple providers. As stated in the Medication Order Review and Processing policy PC.44 "Medication order clarification is a joint responsibility involving the pharmacist, nurse, and/or other licensed practitioner responsible for reviewing, processing, dispensing or administering the medication ordered. If there are any concerns, issues or questions regarding a medication order, the authorized prescriber is contacted for clarification and any changes to the order are documented."

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