Pairing Nurse Triage with Medical Answering Service

By Ken Bleakley

February/March 2007

After-hours telephone services for physicians must be able to address both administrative questions and clinical concerns from patients.  Both physician and patient need to be confident that all inquiries will receive a prompt, caring, and authoritative response.  This requires the deployment of two different skill sets: medical answering service and registered nurse triage.

Medical Answering Services: An efficient answering service can provide superior value to its clients by conveniently servicing callers through a compassionate and accurate response, including:

• Answering and messaging services

• Appointment calls

• Conference calls

• Client satisfaction surveys

• Initial screening for clinical concerns

The staffs who provide these services need not be medical professionals, but they do require medical knowledge.  Emphasis is on speed, efficiency, and accuracy in responding to a wide variety of situations using specialized operating systems.

Nurse Triage Services: When the caller requires clinical information or advice, licensed registered nurses using established guidelines and protocols become necessary.  Using a dedicated operating system and their own clinical skills and experience, they triage, record, and document clinical calls from patients.  Accreditation, insurance, and rigorous quality assurance programs add to the cost and complexity of these services, but provide dependability and confidence in the end result. 

Integrated Services: As each of these types of services become more developed to support the medical practice, the need for a simpler, single service to provide the complete after-hours coverage for the busy physician become increasingly desirable.  The ability to contract with one unified entity with single billing and a mutually compatible functioning becomes a valuable enhancement.  The search and evaluation process are simplified.  The service becomes the after-hours extension for each medical practice.  On nights, weekends, or whenever physicians need a break, they are able to flip incoming calls to a single number and receive:

• A compassionate response to patient needs, answered in the practice's name

• Committed medical answering services

• Accredited medical advice and triage by registered nurses when required

• Medical encounter reports immediately and aggregated reports monthly

• One predicable monthly bill for services

• A dedicated representative to address any concerns

• Optional scheduling and referral services

Meeting the Need: Medical answering services and nurse triage services have responded to the challenge in different ways.  Some simply provide parallel services to medical practices that contract them separately.  Others offer informal pairing arrangements with different levels of integration.  A few provide both services under a single company.  While there are advantages to each model, there are also disadvantages.

Parallel service models provide maximum flexibility to medical practices and frequently combine local answering with nationally accredited medical call centers.  However, the handoff from one service to the other and from one operating system to the other can be problematical, as can fixing responsibility for errors or delays.  Separate billing complicates the task of practice administrators.

The combined service company is automatically equipped to provide a single number to connect the patient to an integrated answering/triage service with a single bill and to assume responsibility for outcomes.  However, this model may generate an incentive for the answering service to refer patients to the company's more expensive nurse triage, even when the call may not be truly of a clinical nature.  As the two different functions may not even be in the same location, it does not necessarily assure a smooth handoff between them.  In addition, a nurse triage service that is also competing for medical answering business will find it difficult to build cooperative relationships with medical answering services already providing answering services to their own clients. 

Optimizing the Roles of Each Service: Once it becomes clear that neither the answering service nor the nurse triage service has any interest or desire to enter the substantially different business of the other, they become natural allies.  They can concentrate on providing the one call/one service/one price model desired by medical practices and patients.  They can concentrate on making their respective systems as compatible as possible, while enhancing the quality of their respective services.  They can also develop joint sales programs focused on mutual specialized or local markets.

The result of these alliances is better and less costly service for the patient and physician alike.  More physicians will be able to afford turning over their practices after-hours to reliable professionals.  The pairing of local and national capabilities also helps to maintain the personal relationship between doctor and patient during the hours when medical practices are closed.  Patients are able to schedule visits to their providers and avoid unnecessary visits to over-crowded emergency rooms.

Ken Bleakley is CEO of Fonemed, whose mission is to connect people by telephone and Internet to health information, services, and products.  Fonemed provides nurse advice throughout North America and the Caribbean.  For more information, call 800-366 3633.