Integrating Answering Service with Nurse Triage

By Charu G. Raheja

Nurse triage centers across the country are being asked to cut costs and offer more services. One of the biggest expenses in today’s triage centers is the cost of nursing time. With the correct tools and workflow, answering services can play an important role in decreasing the use of nursing time, leading to significant cost savings in nurse triage, improved nurse satisfaction and patient care, and increased service offerings.

In the traditional triage center model, physicians subscribing to the service have their own answering service. When a patient calls, the physician’s answering service takes a message and relays the information to the triage center via fax. In turn, nurses receive the faxes, enter patient information into the system, and triage the calls. This traditional model poses several potential problems and time costs. First, nurses need to take the time to enter each patient’s information themselves prior to taking the call. Second, this method does not allow nurses to accurately gauge acuity of the callers and call volume unless they are constantly running back and forth from the fax machine or there is a nurse supervisor assigned to distributing calls, both of which lead to increase use of nursing time.

Alternatively, some call centers have patient calls transferred directly to the nurse, and then patients wait for a nurse to pick up the phone. This method is also inefficient and has a high nursing cost.  First, it can lead to significant hold times for patients depending on call volume – shorter waiting times require overstaffing of nurses and thus higher costs for the triage center. Second, nurses still have to enter basic patient information themselves once they are on the phone with a patient. Third, similarly to the traditional method, this alternative does not allow nurses to gauge acuity of the callers waiting to be helped. Overall, both of these models lead to inefficient use of nursing time and, in some cases, less than ideal patient care.

Answering services can play a significant role in reducing costs and improving patient care by entering calls into the triage system directly. Answering services already have the systems in place to handle large numbers of patient phone calls. They also usually have 24/7 staffing, as well as Internet access, so they can have a live operator answer patient calls and enter basic information about the patient and reason for calling directly into the triage system. The help of an answering service in entering calls allows nurses to review the acuity and volume of incoming calls and can dramatically reduce nursing time by having patient information already in the system. This allows nurses to focus on triaging the calls, thereby improving nurse satisfaction and patient care.

An integrated answering service as part of the workflow provides a more cost-effective, flexible, and efficient triage process. When a patient calls, the answering service takes the information and enters it directly into the triage software. Nurses are then able to view the calls in a format that enables them to judge the acuity, as well as the volume, of calls waiting. This enables the calls to be available in real time – instead of delayed based on fax transmission time. In addition, this enables the nurse to start working on the call without entering the patient data and lets them assess call volume and acuity with a summary of calls appearing on their screen. Furthermore, nurse supervisors are also able to remotely view the queue and nature of calls so that they can keep track of call information to make sure that there is enough staff available to take the calls. In addition to better patient care and improved satisfaction, nurses are able to reduce the time to take the phone calls by about 20%. The savings turn out to be between 75 cents to a dollar on every call in nursing time.

Some hospitals are providing answering services as well as triage service to their clients, allowing them to improve the workflow in their nurse triage as described above. Having an answering service in conjunction to the triage also allows the center to offer a full service to doctors so that doctors don’t need to hire a separate answering service themselves. However, having an in-house answering service is not always necessary.

In the case of smaller hospitals or independent nurse triage centers, providing a full answering service may not be an option from a cost, staffing, and infrastructure perspective. In this case, these triage centers can benefit from a partnership with an existing answering service to provide the answering service component of the call center and to enter patient information for triage calls. Existing answering services already have the infrastructure to take calls, and they can use the Internet to enter patient information for the triage center.

In summary, a partnership between a triage center and an answering center can help improve patient care and satisfaction, improve nurse satisfaction, and decrease costs by allowing the answering service to enter patient information directly into the triage system. Furthermore, doctors also experience improved satisfaction because they don’t need to contract with a separate answering and triage service. Finally, having a system that allows for calls to be entered directly into the system also allows nurse supervisors to remotely view and monitor the queue and adjust the nursing staff based on call volume.

Charu G. Raheja, PhD, is the chair of Triage Logic Management in Winston-Salem, North Carolina. The TriageLogic Call Center Solution offers triage call centers highly secure and comprehensive Web-based tools to handle patient calls consistently, accurately, and efficiently. For more information, contact or call 855-734-4463. 

[From the February/March 2010 issue of AnswerStat magazine]