All posts by Peter Lyle DeHaan

Peter DeHaan is the president of Peter DeHaan Publishing, Inc., (https://peterdehaanpublishing.com) the publisher and editor of Connections Magazine, AnswerStat, TAS Trader, and Medical Call Center News. Peter DeHaan (https://peterdehaan.com) is a published author and blogger.

Avoid Liability with Proper Documentation for Telehealth Nurse Triage

TriageLogic

By the very nature of their profession, telephone triage nurses can’t physically see their patient callers. This begs the question, what kind of liability do they face when they provide dispositions for care? That’s why we were excited to sit down with D.D. Fritch, MSN, MHA, RN, a tenured clinical leader in this area of healthcare, who was happy to shed some light on the legal perspective and why it’s crucial for nurses to have the proper documentation.

Question: Tell us a little about your background. What’s your experience with nurse liability as it pertains to telephone/telehealth triage? How did you get involved in nurse triage?

Answer: I am a pediatric nurse of 33 years, working as a nurse and nurse leader at Children’s Healthcare of Atlanta for 31 years. During my tenure at Children’s, I was the director of the contact center for nine years, which was responsible for their Nurse Advice Line. Since 2018, I have been working as a healthcare consultant, assisting clients with clinical call management, call center operations, and practice administration.

As far as my experience with nurse liability, whether a nurse is practicing in person or virtually, the liability is the same. With that being said, nurse triage has many components of liability that need to be considered.

Q: What information should triage nurses make sure is documented in every clinical note?

A: Documentation is vital. Document the patient’s history, findings, dispositions, what the caller describes verbatim, and the nursing education that is provided. Documentation as a nurse working on the phone is not very different than in person, but there is a skillset to communicating with the patient or caregiver to ensure that documentation is complete and accurate.

Q: What factors are important for the credibility of a clinical note?

A: Credibility comes from documenting the facts, and when you are a triage nurse it is vital for you to record the initial concern as the caller describes. “Reading into” what the caller is saying is very different than completing an assessment and documenting the findings of that assessment.

Q: What happens if a patient has a bad outcome following a triage call that relates to the symptoms they were calling about?

A: This is a broad question. Organizationally, the chart should be reviewed to see if there were any opportunities where the nurse should have acted differently or made a different decision. If the triage company is acting on behalf of a provider, the provider should be notified and the situation should be discussed. If there is an untoward event due to negligence of the triage nurse, then the nurse and the organization that they work for or represent could be liable.

Q: What would need to be proven for a lawsuit to move forward against a triage nurse or their organization or practice?

A: Each state has licensing requirements, and the nurse always needs to practice within scope and according to their license. Practicing out of scope would be a significant concern in a lawsuit.

Q: Do juries tend to look upon nurses in a particular light? For example, do they tend to trust their judgment?

A: The nurse has a license to uphold and an ethical duty to serve, just as any other credentialed witness would.

Q: When is the duty to a patient caller established?

A: Upon initial connection with the nurse.

Q: If a specific nurse triage line is set up solely for patients of a particular healthcare provider, and someone calls in who is not currently a patient, what is the legal responsibility of the nurse who answers that call? How should they respond?

A: This depends on how the call is handled on the front end. Many times the nurse is not the first one to speak to the caller. This information would need to be a part of the initial information gathering prior to any clinical information being captured.

Q: When using Schmitt-Thompson protocols to evaluate a patient caller’s symptoms, do triage nurses need to document all negative responses leading up to the first positive response?

A: How the nurse documents is up to the provider or organization. There is an option to document all negatives or only the positives. Either way, there needs to be an organizational policy and then training for staff to ensure that there is consistency.

Q: How should a triage nurse handle documentation they may have missed adding to a patient’s chart during a call? Are there things they shouldn’t do if they need to update a chart?

A: Document any late entries as an addendum, ensuring that the time and date of the entry as well as the interaction are captured.

Q: Is there any additional information you’d like to add regarding the legal responsibilities and requirements for telephone or telehealth nurse triage?

A: Legal considerations as a triage nurse are something that should be a topic of education and continued competency on an ongoing basis. Quality audits should also be a part of the operating procedures of the nursing leadership team.

Registered nurses are licensed in the state in which they practice (where the patient is located). The nurse should be familiar with clinical protocols and nurse triage details related to their Nurse Practice Act in each state in which they practice. Most states require that nurse triage be performed by a registered nurse. Educate yourself on what your state requires.

In addition, the book The Art and Science of Telephone Triage: How to Practice Nursing Over the Phone, written by Carol Rutenberg and M. Elizabeth Greenberg, is a good resource. There is a chapter on risk management and common pitfalls.

D.D. Fritch is passionate about enhancing care for children and patients through technology. As a nursing leader, D.D. spent most of her 32-year career at Children’s Healthcare of Atlanta, improving its contact center, supporting its telemedicine program, and optimizing its Pediatric Nurse Advice Line. Connect with her at dd@connected2consulting.org.

TriageLogic

Ravi K. Raheja, MD is the CTO and medical director of the TriageLogic Group. Founded in 2007, TriageLogic is a URAC accredited, physician-led provider of high-quality telehealth services, remote patient monitoring, nurse triage, triage education, and software for telephone medicine. Their comprehensive solutions include integrated mobile access and two-way video capability. The TriageLogic group serves over 9,000 physicians and covers over twenty-five million lives nationwide.

The January 2021 Issue of Medical Call Center News



Read the January 2021 issue of Medical Call Center News.

Medical Call Center News is an e-newsletter published by Peter DeHaan Publishing Inc, in conjunction with AnswerStat magazine.

Please tell your coworkers about Medical Call Center News.

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[Medical Call Center News is published by Peter DeHaan Publishing IncPeter Lyle DeHaan, editor.]

Pulsar360 Receives IP Telephony Award


Pulsar360: strategic partners with the TAS industry

Pulsar360 Corporation is proud to announce that it has recently received the Internet Telephony “Product of the Year Award” for 2020. This award recognizes the most innovative and highest quality IP communications brought to market in the past year.

“We are extremely honored and excited to be recognized four years in a row by Internet Telephony, previously for our PBX Hosting and Premise-Based PBX solution in 2017 and 2018 in 2019, for our Enterprise Hosted & Premised Based Solution; and now, in 2020, for our Advanced VoIP & Telecom Solutions. At Pulsar360 Corporation we are constantly innovating and improving our products to meet the demands of our clients and partners. We take great care to ensure that our customers have the very best products,” said Bob Harrison, Chief Channel Officer at Pulsar360 Corporation.

“In the opinion of our distinguished judges, Pulsar360 Corporation’s Advanced VoIP & Telecom Solutions have proven to be among the best IP communications solutions available on the market,” said Rich Tehrani, CEO, TMC.

Pulsar360: strategic partners with the TAS industry

Pulsar360 provides SIP trunking and disaster recovery solutions for medical answering services. Pulsar360, Corp. has served the medical call center industry since 2008.

The November 2020 Issue of Medical Call Center News



Read the November 2020 issue of Medical Call Center News.

Medical Call Center News is an e-newsletter published by Peter DeHaan Publishing Inc, in conjunction with AnswerStat magazine.

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[Medical Call Center News is published by Peter DeHaan Publishing IncPeter Lyle DeHaan, editor.]

The September 2020 Issue of Medical Call Center News



Read the September 2020 issue of Medical Call Center News.

Medical Call Center News is an e-newsletter published by Peter DeHaan Publishing Inc, in conjunction with AnswerStat magazine.

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[Medical Call Center News is published by Peter DeHaan Publishing IncPeter Lyle DeHaan, editor.]

The July 2020 Issue of Medical Call Center News



Read the July 2020 issue of Medical Call Center News.

Medical Call Center News is an e-newsletter published by Peter DeHaan Publishing Inc, in conjunction with AnswerStat magazine.

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[Medical Call Center News is published by Peter DeHaan Publishing IncPeter Lyle DeHaan, editor.]

The May 2020 Issue of Medical Call Center News



Read the May 2020 issue of Medical Call Center News.

Medical Call Center News is an e-newsletter published by Peter DeHaan Publishing Inc, in conjunction with AnswerStat magazine.

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[Medical Call Center News is published by Peter DeHaan Publishing IncPeter Lyle DeHaan, editor.]

Vendor Spotlight On TriageLogic


TriageLogic

Adapting to the Demands of Healthcare with High-quality Solutions for Nurse Triage and Remote Patient Care

In 2006 by Charu Raheja, Ph.D., founded TriageLogic with the purpose of using modern nurse telehealth technology and medical expertise to improve access to healthcare. Their goal is to ensure everyone receives the same standard of care regardless of where they live. Ravi Raheja, MD, serves as the medical director and COO, overseeing all nursing and technology operations in the company to ensure patients receive the highest level of care.

Over the last thirteen years, TriageLogic has stayed true to its mission and continues to provide innovative nurse telehealth technology and mobile applications. TriageLogic also operates one of the largest URAC-accredited healthcare call centers in the United States. As healthcare has evolved, TriageLogic has continued to adapt and release new product lines to meet the changing needs of the industry.

The year 2020 has challenged our healthcare system, causing many medical professionals to work around the clock to implement emergency remote support solutions for patients. TriageLogic has been proud to assist with the COVID-19 pandemic by quickly adapting and creating easy-to-implement solutions for hospitals, medical organizations, and health centers to use for patient care during the COVID-19 crisis.

The following lists some of the solutions available for clients:

Nurse Triage On Call

TriageLogic maintains one of the most sophisticated URAC accredited nurse triage systems in the United States. Their call center software allows clients to customize orders after nurses evaluate the symptoms presented by patients. Nurses can share handouts with patients on behalf of doctors, and MDs can communicate securely with nurses using HIPAA-compliant texting. The company quickly ramped up its services and software implementation as it observed a call volume increase by as much as 35 percent due to COVID-19.

Customized Coronavirus-Trained Hotline and Patient Triage System

These hotlines include a combination of online systems and a remote call center telephony with triage protocols. By partnering with physicians, TriageLogic helps millions of concerned callers, evaluate their symptoms, and coordinate testing for thousands of patients.

Remote Call Center with a Phone System for Doctors and Nurses

TriageLogic can set up nurses and doctors to work remotely, including connecting all staff to a call center-grade, HIPAA-compliant phone system. This system allows organizations to keep their clinical staff at home and coordinate as a team as if they were in the office. From front desk staff to nurses and doctors, the entire team stays together while working remotely, including scheduling visits and conducting telehealth visits. Using secure phone lines keeps patient information confidential.

Nurse Triage Software with Up-To-Date Protocols (including COVID-19)

MyTriageChecklist is a fast-to-train, web-enabled software from TriageLogic that provides continuity in patient care and education. It takes less than an hour to implement, does not store any sensitive patient information, and offers an easy-to-use interface to ensure nurses ask and consistently document all relevant questions related to patient symptoms.

It also includes triage protocols written by Dr. Schmitt and Dr. Thompson, which are updated in real-time. For example, COVID-19 protocols receive regular updates as information becomes available.

Remote Patient Monitoring (RPM)

As monitoring technologies continue to gain traction, the healthcare industry views RPM as a way to help control the cost of care for those with chronic diseases such as congestive heart failure, COPD, asthma, and diabetes.

However, the amount of data that’s generated by monitoring technologies is vast. TriageLogic has partnered with several device companies to create a full end-to-end monitoring system. The system makes it easy for doctors to monitor their chronically ill patients without adding administrative or clinical burden to their staff. TriageLogic can also create specific protocols for nurses to use based on devices and patient conditions.

Reporting Portal

Finally, all TriageLogic solutions come with a robust reporting portal to provide in-depth analytics on the outcomes from patient interaction. TriageLogic aims to stay ahead of the demands of healthcare and create ready-made and easy to implement solutions to continue helping providers give the best possible care to their patients.

TriageLogic is a URAC accredited, physician-led provider of high-quality telehealth services, nurse triage, triage education, and software for telephone medicine. Their comprehensive triage solution includes integrated mobile access and two-way video capability. The TriageLogic group serves over 7,000 physicians and covers over 18 million lives nationwide.

The March 2020 Issue of Medical Call Center News



Read the March 2020 issue of Medical Call Center News.

Medical Call Center News is an e-newsletter published by Peter DeHaan Publishing Inc, in conjunction with AnswerStat magazine.

Please tell your coworkers about Medical Call Center News.

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[Medical Call Center News is published by Peter DeHaan Publishing IncPeter Lyle DeHaan, editor.]

The January 2020 Issue of Medical Call Center News



Read the January 2020 issue of Medical Call Center News.

Medical Call Center News is an e-newsletter published by Peter DeHaan Publishing Inc, in conjunction with AnswerStat magazine.

Please tell your coworkers about Medical Call Center News.

Thank you!

[Medical Call Center News is published by Peter DeHaan Publishing IncPeter Lyle DeHaan, editor.]