By Ravi K. Raheja, MD

How do you ensure patient care quality when it comes to nurse telehealth triage? Whether you use an outsourced nurse triage service or want to license software and use your own team, follow this checklist when addressing every patient caller.

Not only do these important items minimize liability with remote care, but they also ensure a high quality of care for patients and a decrease in overall healthcare costs. We’ve seen firsthand how successful these items have been in our own nurse triage call center, which is why we want to share them with you to improve your own patient health outcomes.

Develop Detailed Nurse Triage Training

To be effective at telehealth triage, nurses must remain focused on each patient’s needs, obtain the appropriate information about their symptoms, know how to handle difficult calls, and document all information thoroughly. At TriageLogic, we use a 10-step approach to training nurses, which can be found in our learning center course: “Critical Steps to a Triage Call.” You can also read a related article on training triage nurses.

Broadly speaking, when it comes to triaging patients over the phone, nurses must remember to smile, show empathy, and remain calm and confident while they are addressing patient questions and concerns. They must also use three types of listening—active, reflective, and empathetic—to fully understand each patient’s symptoms and guide them to the appropriate care.

Along with the potential for angry or distressed callers, triage nurses must also know how to handle patients whose symptoms call for emergency services.

Use National, Standardized Protocols

Nurse triage protocols developed by Drs. Schmitt and Thompson are the gold standard for patient care quality. When integrated with nurse triage software, they provide the most intuitive means of establishing caller dispositions by using yes/no questions to determine symptom severity.

A group of independent medical professions review these protocols annually and update them during important health-related events (like the COVID pandemic).

Give Answering Service Operators Their Own Protocols

Answering service operators (ASOs) are the first people to interact with callers on a nurse triage line. Their purpose is to greet patients and ask them about why they’re calling. This helps identify urgent versus non-urgent issues and passes each caller’s request along to the right triage nurse. However, it’s become clear that ASOs also need their own protocols to avoid delays in patient care.

Why?

ASOs don’t always ask detailed questions. For example, if a patient calls for a medication refill, the ASO should verify if the patient has also started to experience any withdrawal symptoms, rather than simply assume the request is non-urgent.

Establish Average Patient Callback Times

When a call comes into an ASO, they will pass those caller requests along as emergent, urgent, or non-urgent. Each of these groups come with different requirements on how soon triage nurses should call them back. A quality nurse triage program should have established time limits. Sticking to these time limits is vital to patient care quality.

For emergent, that’s five minutes or less. Urgent requires fifteen minutes or under. And non-urgent should be within thirty to sixty minutes.

Staggering calls in this manner not only prioritizes patients based on severity, but it also avoids overwhelming your triage line depending on how many nurses you have scheduled.

Record Calls for Quality Assurance

Recording your nurse triage calls is an important part of any quality assurance program. Doing so keeps your nurses accountable and less likely to deviate from using the Schmitt-Thompson protocols.

It also mitigates liability against your nurses. In case of a poor health outcome, these records corroborate the actions a nurse took, the reasons why, and whether those were correct.

Finally, recorded calls provide oversight and identify potential training needs. Evaluating them will indicate whether a nurse is struggling in a particular part of the triage process and allow managers to create opportunities for improvement.

Implement Secure Texting

Secure texting is an HIPAA-compliant option that allows nurses to chat with doctors without having to download an app or additional software. Nurses send messages to doctors’ phones over browser encryption, and doctors are required to click a link to acknowledge each message before accessing patient data.

This ensures patient confidentiality and speeds up responses from doctors depending on the severity of each patient’s symptoms—all of which leads to greater patient care quality. All messages are then documented in the patient’s file for reference.

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. Contact them if you have questions regarding any of the items from the above checklist or you’d like to discuss how to implement them within your own nurse triage.

By Ravi K. Raheja, MD

Patient phone calls, and questions about whether symptoms require an office or emergency visit, are part of every busy medical practice. However, how do you train nurses to ensure that they give the appropriate care advice every time, while documenting caller information, symptoms, and dispositions?

If your team wants to decrease liability on these calls, implement software with medical protocols that document all this information. Choose a solution that employs time-tested protocols. This helps ensure each patient caller is directed to the appropriate level of care in an appropriate window of time, regardless of when they call.

Effective triage software is an easy-to-use solution for nurses that includes standardized protocols to address any patient symptom. It also includes thorough documentation with timestamps and the ability to customize triage and care instructions based on the needs of the practice. The information should be integrated with your EMR or able to be simply copied to an EMR file, ensuring continuity of care.

Documentation

When it comes to avoiding liability as a triage nurse or healthcare provider, documentation is everything. Consider the following example of a doctor who took a patient’s call while out of the office. He couldn’t notate his care advice to the patient in their chart. In fact, the only option available to him was to scribble his notes on a napkin.

That patient went on to experience a medical complication, then subsequently sued the doctor by disputing what the actual care instructions were during their call. Thanks to that napkin though, the doctor had proof of what he’d said. Thankfully, nurse triage software is far more thorough.

Standardized Care

Seek a solution with protocols that are easy to follow, are updated regularly as new healthcare issues develop, and can be customized with instructions specifically for your practice.

In turn, this ensures that nurses are prompted with the best questions to ask patients based on the severity of their symptoms and allow those nurses to document their thought processes as they triage each call. With this, all their interactions are recorded and easily accessible for reference.

The results? Nurses can shift their attention to their patients, and patients receive the correct outcomes, no matter which nurses they speak with. Another advantage is that all incoming calls receive the same quality of care or advice regardless of which nurses answer them.

Patient History

Along with symptom severity, effective triage software allows nurses to record relevant patient history so that their dispositions for care are based on all their potential health factors. Nurses must be mindful of addressing callers objectively, avoiding stereotypes, and using their listening skills to evaluate symptoms in their entirety.

Timestamps

Triage software should include timestamps for pivotal moments recorded on nurse calls. These include when calls are received, when they’re returned, and when they’re completed.

Consider that the biggest threat to nurse triage is delayed patient care. As such, it’s critical that your nurses correctly address patients’ symptoms in a timely manner, advise them to seek care from the appropriate medical professionals, and have the documentation to back up their work.

Clear Dispositions

Part of the nurse triage process is providing clear dispositions and follow-up instructions. If a patient’s condition suddenly changes, a nurse’s notes should reflect this change, as well as the triage advice they offered.

When patients are referred to providers, this documentation should also be easy to share with them. If it is, those providers can address those patients immediately and maintain a continuity of care, especially when their patients’ needs are urgent.

If a patient’s health begins to deteriorate, triage software should have instructions for the responding nurse to know how to expedite assistance from a referred provider. This should include a secure texting and chat option that lets nurses contact physicians, update them on the conditions of their patients, and close the loop on care.

Conclusion

Triage software can help ensure patients are directed to the appropriate level of care in an appropriate window of time. This decreases provider liability and improves patient care.

Ravi K. Raheja, MD is the CTO and medical director of the TriageLogic Group. Founded in 2007, TriageLogic is a URAC accredited, physician-lead provider of high-quality telehealth services, remote patient monitoring, nurse triage, triage education, and software for telephone medicine. The TriageLogic group serves over 9,000 physicians and covers over 25 million lives nationwide.

Contact them to schedule a demo and see how TriageLogic’s MyTriageChecklist solution can benefit your patient callers and their dispositions.