Category Archives: Articles

Articles from AnswerStat

Checklist to Ensure Patient Care Quality in Nurse Telehealth Triage

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.


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.

Decrease Patient Liability Using Nurse Triage Software

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.


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.


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.


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.

Channel Specialization versus Multichannel Proficiency

Effectively Handle Communication Channels in a Medical Contact Center

By Peter Lyle DeHaan, Ph.D.

In the last issue of AnswerStat we looked at the need for multichannel integration in your healthcare contact center to better serve patients and produce superior outcomes. We considered this from a systems standpoint. Now let’s look at multichannel from an agent and operational perspective, specifically channel specialization versus multichannel proficiency.

Ideally you want every agent trained and fully proficient to handle communication on any channel option that comes in, be it voice, text, email, video, social media, and so forth. Some agents relish being proficient on all channels, while others prefer to specialize. A contact center needs both types of agents.

Channel Specialization

An agent that specializes in one channel, for instance telephone calls, will develop a higher level of effectiveness by focusing on that one channel. Through repetition they’ll gain an enhanced level of skill through their specialization.

This will enable them to move from one call to another with greater speed and increased efficacy. In short, they’ll get more done faster.

But they must also be cross trained on other channels. There are two reasons for this.

One is in the event of a telephone call that needs to switch channels, such as to move to video or email to better facilitate effective communication. In this instance you don’t want an agent with a telephone channel specialization handing the call off to a video or email specialist. Instead, you want the original agent to move with the patient or caller to the new channel.

The second reason you want agents cross trained is so they can switch to a different channel if there’s a need to do so. This could occur with an increased amount of traffic in a channel different from the one they specialize in. Without this cross training, you could end up with specialists in one channel sitting idle while specialists in another channel struggle to keep up.

Though you have agents that specialize in one channel and mostly work in that area, they must be ready and willing to jump to another channel when the situation requires it.

Multichannel Proficiency

Other agents would find channel specialization to be quite boring. They relish being proficient on many channels, even on every channel your healthcare contact center handles. They enjoy the variety that comes from interacting with patients on various channels.

These multi-channel agents can handle patient contacts on any channel as needed, whenever needed. This allows them to switch between real-time communication (telephone and video calls) depending on the traffic demands at any moment. Yet at the same time they are equally proficient at processing non-real-time communication (email, text, and social media) as required.

This means they can effectively work in the channel where they’re most needed.

Specialists and Generalists

While channel specialization is good for some agents and multichannel proficiency is ideal for others, this mix of channel focus is also essential for your contact center. Just like with healthcare, a contact center needs both specialists and generalists.

The specialists can concentrate on one channel, reaching a level of effectiveness that a generalist could never achieve. Yet a generalist is effective at quickly and easily migrating from one channel to another.

Though every agent in your contact center should be cross trained to handle any channel, determine which area is the best for each agent, channel specialization or multichannel proficiency. You need both.

Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat. He’s a passionate wordsmith whose goal is to change the world one word at a time.   Read more of his articles at

Vendor Spotlight: Improving Response to Critical Laboratory Results with Secure Messaging

By Nicole Limpert

George Bernard Shaw once said, “The single biggest problem in communication is the illusion that it has taken place.” This is especially true in the healthcare sector. Unfortunately, ineffective diagnostic communication can have dire consequences for patients. It is estimated that there are 40,000–80,000 deaths in the United States each year due to diagnostic error. Poor communication of laboratory test results is a contributing factor in these errors.

Critical laboratory results, also known as panic results or values, are defined as test results that exceed established high or low limits. Abnormal results are different from critical values. “Abnormal” and “critical” are not used interchangeably.

Critical results are considered life threatening and require corrective action to be taken promptly. After the critical laboratory results has been verified and entered into the lab’s computer system, notifications are sent to the patient’s physician and/or physician’s representative, the ordering entity, and any other clinical personnel responsible for the patient’s care.

Critical Results Reporting Standards

According to the “National Patient Safety Goals” set by The Joint Commission, timely reporting of critical results need to be made to the responsible licensed caregiver(s) within an established time frame so that the patient can be promptly treated.

They outline three elements of performance to achieve this goal:

  1. Collaborate with organization leaders to develop written procedures for managing the critical results of tests and diagnostic procedures that address the following:
  • The definition of critical results of tests and diagnostic procedures.
  • By whom and to whom critical results of tests and diagnostic procedures are reported.
  • The acceptable length of time between the availability and reporting of critical results of tests and diagnostic procedures.

2. Implement the procedures for managing the critical results of tests and diagnostic procedures.

3. Evaluate the timeliness of reporting the critical results of tests and diagnostic procedures.

Critical Lab Communication

When a critical lab value is verified, often a phone call is made to report the result and it is documented in the laboratory information system. To comply with patient safety goals, the person taking the call must read back the patient’s name, the hospital number, and all laboratory results. Read back is required to ensure accurate transmission of information.

Historically, verbal communication has been considered the preferred procedure for notifying critical values. However, the need to communicate lab diagnostics quickly and accurately is paramount for lowering the risk of a patient experiencing an adverse medical event.

An article in the National Library of Medicine titled “Critical Laboratory Values Communication: Summary Recommendations from Available Guidelines” finds that “The results of surveys conducted in the UK, Italy, US, China, and Croatia have notably emphasized that there is poor consensus regarding many aspects of critical values management. This is a concerning issue, for not less than three good reasons.

“First, the lack or delayed communication of critical values has been clearly recognized as a source of significant harm to the patients, since these test results may lead to treatment modification in as many as 98 percent of patients admitted to surgical wards and up to 91 percent of those admitted to medical departments.

“Then, critical values communication is an integral part of many accreditation procedures for medical laboratories, including the universally agreed International Organization for Standardization (ISO).

“Finally, timely notification of critical values has been endorsed as one of the leading quality indicators of the post-analytical phase [of laboratory medicine] by the Working Group ‘Laboratory Errors and Patient Safety’ (WG-LEPS) of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC).”

Information technology tools are becoming an essential component of medical lab communication because they provide:

  • Fast and accurate communications
  • Automated systems
  • Reporting
  • Simplified communications
  • HIPAA compliance to protect patient health information

The Traditional Process of Reporting Critical Values

The College of American Pathologists (CAP) offers a laboratory accreditation program. To attain accreditation through the CAP, they require that at least 90 percent of critical values be reported within 30 minutes after obtaining a verified result. A similar requirement is in place through The Joint Commission.

Sometimes it is difficult for organizations to attain or retain accreditation because the traditional process to verify and document notifications (read back) can be time consuming. Typically, institutions will designate categories of personnel who are authorized to receive critical values, usually physicians and nurses.

If the critical laboratory results are communicated to a suitable medical staff member, the name of that person, time of contact, and documentation of read back is recorded. If the result is provided to non-medical personnel, that person is required to notify the correct physician, record the notification, and read back in the patient’s medical record.

If the non-medical personnel are unsuccessful in contacting an appropriate person for transmission, the next step is often to page the provider. Significant delays can result if there are issues with contacting the provider or using precious time to find out who is on-call.

The Benefits of Using a Secure Messaging App

Secure messaging apps can outperform traditional phone calls by improving timeliness when reporting critical laboratory results. When healthcare organizations change their process of reporting critical values by telephone to using a secure messaging app instead, they can meet or exceed the standards put forth by accrediting agencies, experience increased efficiency by immediately getting the results to the right person, see a reduction in the time it takes to report results, and have a reliable record of the communication because messages are automatically time-stamped when sent, received, and read. Built-in reporting features provide accurate information about the communication process.

A secure mobile messaging app also provides:

  • End-to-end message encryption to protect electronic patient health information and ensure all communications are secure and protected
  • Freedom from outdated pagers. Devices can be consolidated through secure messaging apps so that all correspondence can be done from a smartphone, tablet, laptop, smartwatch, or desktop computer
  • Ease of use
  • Customization
  • The ability to send massive amounts of data quickly and accurately while keeping users connected through WiFi and cellular networks
  • Voice-to-text modes so users can speak a message into their device, and it automatically converts into text
  • Persistent alert settings ensure important messages won’t be missed
  • A message log to keep track of messaging histories
  • Interoperability by having the ability to seamlessly integrate with on-call scheduling
  • Safety features such as bio-metric access and remote disabling if a device is lost or stolen

Notification of critical laboratory results is a crucial function of the clinical laboratory. Using technology such as secure messaging, ensures information is received by the correct personnel, quickly and accurately, to help improve patient care.

Nicole Limpert is the marketing content writer for 1Call. The 1Call Division of Amtelco is a leader in developing software solutions and applications designed for the specific needs of the healthcare call center marketplace. 1Call features a complete line of modular solutions specifically designed to streamline enterprise-wide communications, save an organization’s limited resources, and make them tremendously efficient, helping them bring wellness to their members and their bottom line.

Multi-Channel Integration

Serve Patients Better and Produce Superior Outcomes

By Peter Lyle DeHaan, Ph.D.

Some healthcare call centers only handle telephone calls by design and others do it because that’s what they’ve always done. But most have embraced a contact center mindset, where they’re handling more than telephone calls. This can include email, text messaging, and web chat. They may also incorporate social media monitoring and response.

There is also an opportunity with video. Integrating video communications into the call center has received much theoretical attention for a couple of decades, with proponents predicting it would be only a year or two out. We are, at last, moving from potential to possible.

Over the past two years many people have become more comfortable talking to a camera to communicate with someone far away. Though not everyone embraced this as an acceptable alternative to in-person meetings, they did, however, become more comfortable using it and less resistant to the technology.

This prepares people for the option of video chatting with their healthcare provider, nurse triage operation, or medical call center. These are exciting times for patients and their healthcare call centers.

All these options, however, will inevitably lead to patients using multiple communication channels to accomplish their task, depending on what’s available at the time or what will achieve their goal the fastest.

What could start as a telephone call could switch to video for face-to-face interaction. In the same way, a text message chain could migrate to the telephone or a social media post to email. The only limit to the sequences is our creativity.

Yet regardless of the scenario, one key issue remains paramount. Each channel must integrate with all the others, allowing information to effortlessly pass from one option to another. We must eliminate isolated silos of information that don’t communicate with each other. We need full multi-channel integration.

This usually falls to the platform vendor. If you use a singular system to handle all communication channels, you’re one step closer to making multi-channel integration a reality. Though harder, integration between disparate systems can also occur. It just requires more effort on the part of the respective vendors to pull off.

Here’s what you can do to move things forward to enjoy multi-channel integration.

Educate Staff

Make sure your front-line employees know what they must do to allow for the smoothest information handoff as patients move from one channel to another. If your staff doesn’t do their part correctly, the decree of integration won’t matter.

Test Your System

Make a contact on one channel as a patient would. Then switch channels and see what happens. Is your text messaging exchange accessible by the telephone rep when you switch to voice? Or do you need to start over and re-state the same information?

Test this in each combination of channels possible, regardless of how unlikely it seems to you that anyone would ever make that switch. Know that someone will.

Identify Weaknesses

As you conduct your field test of switching channels, look for three things. Identify what works well, what somewhat works, and what doesn’t work at all. Celebrate the areas of success, seek ways to shore up the areas that have limitations, and note what doesn’t work at all.

Encourage Your Vendor

Armed with this information, approach your vendor, not in a confrontational manner, but with a positive, let’s-work-together attitude to move toward full multi-channel integration.


Multi-channel integration is what your patients expect. It’s what they deserve. Start now to move toward this outcome.

Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat. He’s a passionate wordsmith whose goal is to change the world one word at a time.

How Effective Communication Helps Organizations Achieve the Quintuple Aim

By Nicole Limpert

What is the goal of healthcare? An answer such as “good health” may seem like an obvious response, however, sometimes a simple question has a complex answer. For many years, one of the most influential answers to this question was put forth in 2001 by the Institute of Medicine (IOM) in a report called “Crossing the Quality Chasm.” Their framework included these six goals for any healthcare system:

  • Safe: Avoiding harm to patients from the care that is intended to help them.
  • Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding under-use and misuse).
  • Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
  • Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care.
  • Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy.
  • Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

In 2006, two faculty members of the Institute for Healthcare Improvement, John Whittington, MD and Tom Nolan, MD, developed the idea of the “triple aim” to define the aims of healthcare. They concluded the social needs outlined by the IOM were only for individuals who needed care. The health of the population was a second component that wasn’t included in the IOM framework.

The Triple Aim consists of three points:

  • Experience of Care: The original IOM list (above).
  • Population Health: Addresses the “why” related to healthcare needs. “Why does a person have a heart attack, break their arm, or experience depression?” This point looks at the causes of why a person experiences an adverse health event, and how to keep everyone in good health.
  • Per Capita Cost: Keep costs down because most individuals, companies, and governments have limited resources and need to spend funds on things other than healthcare.

Additional aspects to the triple aim have been adopted by healthcare organizations to include “improved clinical experience” (the quadruple aim) to combat staff burnout and lower patient satisfaction and health equity (the quintuple aim) as it pertains to policy including systematic incorporation, measurable and transparent reporting, consideration of systemic contributing factors, and reimbursement.

Contact Center Software
and the Quintuple Aim

Most of the previously mentioned goals include a communication component. Effective communication software that works with an organization’s existing technology is a crucial tool to help healthcare systems achieve the quintuple aim.

Removing Barriers to Health Equity

The Health Resources and Services Administration (HRSA) is a federal agency of the U.S. Department of Health and Human Services focuses on improving the healthcare of people who are geographically isolated, and economically or medically vulnerable. Medically under-served populations and areas are designated by HRSA as having too few primary care providers, high infant mortality, high poverty, or a high elderly population.

These populations include uninsured individuals, vulnerable populations including the elderly, low-income, ethnic minorities, migrants, and people who received a limited education, and those with poor access to healthcare because of inadequate transportation or a lack of available services.

Technology enables medical contact centers to effectively become an extension of a hospital or clinic’s operations 24 hours a day, 7 days a week. Robust communication software used by hospital centers can securely access a patient’s electronic medical record (EMR), update EMRs with notes, and record calls that need to be used for insurance claims and workman’s compensation. Because everything is documented, detailed reports can be generated for reporting purposes.

Hospital contact centers help to address two of the biggest barriers to healthcare: language and transportation. Medical staff work with an enormously diverse patient population. Understanding a person’s language leads to better healthcare. Multi-lingual contact center operators or confidential over-the-phone interpreting services can be used for access to hundreds of different languages.

Patients with mobility challenges or who live in rural areas can receive some health services via telehealth. Operators can coordinate care, make follow-up calls, schedule visits, contact on-call medical staff, and manage referrals. Contact centers that are staffed by qualified nurses or multidisciplinary teams (such as a resident, pharmacist, and social worker) can make health assessments, give medical advice, mental health counseling, and escalate critical concerns.

Timely, Efficient, Patient-Centered Care for an Improved Clinical Experience

Getting the right message, to the right person, at the right time can improve patient care. The need for efficient, reliable communication is present throughout a patient’s journey. A hospital’s contact center is the hub of communication for an organization’s calls and chats and the same software that is used at the center can also be leveraged within the hospital or clinic to improve clinical communication and workflows.

When a patient is admitted into a hospital, they may be moved from one room to another while waiting for tests and procedures, and during recovery. It can become difficult to locate and communicate with a patient once they are receiving care within the system.

A robust contact center platform can assign a fixed phone number to each patient to follow the patient for the duration of their stay. Associating each patient with one phone number helps ease the stress of family and friends who are trying to contact them, streamline the communication process for anyone on the patient’s care team, and reduce the number of calls to the hospital’s contact center.

Contact center software can work together with a hospital’s event notification software system to expedite enterprise-wide critical alerts in healthcare environments by capturing requests from ADT (admission, discharge, and transfer) messages, nurse call messages, smart beds, pain management, alerts, alarms, orders, or appointments. Then, emergency notification software instantly sends those messages to designated medical staff recipients using a wide variety of methods, including Vocera badges, IP phones from Cisco and Spectralink, SMS, email, secure messaging apps, and more.

All statistics can also be accumulated for each notification to provide an easy-to-follow audit trail for reporting purposes and to help healthcare organizations refine their communication processes.

Enhancing Patient and Staff Safety with Web-based Communication

The ability to access health information at any time from any place is a fundamental and critical part of any healthcare organization’s communication protocol. Hospital personnel can use some of the same web-based communication software that is used in their call center to deliver fast, secure communications.

  • Secure Messaging: Secure organizational communication is crucial for protecting patients, medical staff, and hospital organizations. HIPAA-compliant messaging apps send secure text, photo, audio, and video content while protecting patient privacy. These apps can be used via smartphones, tablets, and desktop computers. Secure messaging apps can be leveraged to simplify collaborative care to provide a better patient experience, and speed the process of patient admissions, lab results, and patient transport.

    An additional benefit of secure messaging is the ability to triage low-priority alerts and route alarms directly to clinician devices to reduce sensory overload for both patients and care providers. Patient care is improved when important alarms get a response as quickly as possible, but a restful, quiet healing environment is also important for patient recovery.
  • Care Team Collaboration: Nurses, physicians, and other staff use mobile-friendly care team collaboration applications to remotely access on-call schedules, directories, messages, and reports.
  • Workforce Management: Staff can view, edit, copy, override, assign, and unassign schedules in real-time. They can use directories to quickly find and contact staff and use the reporting function to track, view, and print communications.

Correcting inefficient communication can help an organization towards their triple, quadruple, or even quintuple aim. Using the tools and software that may already be available in a hospital’s contact center provides a path to successfully attain the goals of the entire enterprise.

Nicole Limpert is the marketing content writer for 1Call. The 1Call Division of Amtelco is a leader in developing software solutions and applications designed for the specific needs of the healthcare call center marketplace. 1Call features a complete line of modular solutions specifically designed to streamline enterprise-wide communications, save an organization’s limited resources, and make them tremendously efficient, helping them bring wellness to their members and their bottom line.

Tools to Improve Call Center Efficiency

By Mark Dwyer

The Merriam-Webster Dictionary defines efficiency as the effective operation measured by comparing production with cost (energy, time, and money). Never has call center efficiency been as critical as today with the limited number of available telehealth nurses and trained call center agents, the high costs of hiring and retaining qualified staff, increased call volumes, and the growing costs of technology, hardware, and space for running a call center.

So, how can you increase your call center’s productivity, whether you use it for nurse telehealth triage, marketing, referral, or any number of functions? Let us review several opportunities.

Start with Information

Data is king when evaluating how efficiently your call center staff handles calls and how successful it is in satisfying customers/patients. There are numerous standard reports in most call center solutions that provide the data needed to calculate your call center’s efficiency. If valid, you can use this data to project basic staffing needs.

There are several free and fee-based staffing tools available. Two such tools include the Erlang Calculator for Call Center Staffing and a staffing tool developed by Bright Pattern. Remember to consider values such as attrition rate, shrinkage, abandoned calls, and multi-skilled agents in your calculations. You can use these formulas to determine both non-clinical and clinical call center staffing needs, provided you use values that accurately represent your call center.

Regardless of the tool you use, be sure to generate graphical trend reports as they more clearly present times when your staff either under or over-performs against your target metrics. If you’re new to call center staffing, I recommend the YouTube video by Call Center Management titled “Calculate the # of agents you need.

Integration Increases Efficiency

Efficiency strategies include many things. For example, some systems can preload the caller’s name and several other demographics by using caller ID before the nurse or agent receives the call.

At institutions with centers of excellence that maintain their own focused call centers, use your phone system to direct calls using skills-based routing. For example, the system can direct cardiac calls to the heart center, oncology calls to the cancer center, etc.

When integration with your phone system is unavailable, many sites use front-enders to gather initial demographics before handing the call off to a nurse. Some organizations go even further using the front-enders to identify callers needing urgent attention to hand off immediately to a nurse versus those they can safely add to the nurse follow-up call queue.

Once in the call queue, ongoing attention to the queue is paramount to make sure calls with the greatest need for care receive priority. Many busy sites dedicate a nurse or nurse manager to perform this task during peak call times.

Consider Chat and Automation

Chat is also becoming a vital tool in off-loading both inbound and outbound calls from the queue. Today’s healthcare users often prefer to chat rather than talk on a phone.

By using chat and AI-generated chatbots, sophisticated systems can ask preliminary questions before transferring the caller to a live nurse or agent for a further chat or live phone interaction. Chat reduces staffing and provides the techno-savvy generation with their preferred communication methodology. Automation can further increase efficiency by redirecting general requests for information to the hospital website’s Q&A section.

Optimize Call Flow

Remember, as I stated, data is king. From the data gathered by the software as staff process calls, managers can simplify call flow to streamline the process. In addition, as your users learn the system, you can remove specific prompts, call guides, and fields, eliminating unneeded keystrokes.

Some software also provides hot-keys (such as Alt-S) to access additional software functions supporting full-on keyboarding. Others offer systems that are more mouse-click friendly. The best offers both options to enable your different types of users to process calls most efficiently.

When talking about call flow, I would be remiss not to mention the strategic value provided by software that is customizable to meet your needs. A solution that claims to fit all clients does not fit any. To be truly efficient, you need to work with vendors that partner with you to design a system that serves your unique needs.

The ideal solution should also include reports to track the fields used and not used, enabling you to hide the unused fields. Can your team hide the fields, or does it require vendor support? Remember, vendor support means additional costs.

Tap Video

Another commonly used efficiency tool is the video visit. Video visit is especially valuable if your call center also provides care management or disease management services. In addition, videos are of value when triaging certain situations. A good example is when a mom calls about a lethargic child. Seeing a video of the child facilitates more accurate, quicker triage.

For sites not equipped for video, even the ability to accept static photos increases efficiency by allowing the nurse to see the severity of a rash, laceration, or other condition.

Other Tools

Another feature that goes a long way to improving call center efficiency is a solution that provides a command center dashboard. This real-time data enables the call center to switch directions as needed, reallocating staff and staffing based on real-time data.

Quality review auditing tools also enhance productivity by identifying improper call handling or triaging early in a call center agent’s or nurse’s career, enabling fast remediation before bad, efficiency-zapping habits become habitual. Managers must conduct ongoing reviews of call center staff to identify potential areas for improvement. Of great value here are resources provided by your software vendor, including new hire training, refresher courses, training documentation, and no-cost webinars to keep your staff using the software at its peak efficiency.

Benchmark Your Performance

Finally, be cautious not to become overly impressed with your call center’s performance until you compare it to the industry’s standards and, more importantly, to other call centers using the same software solution. For example, your site’s call times may beat national averages. However, do they stand up against the call times of other hospitals using your same software?

Be sure to look for a vendor that can anonymously collect non-PHI call data from its clients to generate individual call center-specific numbers and multi-site aggregate results. This will enable you to evaluate your data against that of the aggregate. By comparing apples to apples, you can more accurately identify if you’re being as efficient as possible.


Time is money, and saving time saves money. The best way to accomplish this is by using your call center solution as effectively as possible.

Mark Dwyer is LVM Systems’ chief operations officer. He has more than a quarter century of experience in the healthcare call center industry.

Self-Care Tips for Physicians, Telehealth Triage Nurses, and Office Managers

By Ravi K. Raheja, MD

Due to the many hours they work and the number of patients they see, it can be easy for physicians, nurses, and office managers to neglect their own wellness. That’s even before tacking on the increased volume in COVID-related calls that many health systems are experiencing, and the mental health concerns often seen during the winter months.

All these factors reinforce how necessary it is for workers to have a means of alleviating the physical and mental stresses they experience on any given day. With that in mind, here are some of our top recommendations for healthcare staff on how they can manage theirs.

Start With the Heart

The American Heart Association phrases it best: move more. This is especially relevant to triage nurses as their jobs put them in front of computer screens for extended periods of time answering patient phone calls and offering the best dispositions for care. While they might not be able to leave their workstations frequently, there are several desk exercises that are available to them for maintaining their energy levels and staying motivated. Here are two examples:

Neck Stretch: This simple stretch helps loosen the upper back and neck muscle called the trapezius, which can ease tension, reduce stiffness, and prevent headaches.

  • Sit up straight in your chair.
  • Try to touch your ear to your shoulder without lifting your shoulder.
  • Use your hand to push lightly until you feel the stretch in your neck.
  • Hold for ten to fifteen seconds.
  • Repeat on the other side.

Shoulder Roll: Although not a stretch, this technique relieves stress because people unconsciously hold tension in their shoulders.

  • Sit up straight in your chair.
  • Roll your shoulders forward ten times at a slow, consistent pace.
  • Switch and roll your shoulders backwards ten times.

Get Some Sun

Chances are, you already know plenty about the importance of sunlight. It ramps up your body’s production of Vitamin D, which protects you from inflammation, lowers your blood pressure, strengthens your muscles, and improves your brain function. And all you need is five to fifteen minutes of it a day to experience these positive effects. It only makes sense, then, that physicians, nurses, and office managers take time to soak up some rays—even if it’s before and after their shift —by taking brief walks outside. This also gives them the perfect opportunities to…

Practice Breathing Exercises

The healthcare field can make you tense. It’s especially challenging triaging patient symptoms over the phone when callers are emotional or have difficulty explaining their concerns.

While nurses receive training on the best ways to manage difficult calls, they also need to take time in between those calls to breathe and reduce tension. As mentioned above, this is easy to combine with walks outdoors, but it’s also possible to do from workstations. Either location requires the same basic steps:

  • Sit up straight in your chair if indoors or stand up straight if outside.
  • Inhale for five seconds at a pace that allows you to fully expand your chest on count five. Try to use your diaphragm.
  • Hold your breath for three full seconds.
  • Exhale for seven seconds at a pace that empties your lungs by count seven.
  • Repeat this process ten times, or as necessary.

It might not seem like much at first, but these exercises can have substantial effects on your heart rate and cognitive abilities.

Share the Workload

There’s a lot of turnover in the healthcare industry. Some of that can be alleviated by giving physicians, nurses, and office managers more flexibility in how they use their time. Outsourcing calls can go a long way toward freeing up in-house resources for handling immediate, in-person patient needs.

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. Their comprehensive solutions include integrated mobile access and two-way video capability. The TriageLogic group serves over 9,000 physicians and covers over 25 million lives nationwide.

How Telehealth Triage Nurses Can Address Mental Health Calls During Winter

By Ravi K. Raheja, MD

Much like the holidays that precede them, the winter months usually see an uptick in reported mental illness. These include seasonal affective disorder (SAD), depression, and suicide, reflected in the types of patient calls received through nurse triage. Because these mental health cases demonstrate similar symptoms, it’s important that telehealth triage nurses have the tools to properly address each.


Although cases of seasonal affective disorder are known to happen in warmer months, most tend to manifest and peak during winter. Symptoms can range from mild—increased appetite, weight gain, low energy, and oversleeping—to more severe, like feelings of hopelessness and worthlessness, problems sleeping, and thoughts of suicide, reportsNIH.

Recommendations: In milder cases, being active and getting more sunlight (at least ten minutes in the morning and ten minutes in the afternoon) may be all that’s needed to improve a person’s mood, but severe symptoms warrant guidance by the appropriate mental health professional. Nurse triage protocols provide nurses with the right questions to glean information from patient callers and guide them to the appropriate care.


According to NIH, roughly 7.8 percent of US adults ages 18 and above experienced at least one major depressive episode in 2019. Unsurprisingly, depression rates were exacerbated at the start of the COVID-19 pandemic—nearly three-fold, notes Vox—leading up to our current days of “pandemic fatigue.”

Recommendations: Triage nurses recognize that there will be times that require them to act as emotional counselors before they’re able to ask patients about their symptoms. Start by training nurses on the 10 Critical Steps to Taking a Triage Call that include methods for coaxing callers into the proper states of mind to obtain the information they need.


Perhaps surprisingly, overall suicide rates reportedly dropped over the last couple of years. It’s worth noting that these statistics do not take into consideration unintentional drug overdoses, or the disproportionate suicide rates based on race and ethnicity. Furthermore, this shouldn’t diminish the fact that suicide remains one of the leading causes of death in younger adults, both in the 15-24 and 24-35 age brackets.

Recommendations: Telehealth triage nurses can assist callers who are contemplating suicide by establishing connections with them, as this serves as the best means of de-escalation. Pulling again from the 10 Critical Steps, nurses offer sympathetic, non-judgmental assistance, acting as a positive force for these callers in order to understand what they’re experiencing.

It’s important to note that any caller who says they’re contemplating suicide is still actively seeking help.


A telehealth triage nurse received a call from a retired firefighter who stated that they were planning to end their life. By acknowledging and listening to the patient, the nurse learned they were a cancer survivor, had recently been diagnosed with metastasis, and were given three months to live.

The nurse’s solution was to keep the patient calm and talking while simultaneously alerting their manager on duty, who contacted local police to perform a safety check on the patient. Thankfully, that patient was found in their car and transported to a hospital for care.

Additional Recommendations

While professional healthcare providers are necessary when it comes to severe mental illness, telehealth triage nurses still can offer simple solutions to patients with milder symptoms to help them improve their mood, boost their energy levels, and sharpen their mental focus. These can include exercising, improved diet, and reduction or elimination of alcohol.

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. Their comprehensive solutions include integrated mobile access and two-way video capability. The TriageLogic group serves over 9,000 physicians and covers over 25 million lives nationwide. Contact them today to find out more.

What Healthcare Leaders Should Know About Contact Centers

By Nicole Limpert

It’s important for healthcare leaders to know that their contact centers can help improve patient and employee satisfaction, reduce costs, and provide critical communication tools within the hospital setting.

A Quality Contact Center Helps Retain Patients

An organization’s contact center serves as the communication hub for the entire enterprise. The operators perform several important and diverse tasks including answering the main switchboard, communicating with patients and their families, handling emergencies and disaster response, and contacting on-call medical staff. 

One of the most significant functions of a hospital call center is serving as a virtual lobby. Often, speaking with an agent is the first contact a patient has with the organization and their impression needs to be positive. Patients have options and can always find another provider if their experience is lacking in some way.

The patient’s experience with call center agents plays a critical role in their overall satisfaction with care access and the health services they receive. When asking patients to provide information about their health care experience via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, their interactions with hospital contact center agents may influence their responses. Any unfavorable experiences could lead to unacceptable survey results and cause the organization to lose some reimbursements.

Addressing Physician Pain Points

One of the biggest pain points for physicians and clinicians is trying to provide excellent patient care while dealing with staff shortages. There simply isn’t enough administrative staff to efficiently operate. Another challenge in healthcare is ensuring fast, accurate communication. Contact center operators and the software they use can help address both these issues.

Hospital call center agents are increasingly supporting medical staff by relieving some of their administrative burdens. Operators can assist patients during intake with insurance, registration, and other services over the phone or via video using a tablet. Shelley White, director of patient access services for State University of New York (SUNY) Upstate Medical University explains how her team is assisting hospital staff, “During this coronavirus crisis, our ER registration is sometimes short-staffed, but we are able to help by watching our track board, which is tied into the EMR system with Epic. 

“When a COVID-19 patient is admitted, we can call the patient to register them and verify insurance information over the phone. This process would normally be done in-person by ER staff, but we can do it remotely and ease some of their workloads.”

Communication can be improved within the hospital or clinical setting by leveraging the integration engine software used by contact centers to connect disparate healthcare software to interface with alarms, nurse-on-call, automated alerts, and critical lab results to work together and add functionality to improve workflows and patient care.

Alicia Wise, former IS project coordinator for AnMed Health in Anderson, SC explains how they used their call center integration engine software to automate their nuclear medicine program and procedures, “When a test is ordered for a patient, the night before we’re able to automatically email or fax that information to the vendor that provides us with our isotopes and different things needed for that procedure for the next morning. Having that information relayed automatically helps to speed up the process for the patient and save the cost of having things put on hold or standby because the communication didn’t happen.”

Virtual Consolidation Results in Real Life Cost Savings

Large healthcare systems with multiple locations, buildings, and contact centers can run on a single virtual server located anywhere in the country. Everything can function together seamlessly even if they all use different PBX telephone systems.

This enables hospital contact centers to be agile during weather events, crisis situations, and other calamities such as the current pandemic. Call center leaders can also grow their staff and provide more services without adding additional server hardware. 

Virtual servers provide cost savings to an organization because less physical equipment needs to be maintained. This is crucially important considering many organizations face a budget crisis. 

Other benefits of running call centers virtually include:

  • Re-routing calls to another center during peak times, staff shortages, or emergencies.
  • Offering flexible work schedules to operators to achieve 24/7 coverage by using agents located in different time zones.
  • Allowing supervisors to tap a larger pool of staff to use as fill-in operators if an agent is sick or pursue alternate labor markets such as retired staff or students. 

Keeping Staff Safe While Working from Home

When the pandemic was declared in March 2020, The University of Texas MD Anderson Cancer Center required non-direct patient care personnel to work remotely. This included the operators for the askMDA line. “Before April 2020, our operators had never worked remotely,” says Ninette Thomas, askMDA operator manager. “We began to look at the resources we already had to develop a hybrid remote call center and realized we were not harnessing the full capability of the technology available to us.”

Web-based communication is fast, secure, improves communication times, adds efficiencies through remote access, and reduces the number of potential errors caused by miscommunication and absences. Ninette comments, “What was surprising to me was that I anticipated having a problem with performance when my operators went home, but what I found was that our productivity actually went up.”

Any personal computer can transform into a professional agent workstation. All the tools used by an operator in a contact center are accessible to the virtual agent. “All we need is a power source to work. We can literally work from anywhere,” states Ninette.

Michael Wolf, principal applications system analyst and technical and support lead for the IT team that supports the operators adds, “Now that the operators have the ability to work remotely, the IT department has experienced benefits such as decreased overhead to maintain the equipment or perform quarterly tests, reducing our support time.”


Contact centers use technology and well-trained teams to assist patients and medical staff in meaningful ways to play an even bigger role in improving a patient’s journey. Healthcare leaders can help their organizations do more with less by ensuring their organization is leveraging the capabilities of their call center staff and software.

Nicole Limpert is the marketing content writer for Amtelco and their 1Call Healthcare Division. Amtelco is a leading provider of innovative communication applications. 1Call develops software solutions and applications designed for the specific needs of healthcare organizations.