Tag Archives: telehealth articles

Vendor Spotlight On 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.

TriageLogic Implements Emergency COVID-19 Hotlines and Remote Care Solutions


TriageLogic

TriageLogic announced easy-to-implement solutions that hospitals, medical organizations, and health centers can use for patient care during the COVID-19 crisis. As the healthcare sector adapts to the coronavirus pandemic, many medical professionals work around the clock to implement emergency support solutions for patients who present worrying symptoms, as well as those who need help understanding the guidelines for care. 

A COVID19 hotline is available 24/7 to screen patient questions, provide information, and follow scripts on behalf of specific practices and medical groups. Click To Tweet

The following solutions have minimal implementation time requirements:

  • A Coronavirus-trained hotline is available 24/7 to screen patient questions, provide information, and follow scripts on behalf of specific practices and medical groups. With a significant increase in patient calls, the ability to discern which ones require additional medical attention and which are only seeking advice is paramount to a functional office staff. 
  • Nurse triage software with Covid-19 protocols, through MyTriageChecklist, is a fast-to-train, web-enabled software 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 consistently ask and document all relevant questions related to patient symptoms. 
  • Remote call center with phone system can enable your certified nurses to work at any location connected to a call center-grade, HIPAA-compliant phone system. This allows an organization to keep their clinical staff at home and coordinate as a team to remotely evaluate patients.

“We are working around the clock to help our current clients as well as other health centers put processes in place to help patients and concerned callers. We are also working with remote monitoring companies to have a process in place to help patients at risk, or after a hospitalization at their homes,” said TriageLogic’s Ravi Raheja, MD.

TriageLogic

TriageLogic offers easy to implement solutions for healthcare organizations to address the COVID-19 crisis. This includes setting up information hotlines, giving nurses the tools to evaluate patients over the phone, and helping set up remote call center phone systems. Visit www.triagelogic.com for more information or email info@triagelogic.com.

Implementing Virtual Call Centers with Telehealth Systems to Address COVID-19


TriageLogic

TriageLogic announced a quick-to-deploy and easy-to-use telehealth system with a virtual call center that hospitals, medical organizations, and health centers can use for patient care during the COVID-19 crisis.

As health organizations adapt to the coronavirus pandemic, they look for a system they can deploy quickly for staff and nurses to work remotely to set up doctor visits, answer patient questions, evaluate their symptoms, and determine who needs further evaluation by a doctor. Team members can communicate with their physicians and set up two-way video visits using secure, HIPAA-compliant texting options that do not require the use of a mobile app. This allows the remote hospital associates to set up and coordinate telehealth visits for doctors instead of in-person visits.

Nurses can also be included in the solution by having COVID-19 and other medical protocols available in a web-based system. The information from the phone call can be exported to the hospital’s EMR system or be integrated with Salesforce.

TriageLogic was able to set up a telehealth system within a couple of days for our nurses and doctors to work remotely and continue their medical visits. Click To Tweet

TriageLogic can deploy the following solutions related to sending staff home:

  • Cloud-based HIPAA compliant call center telephony system for coordination of remote staff
  • Phone system to connect remote workers with queueing and full contact center capability
  • COVID-19 nurse triage protocols for use with existing EMR or CRM such as Salesforce
  • Web-based triage software with COVID-19 and other protocols
  • Coordination of telemedicine visits between non-clinical, nurses, and doctors in client EMR
  • TriageLogic assists in recommending efficient workflow and implementation of two-way video visits

Additional solutions such as a fully staffed COVID-19 hotline and remote patient monitoring are also available. “TriageLogic was able to set up a telehealth system within a couple of days for our nurses and doctors to work remotely and continue their medical visits,” said Melinda, director of PPM business operations for a large children’s hospital.

TriageLogic

Visit www.TriageLogic.com or email info@triagelogic.com for more information.

Emergency Medical and Continuity Remote Care Solutions to Address the Coronavirus Outbreak


TriageLogic

By Ravi K. Raheja, MD

The Covid-19 pandemic continues to change nearly all parts of our lives and businesses. As a result of this national emergency, medical professionals, hospitals, and organizations are working around the clock to implement emergency support solutions for patients presenting worrying symptoms as well as those who need help understanding the guidelines for care.  

This article focuses on emergency solutions that providers can implement quickly in this time of crisis.

Set-up a Virtual Doctor Office

We understand that virtual visits are going to be necessary to save time and decrease in-person patient contact. However, medical practices must consider how to create a system that allows medical visits to continue as if they were in the office. 

Here are some things to consider:

Doctors can evaluate patients over the phone and prescribe. Many practices already have the technology to see patients virtually, and there are several platforms available that healthcare providers, who do not yet have the technology, can implement quickly. When selecting a technology, choose a vendor that can provide HIPAA-safe calls, record information as needed, and make it easy to access without a mobile application.

Medical practices must consider how to create a system that allows medical visits to continue as if they were in the office.  Click To Tweet

Nurses play a vital role in helping contain the epidemic and alleviate the calls that go to the doctors. Nurses need to use triage protocols (including COVID-19 protocols) to evaluate and determine which patients require a consultation with a doctor. The protocols experience regular updates, written by doctors, as the latest information becomes available. These protocols are available for free from TriageLogic.

Software System

Look for a company that can quickly implement a virtual office that allows front desk, nurses, and doctors to continue working and operating remotely as if they were in an office. Vendors that have a record of working with doctors can implement these solutions quickly and affordably.

TriageLogic

Ravi K. Raheja, MD is the COO and medical director of the TriageLogic Group. Founded in 2005, 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. For more information visit www.triagelogic.com and www.continuwell.com or email support@triagelogic.com

Coronavirus and the Healthcare Call Center


LVM Systems

By Mark Dwyer

Healthcare call centers face unprecedented challenges in response to the Coronavirus (COVID-19) pandemic. At a time when efficient call processing is even more critical than usual, due to increased call volumes, call times have lengthened. Much is attributable to the plethora of misinformation individuals have readily available to them over the internet, via the media, and from family and friends. Now, not only do call center nurses need to calm the caller, they must correct the caller’s misunderstandings.

Add to this the pace at which medically valid updates occur. Triage call centers must keep up with the weekly, and sometimes daily, changes to the guidelines for handling possible COVID-19 calls.

COVID-19 has generated tremendous activity related to telehealth as a method of triaging and treating those who are infected. Given that COVID-19 symptoms can vary from very mild to severe and that the virus spreads through close contact, telehealth can be a powerful tool in combating the crisis.

Health center providers may now deliver in-scope services via telehealth to individuals who have not previously presented for care at a health center site and who are not current patients of the health center for the duration of this public health emergency. These include triage services with or without initial consultations. Some of the specific changes include:

  • Continuation of zero member liability (such as copays and cost-sharing) for care that is delivered via telehealth.
  • Any services provided virtually will be eligible for telehealth coverage.
  • All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020, through June 30, 2020.
  • Telehealth services may be delivered by providers with any connection technology to ensure patient access to care.
COVID-19 has forced healthcare to look at all aspects of its care delivery system. Click To Tweet

New Telehealth Policies Expand Coverage for Healthcare Services

Numerous states have taken steps to waive their requirement that a physician is licensed in the state to provide care to patients through their declarations of statewide emergency. More states are sure to follow.

According to Gregory A. Hood, MD, an internist in Lexington, Kentucky, who is on the advisory board of Medscape Business of Medicine, “The waiving of state licensure requirements should help ease a number of stress points of the current crisis in ways that benefit society.”

Healthcare providers, supported by states and payers, can leverage telehealth in ways not possible in previous epidemics to triage, diagnose, and treat patients while effectively protecting healthcare workers and reducing the spread of the disease. States that have broad authority as payers can play a crucial role in driving the use of telehealth as a method of treatment by implementing reimbursement policies that enable providers to offer virtual care services to patients.

Like many other aspects of the United States’ healthcare industry, when COVID-19 ends, the healthcare call center will never be the same. We will work smarter, more efficiently, schedule more creatively, and support more remote staff. We will embrace telehealth, tele-triage, and telemedicine with video calls, chat, and online physician consults.

More insurance companies will reimburse for online physician visits enticing more to participate. Triage call centers may also have more opportunities to work with EMS and police stations to help triage patients. Finally, data sharing will increase to the patient’s PCP into their EMR records or other approved endpoints. Data aggregation and reporting will enable call centers to analyze better yearly trends leading to heightened prediction and prevention of disease. 

COVID-19 has forced healthcare to look at all aspects of its care delivery system. May we all be the better for it. 

LVM Systems logo

Mark Dwyer is a veteran of the healthcare call center industry and serves as COO of LVM Systems.

What Kind of Healthcare Coverage Do You Provide to Your Staff?



Take Steps to Meet the Healthcare Needs of Your Healthcare Call Center Staff

By Peter Lyle DeHaan, Ph.D.

Author Peter Lyle DeHaan

I enjoy going to the zoo with family. We go several times each year. A special bonus are those opportunities to interact with the zookeepers and learn more about the animals under their care. During a recent visit we had the privilege of an extended discussion with one of the caretakers after she tended to the zoo’s three lions.

She shared insider information about their feeding, their training, and their healthcare. After covering the extensive medical care these three amazing creatures receive—the testing, monitoring, medication, and access to specialists—she grew momentarily somber. “They receive much better healthcare than I do.” We sadly nodded that we understood. Then she perked up and resumed telling us about these animals that she so clearly loves.

I wonder if a similar thing happens in our healthcare call centers. Do employees hang up from a phone call and shake their heads in dismay, muttering “That caller receives far better healthcare than I do.”? I hope not, but I fear it’s true far more often than it’s not.

It may be understandable for this to happen occasionally, but it’s inexcusable if it happens often. This needs to change. Take steps to better meet the healthcare needs of healthcare call center staff.

A key aspect of enabling call-center staff to best meet the healthcare needs of callers is to start by making sure you best meet the healthcare needs of your staff. Click To Tweet

To expect workers in healthcare call centers to serve patients and callers with excellence, they must first have a good perspective for them to work from. This includes providing healthcare workers with adequate healthcare coverage and services.

Falling short of doing so handicaps them from performing their jobs with distinction and serving callers with appropriate empathy. It would be like making restaurant staff work on an empty stomach but expecting it to not impact their patrons’ experience.

Call centers invest money on ongoing agent training, coaching, and quality assurance programs. Make sure to also invest in call center staff’s healthcare. This will help ensure that they better connect with the people they talk to on the phone, without negativity and resentment showing through.

A key aspect of enabling call-center staff to best meet the healthcare needs of callers is to start by making sure you best meet the healthcare needs of your staff. If you find yourself needing to make changes, you may not be able to fix everything all at one time. But you can move in that direction. Start today.

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.

The Goal of the Telephone Triage Process



By Rose Moon, RN, BSN

Telephone triage processes are proven to improve access to care professionals, lower patient anxiety, save on ER costs, and prevent unnecessary health complications. The primary goal of the telephone triage process is to deliver safe, quality-oriented telephone triage partnered with outstanding customer service. The health, safety, and wellbeing of the patient is at the forefront of every telephone encounter. 

The purpose of the telephone triage process is to assess the patient’s current signs and symptoms, concurrently evaluating their past medical history and current medications. It performs the patient assessment in accordance with protocols which guide the nurse to determine the proper triage disposition to direct care to the safest, most cost-effective solution available at that time. 

Triage nurses don’t always have to be right; we just can’t afford to be wrong. Click To Tweet

To accomplish the goals of the telephone triage process, an organization needs to recruit, hire, train, and retain experienced telephone triage nurses. Two valued components that will result in quality patient outcomes are providing comprehensive, detailed orientation, as well as equipping the nursing staff with needed tools: gold-standard telephone triage protocols. 

However, the final determining factor of quality phone triage lies in the training of nurses to utilize the protocol tool properly. Anyone can read a protocol. It is the knowledgeable triage nurse who applies the following attributes of enhanced assessment skills, superior judgment, prior nursing experience, and exceptional decision-making abilities to the protocol tool that results in safe, quality outcomes and cost-effective patient care. 

Performing hands-on patient assessment allows the healthcare provider to visualize cyanosis, smell foul drainage, palpate an abdomen, and use a stethoscope to assess patients’ lung sounds. Telephone triage nurses don’t have such luxuries to assess patient needs. They’re limited to their ability to query and listen intently to the caller to obtain the necessary details of the patient’s medical symptoms and then direct medical care accordingly.

Successful triage nurses live by the following golden rules of the telephone triage process:

  • Every call is life threatening until proven otherwise.
  • Complete an ABCD assessment with every telephone encounter: Airway, Breathing, Circulation, Deficit (Neuro).
  • Assessing patients over the phone is high risk; therefore, take the callers word as truth. 
  • Follow your sixth sense: protocols are decision support tools; nursing judgment determines outcomes.
  • Know your patients’ medical history and current medications.
  • Assess your callers as well as your patients. Be a patient advocate.
  • Never provide a dosage of a medication without a complete patient assessment. 
  • Always confirm labeled dosage of a medication as well as the means in which the caretaker plans to administer the drug.
  • Always assess the caller’s level of comfort with the established plan of care before ending the call:
  • “Are you comfortable with these recommendations?”
  • “Now tell me what you plan to do next.”
  • If it isn’t documented, it didn’t happen. Use defensive documentation. Paint a picture.
  • Regardless of the reason for the call, always obtain a rectal temperature on an infant under the age of three months.
  • Document the exact mechanism of injury.
  • Be alert for red flags. Any time a caller uses or implies one of the following phrases be sure to clarify the underlying meaning. Carefully analyze your disposition and recommendation for follow-up care:
  • Grunting or moaning
  • Lethargic or listless
  • Sleeping more than usual 
  • Just doesn’t look right, act right, or is fussy
  • Sleeps through a rectal temperature
  • High pitched cry or unusual, funny cry
  • History of sickle cell or immune deficiency 
  • Frequent caller
  • Caller that expresses anxiousness or numerous questions after discussing a plan of care
  • Patient symptoms of headache, dizziness, disorientation, nausea, fatigue, or irritability; flu versus carbon dioxide exposure
  • At the conclusion of the patient telephone encounter, instruct callers to call back or seek medical evaluation if current symptoms become worse or additional signs and symptoms of concern develop.

Triage nurses don’t always have to be right; we just can’t afford to be wrong. Always err on the side of caution.

Learn more about telephone nurse triage and how to implement successful triage nurse centers by downloading the free e-book: Telephone Nurse Triage Handbook

How to Build an Actionable and Strategic Patient Experience Plan



By Gary Druckenmiller

In recent years, hospitals have become increasingly familiar with the merits of providing a superior experience to patients and consumers. Studies show that organizations with successful patient experience strategies see up to a 5 percent increase in new patients, a 15 percent increase in patient retention, and an 18 percent decrease in out-of-network referrals.

It’s no wonder why 81 percent of executives consider patient experience a top priority. And yet, many health systems haven’t created an actionable strategy that genuinely improves the experience across all touchpoints along the patient journey. In particular, they fail to acknowledge the importance of marketing communications and outreach in these strategies.

Even if patients are part of a vast health system, they expect experiences tailored to them as individuals throughout the care continuum. This is why health systems need the right technology in place to craft data-driven patient experience plans—messaging that directly addresses a patient’s needs both inside and outside the health system’s four walls.

By improving the patient experience with personalized communications and data-driven outreach, health systems enjoy increased loyalty and satisfaction, higher ROI, and improved margins. Here are a few strategies that health systems can employ to build an actionable, strategic patient experience plan:

Integrate the Right Technology

To design an effective patient experience strategy, health systems must first ensure that the right marketing technology is in place to reach patients at the right times, over the right channels. 

Consider the following four solutions: 

1. Healthcare CRM: A healthcare-specific customer relationship management platform (HCRM) is an absolute necessity for a successful patient experience plan. A HCRM is the centralized hub for all precision marketing. With an HCRM, healthcare marketers collect and compile data in a centralized location, monitoring important information such as recent communications, changes to demographic information, and clinical details and propensities. This information is key to crafting the hyper-personalized experiences that today’s patients expect.

In practice, a healthcare marketer may use the HCRM to understand the various touch points along the patient journey, including understanding which resources were engaged with before that first appointment was scheduled. An analysis as simple as this reveals valuable information as to which messages, channels, and tactics resonate with which demographic—and which are less effective. The longer a patient stays within the health system, the more data is integrated into their CRM profile, setting the stage for improved targeting and a better overall experience, along with the ability to apply those learnings to other consumers in the same cohort or segment. 

Patient experience recently became the centerpiece of many health systems’ strategic growth initiatives. Click To Tweet

2. Marketing Automation: A marketing automation platform orchestrates the execution of personalized engagement plans. It allows healthcare marketing teams to send messages at the ideal time following specific customer interactions or touchpoints—for example, sending an email invitation to a diabetes management seminar the day after a user downloads an e-book about Type I Diabetes on the health system’s website. It’s simply not feasible to deploy this type of patient nurturing campaign at a large scale without marketing automation software, especially since the data within a HCRM only grows more complex over time.

3. Patient Engagement Center: First impressions are everything—and often hospital call centers are the first interactions with consumers. To meet consumer expectations, call center representatives need to not only be personable, efficient, and conscientious, but they need to be proactive, demonstrating that the health system knows the caller, why they are calling, and can provide the best care. With that comes the need to prioritize first call resolution, as opposed to forcing the consumer to call back multiple times to ask follow-up questions.

To deliver proactive and world-class customer experiences, call center representatives need access to a dashboard containing all relevant caller information and proactive alerts about the caller. For existing patients, this includes details from the patient profile contained within the HCRM as well as clinical and demographic data sourced from the EHR. Other tools that provide insight into consumer data and marketing engagement history (even if the caller is not a registered patient) are also worth investing in.

4. Business Insights: With a business insights solution, healthcare marketers unlock the most valuable opportunities—such as a specific demographic, geographic market, or service line—on which to focus their initial patient experience campaigns. By examining a service line or geographic area with cross-sectional data, health systems begin to understand the basic needs and desires of this set of consumers. They can then shape lists of target consumers that fit the ideal persona, supporting informed, hyper-segmented engagement campaigns with messaging that speaks to those needs and characteristics.

With the right technology, a health system ensures messages deployed across consumer touchpoints meet each patient’s needs. Using historical data to inform outreach, marketers improve patient experience while creating a seamless, convenient approach to care.

Create Personalized Patient Experiences

Personalization is one of the most effective ways to improve patient experiences. One of the easiest ways for healthcare marketers to leverage personalization is by simply asking patients and consumers what they prefer. For example, they can indicate their preferred method of contact (such as phone, email, or text message) and set a time of day that works best to receive communication from their provider. Short online or emailed surveys are another great way for marketers to gather information about patient preferences and personalize campaigns accordingly.

Keep in mind, however, personalizing patient interactions helps build trust, but it’s important not to go too far. For example, if a consumer has passively searched online for oncology services, the call center representative should not mention their browsing history during a call. 

Use Precision Marketing to Deploy Consistent Messaging

These principles apply to acquisition and retention. Once a patient has already converted to a health system, precision marketing campaigns continue to be effective in encouraging ongoing engagement with unique content. These campaigns leverage HCRM-connected workflows that strategically guide communications, track engagements with marketing materials, and monitor a patient’s journey from, for instance, pre-screening to specialist consultation to surgical procedure.

This strategy includes integrating decision points that influence the patient’s journey based on their actions, or lack thereof. If a patient registers for an upcoming cardiology seminar, they should be included in cardiology-related emailing lists. These workflows don’t just allow the most relevant messages to be sent, they record these non-clinical engagements, and support patients in their healthcare journey.

Final Thoughts

Today’s consumers expect seamless, personalized interactions from all businesses with whom they interact—and this includes their healthcare provider. Unsurprisingly, patient experience recently became the centerpiece of many health systems’ strategic growth initiatives. Healthcare marketers play a critical role in crafting a great healthcare experience, so it’s important they employ the right tactics to ensure positive interactions throughout the patient journey.

They must tap advanced marketing technology to organize and analyze information from all aspects of the organization, both inside and outside the health system. With a comprehensive view of patient needs and demographics and a deep understanding of the experiences that they value most, health systems will enjoy improved ROI, sustainable growth, and a sharp competitive edge.

Gary Druckenmiller, Jr. is vice president of customer success at Evariant. With almost twenty-five years of digital makeover efforts behind him, he functions as a lead business strategist, a digital marketing thought leader, and a C-level executive sponsor for all Evariant enterprise clients, primarily focused on advising health system leadership of opportunistic methods to find, guide, and keep patients for life.

E-Cigarettes and Vaping



By David Thompson, MD, and Gary Marks, DO

Use of electronic cigarettes (vaping) has risen greatly over the last several years. Adult smokers have increasingly turned to e-cigs to quit or decrease tobacco smoking. An especially concerning fact is that e-cigs have become the most widely used tobacco products by youth. One in five high school students use e-cigs, and one in twenty middle schoolers. The U.S. Surgeon General declared the use of e-cigs among young people an epidemic.

The Centers for Disease Control and Prevention (CDC) has reported an outbreak of lung injury from smoking e-cigs. As of October 1, 2019, there have been over 1,000 cases with eighteen deaths.
Telephone triage nurses should be ready to answer questions from concerned callers. Here is an overview of this important topic.

What are Electronic Cigarettes (e-cigs)?

E-cigarettes go by many names such as e-cigs, e-hookahs, vape pens, vapes, tank systems, or ENDS (Electronic Nicotine Delivery system). E-cigarettes have three main parts: a battery, a fluid chamber, and a heating element. The battery powers the heating element and the heating element turns the liquid into vapor. Users inhale the vapor. This is why smoking e-cigs is also called “vaping.”

E-cigarettes may look like pipes, cigars, pens, regular cigarettes, or even USB flash drives. “Pod mods” are re-chargeable and have increasing popularity among teens. A popular brand is JUUL.

E-cigs may be less harmful than smoking normal cigarettes. Still, vaping does have health risks and complications. Click To Tweet

What Is in the E-cigarette Fluid?

E-cigarette fluid has three main types of chemicals:

Nicotine: Nicotine content ranges from none to 36 mg/dL.

Flavor: There are thousands of different flavors. Some flavors are chocolate, cotton candy, gummy bear, and bubble gum. Such flavors may add to the use of e-cigs and nicotine addiction in children.

Other Chemicals: Other likely harmful substances in e-cigarette vapor are propylene glycol, heavy metals (nickel, lead, tin), and possible cancer-causing chemicals. It is not easy for users to know exactly what they are vaping. There have been e-cigarette cartridges labeled “nicotine-free” that contain nicotine.

Some people use marijuana products or other drugs by vaping.

What Are the Risks and Complications?

E-cigs may be less harmful than smoking normal cigarettes. Still, vaping does have health risks and complications:

Nicotine: Nicotine is a stimulant. Nicotine is addictive and can lead to cravings. It is the same chemical that makes normal cigarettes habit-forming. Nicotine can harm the growing brain of adolescents and young adults. For those that are pregnant, nicotine can be harmful to an unborn baby.

Vaping-linked Lung Injury: The Centers for Disease Control and Prevention (CDC) has recently reported an outbreak of lung injury from smoking e-cigs. The cause of this is not yet known. Most of those with lung injury used a marijuana product (THC) with their e-cig. Symptoms are cough, shortness of breath, chest pain, fever, upset stomach, throwing up, diarrhea, and stomach pain. Symptoms appear over days to weeks.

In addition, battery failure can lead to an explosion or fire. And swallowing the e-cigarette liquid can be very harmful and even deadly, especially to children. Last, the long-term effects of vaping are not known.

Do E-cigs Help People Quit Smoking?

Many people start using e-cigs to quit or stop smoking normal cigarettes. It is not yet known if e-cigs work well for those trying to quit smoking. One study found that many smokers trying to quit regular cigarettes by using e-cigs ended up using both products. The FDA has not approved e-cigarettes to help people quit smoking.

Some Closing Recommendations

Here are some recommendations supported by the CDC:

  • Pregnant women, teens, and children should not use e-cigs.
  • If you don’t currently use e-cigs, do not start.
  • If you are currently using e-cigs to quit smoking, do not return to smoking cigarettes. Talk with your doctor about the patch or other treatments.
  • Do not buy e-cigarette products off the streets.
  • Do not change or add anything to the e-cig product beyond what the manufacturer has approved.
  • Call your healthcare provider if you use e-cigs and develop a cough or have trouble breathing.

David Thompson, MD, is the adult content author at Schmitt-Thompson Clinical Content, and Gary Marks, DO, is the adult medical editor at Schmitt-Thompson Clinical Content.

Combating Alarm Fatigue


1Call-call center

Presented by 1Call, a Division of Amtelco

How Alarm Fatigue Affects Staff and Patients

If you step into any in-patient hospital or critical care center, you’ll notice one thing in common: near-constant, loud, piercing alarms. Of course, the purpose of an alarm is to get someone’s attention immediately when something abnormal occurs. One study records an average of 1.2 alarms heard by a nurse every sixty seconds or as many as 359 alarms per medical procedure. Few alarms are of any clinical value, making them frustrating to hospital staff and, in the worst cases, harmful to patients. Overall, frequent false alarms and noise levels do little to foster a healing, comforting environment.

Alarm fatigue results in increased response time or decreased response rate due to experiencing excessive alarms. Click To Tweet

The ECRI Institute listed alarm fatigue, or missed alarms, as the #7th Health Technology Hazard of 2019. An average nurse in the ICU has to deal with three dozen kinds of alarm sounds, but several studies support the fact that most people cannot differentiate between more than six different alarm sounds.

Imagine you’re a nurse who has just sterilized your hands to administer care to one patient, and you hear an alarm sound from another room. Immediately, you’re distracted from your task at hand. You must quickly identify the alarm type from where you’re standing and decide if it’s more important than the care you were about to provide. Regardless, you’re distracted from the task at hand.

To complicate matters further, many alarms are non-critical issues or irrelevant to the specific patient. In fact, recent studies estimate as many as 90 percent of alarms in critical care settings are either false or clinically irrelevant. This leads healthcare providers to believe that many devices are crying wolf, delaying practitioner response time when a real emergency occurs. This is alarm fatigue at its core: a delayed response, or no response at all. Sometimes, habituation results in some alarms not even being heard.

It’s no surprise that alarm fatigue is a severe challenge for healthcare providers. Alarm fatigue results in increased response time or decreased response rate due to experiencing excessive alarms. When nurses do not respond quickly enough to the few alarms that need response, patient care is affected. The Joint Commission made alarm management a National Patient Safety Goal over five years ago and has prioritized it every year. There were more than 560 alarm-related deaths in the United States from 2005 to 2008, and by 2012, the number was reduced to 80 deaths over a three-year period.

Strategies to Reduce Alarm Fatigue

Any time spent responding to false alarms is time that could have been spent focusing on patient care. Here are two strategies to reduce alarm fatigue: 

1. Reducing false alarms by considering the clinical context: A standardized set of alarms for every patient is one of the primary contributors to excessive, unnecessary alarms. These can be tweaked for the needs of the patient during check-in. For example, a sharp increase in blood sugar of a diabetic patient may be extremely important and time-sensitive, while the same alert in a non-diabetic patient isn’t a cause for concern. By taking the vital signs of the individual patient into consideration when setting alerts, practitioners reduce the number of false alarms from the start. One solution to this challenge is a dedicated messaging platform that allows for electronic health record (EHR) integration.

By taking a few moments to set up the customized alarms relevant to the patient’s characteristics, the frequency of unnecessary or unimportant alarms decreases significantly. Additionally, when a care team knows that alerts are chosen precisely, individual practitioners respond more carefully when alarms sound.

2. Alarm Priority Systems and Customization: Clinical alerting that routes alarms directly to practitioners’ devices reduce sensory overload for both patients and care providers. Patient care is improved when important alarms get a response as quickly as possible, but patient care is also improved by a restful, quiet healing environment. By funneling the important alarms directly to the physician or nurse on-call, the number of distracting, audible alarms on the floor decreases to only the most critical. 

A messaging platform that integrates with the nursing call center helps triage low-priority alerts to unit coordinators. Only actionable alarms relevant to the nurse’s unit are sent directly to them. More importantly, directing all alarms to one specific device reduces the cognitive load and number of distractions a nurse experiences during a shift.

Additionally, funneling alerts to one device means that the care provider can identify the type and location of the alarm immediately: without having to memorize dozens of alert sounds, drop their current task, or rush to another end of the unit.