Tag Archives: telephone triage articles

How Telehealth Triage Nurses Can Address Mental Health Calls During Winter

TriageLogic


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.

SAD

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.

Depression

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.

Suicide

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.

Example

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.

Seven Difficult Telehealth Triage Calls a Nurse Should Be Prepared to Take

TriageLogic

By Ravi K. Raheja, MD

During trying times it isn’t surprising for telehealth triage nurses to see an increase in difficult calls. When we say difficult, we refer to those that are either: about cases of abuse or neglect; from unauthorized callers; about chronic ailments or repeat callers; about complicated medical or psychosocial issues; from callers who are excessively worried, anxious, or angry; and from callers who are hard to understand or communicate with. 

Like all areas of effective nurse triage, there are ways to handle each of these calls effectively so that patients receive the proper dispositions for care. Here’s a breakdown of each type, and the best ways for triage nurses to handle them. 

1. Abuse and Neglect

When telehealth triage nurses receive calls about these concerns, they must gather as much information as possible, often using open-ended questions, especially when these calls are about children. In the US alone, approximately five children die a day because of abuse and neglect. 

Nurses must remain professional and empathetic, as this will improve their chances of obtaining that information and determining if anyone is in immediate danger. If the call is about a child, nurses will also determine whether the patient’s physician should be informed to provide additional instructions, both for the child’s immediate care and for the next steps regarding their situation.

2. Unauthorized Callers            

Some individuals call a triage line to ask about a patient whom they are neither directly related to nor have received permission by that patient to receive information about their health. How a triage nurse responds will depend on the specifics of the call.

For instance, friends and relatives who are taking care of a pediatric patient may be treated the same as though they are the patient’s guardians. But if someone calls to ask only for information about that child’s health, that caller must be referred to the patient’s actual parents.

In some cases, it may be a child who phones the triage line directly. If this is the case, the best way to handle this call is to encourage the child to hand the phone over to an adult for further discussion.

3. Chronic Ailments and Repeat Callers

There will be times when callers need extra reassurance about their medical concerns. Others may have medical conditions that are not easy to identify. Each deserves the appropriate level of empathy and attention.

For example, patients who call back about the same concern within twenty-four hours are often known as acute callers. In such cases, it is imperative that nurses make sure to use reflexive listening to talk about those health concerns and encourage the patient to seek the most appropriate level of care—whether that care is at home, from their physician, or at the ER. If no serious issue presents itself based on reported symptoms, the nurse should console the patient and encourage them to make an appointment with their doctor.

4. Medical and Psychosocial Concerns

Calls that fall into this area of healthcare often rely on three solutions.

If they’re found to be minor or acute medical concerns, triage nurses rely on the appropriate protocols. If the caller’s concerns are chronic, nurses must follow specific guidelines from the physician’s practice or the applicable protocols.

In situations where guidelines or protocols are either not available or do not cover the issue at hand, the nurse must contact the physician directly to get further instruction. If that physician is not available, the nurse may determine that the best course of action is to encourage the caller to seek advice and care from the closest ER.

5. Excessively Anxious or Angry Callers

People are at their worst when they’re scared, sick, tired, or hungry, so it’s no surprise when their health influences one or all these factors. That’s why triage nurses must always use compassion to diffuse any heightened tension from an angry caller, gain the caller’s trust and understanding, and encourage the caller to follow their instructions. Effective telehealth triage nurses should:

Listen: They focus on what the caller is saying, don’t talk over the caller, and ask them to clarify when necessary.

Relate. They show empathy to the caller’s situation. A caller wants to feel heard and understood, so nurses can offer condolences about the confusion the caller may be experiencing, the situation the caller is in, or the caller’s feelings about it.

6. Propose an Action Plan

The triage nurse should lay out instructions on what type of care the caller should seek, whether customized instructions from a physician’s practice or based on triage protocols. Nurses should use comforting terminology to remind the caller that they are there to help. 

Some examples include:

  • “Based on what you describe, I’m going to assist you by following the protocols set by your doctor.”
  • “I’m concerned about your symptoms, so please hang up and call 911. I’ll call back in five minutes to make sure you’re okay.”
  • “I’ve noted your concerns and symptoms and will have your physician contact you to review them. I’ll ask them to call you at their earliest convenience.”

There will also be times when the patient is either not responsive to the nurse’s guidance or is verbally abusive. Don’t expect triage nurses to tolerate inappropriate behavior directed at them from a patient caller. 

In these instances, they should inform the caller that they want to help them, but that if they do not cease the abuse and calm down, the nurse will not be able to assist them any further. If the caller persists after a second warning, the triage nurse should inform them that they are hanging up and that the caller’s physician will contact them.

7. Callers Who Are Difficult to Understand

The holidays also tend to see increases in alcohol and drug use, which can influence how well telehealth nurses may or may not be able to understand patient callers who are under the influence. If those nurses can’t establish a dialogue, their best course of action—like the example above—is to ask their supervisor first, then contact the caller’s physician. If their physician is not available, the nurse should instruct the caller to go to the ER.

This may also be the case if nurses do not understand the patient’s language or if the patient has a speech or hearing impairment.

In Summary

Telehealth triage nurses will meet a wide range of patient callers, personalities, and symptoms that can influence how well they’re able to arrive at the best dispositions for care. With the right training, triage software, and triage protocols, their services will be even more effective at improving health outcomes. 

TriageLogic

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 twenty-five million lives nationwide.

Avoid Liability with Proper Documentation for Telehealth Nurse Triage

TriageLogic

By Ravi K. Raheja, MD

By the very nature of their profession, telephone triage nurses can’t physically see their patient callers. This begs the question, what kind of liability do they face when they provide dispositions for care?

That’s why we were excited to sit down with D.D. Fritch, MSN, MHA, RN, a tenured clinical leader in this area of healthcare, who was happy to shed some light on the legal perspective and why it’s crucial for nurses to have the proper documentation.

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

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

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

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

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

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

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

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

A: This is a broad question. Organizationally, the chart should be reviewed to see if there were any opportunities where the nurse should have acted differently or made a different decision. If the triage company is acting on behalf of a provider, the provider should be notified and the situation should be discussed.

If there is an untoward event due to negligence of the triage nurse, then the nurse and the organization that they work for or represent could be liable.

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

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

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

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

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

A: Upon initial connection with the nurse.

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

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

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

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

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

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

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

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

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

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

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

TriageLogic

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

Nurse Triage Protocol Software

TriageLogic

By Ravi K. Raheja, MD

Healthcare organizations benefit greatly when their nurse triage and telehealth services use triage protocol software. This has been shown to decrease unnecessary provider spend and substantially improve patient health outcomes. 

Many prefer the Schmitt-Thompson protocols as the best method for dispositions on patient symptoms. Here’s why:

Developed by Doctors

As a pediatrician, Barton Schmitt, MD contributes to office-hours and after-hours protocols focused on child symptoms and severity. He wrote the first book on pediatric telephone triage in 1980, and currently serves as Professor of Pediatrics at the University of Colorado School of Medicine. He was also the previous medical director for the after-hours call center at Children’s Hospital Colorado.

Specializing in internal and emergency medicine, David Thompson, MD contributes to those same protocols by addressing adult symptoms. He’s published several medical articles that focus on patient satisfaction and chief complaint coding. He currently serves part-time with the faculty at Northwestern Memorial Hospital’s emergency department.

Updated in Real-Time

Schmitt-Thompson protocols receive regular updates for accuracy and relevance. Typically done by a board of medical professionals on a yearly basis, doctors can submit periodic recommendations for changes as they use them.

Protocols may also undergo updates or additions when an immediate need arises. For instance, some were developed at the start of the COVID-19 pandemic and are now on their seventh revision. When these changes go into effect, nurse call centers have access to them and can utilize them in conjunction with their triage software.

Daytime and Nighttime Protocols

Schmitt-Thompson protocols have two versions: one to employ during office hours and one for after when there is not an option to send the patient to see their doctor. 

Integration

Protocols are meant to be used in combination with a nurse’s own expertise. The software with the protocols can be integrated easily with electronic health records (EHR) or other health cloud systems such as Salesforce. This allows telehealth or triage nurses to fully document all patient interactions and synchronize that information directly to a provider’s in-house EHR. The result is a digital paper trail and stronger continuity of care.

TriageLogic

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

Medical Answering Services and Telephone Triage

By Nicole Limpert

1Call, a division of Amtelco

Doctors in the United States first began using answering services in the 1920s so they would be made aware of patient emergencies. At that time, operators were basic message-takers and would pass along patient concerns and contact information to the doctor.

Today’s medical answering services provide a much wider range of services to lighten the administrative workloads of medical offices, and not only assist doctors, but also surgeons, hospice, home health, dentists, orthodontists, and even large healthcare systems. Medical organizations that use an answering service can experience increased appointment setting rates, better patient-doctor communication, improved patient satisfaction, and provide their patients with reliable access to care 24 hours a day, 7 days a week.

Some medical answering services can even provide telephone triage if they employ licensed professional staff members trained to give an accurate assessment of a patient caller’s concerns.

Telephone Triage

The use of triage originated during World War I to avoid focusing resources on victims with fatal injuries. Sometime in the early 1970s, health maintenance organizations (HMOs) instituted telephone advice services which led to hospital emergency departments establishing 24-hour telephone advice programs. Telephone triage is now a sophisticated practice usually performed by nurses and other highly trained medical personnel.

Telehealth, telemedicine, and telephone triage may all sound similar, but each are quite different. Telehealth focuses on the actual delivery of care (both preventative and curative). Telemedicine involves the diagnosis of a patient’s health compliant and recommended treatment by a physician via any form of telecommunication. Telephone triage is the assessment of a patient’s symptoms and the urgency needed to quickly get that patient connected with the correct doctor or department. 

Telephone Triage Communication Model

Effective communication is critical in telephone triage. Typical models of communication include three parts:

1. Data Collection: The answering service agent gathers data from the patient caller about the problem and asks open-ended questions to encourage more information about the symptoms.

2. Confirmation: The agent repeats the information using some medical terminology but in a way that the patient can understand. The patient confirms and redefines the symptoms if necessary.

3. Disposition: The agent may give advice about treating symptoms, but the main outcome is to quickly connect the patient caller with an appropriate doctor, clinic, or hospital department. 

To assist operators with remembering which questions to ask during the assessment, it is common for them to use a mnemonic device called OLD CART:

O (onset of symptoms): When did the symptom(s) first occur? Has it happened before?

L (location): Where on the body is the symptom occurring?

D (duration): How long has the symptom(s) been present and is it constant or does it come and go?

C (characteristics): Describe what the symptom(s) feels like.

A (associated factors): Are there any other signs and symptoms that occur?

R (relieving factors): Does anything make it feel better or reduce the severity?

T (treatments tried): What has been tried to relieve the symptom? Has anything worked?

Advantages and Disadvantages of Telephone Triage

There have been many studies published about telephone triage and how they help reduce a healthcare organization’s costs while helping patients experience better health and greater satisfaction. BMC Health Services Research conducted a review of existing body of research about telephone triage and advice services (TTAS) and found that, “TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care.”

The primary disadvantage of telephone triage is liability. Lawsuits can be filed if a patient call was mishandled. For example, a negative health outcome can be attributed to a miscommunication, because a patient was on hold for a long time, or due to a lack of information about the patient.

If the situation is serious enough and becomes a legal issue, the courts may even hold a doctor responsible if they find the person assisting the patient via telephone triage lacked skill or training. In the unfortunate event of a serious medical problem or death because of mistakes made by a triage service, anyone connected with the case (such as nurses, physicians, other medical personnel, the healthcare organization, and the patient’s health plan) could be sued.

Importance of Call Center Software for Effective Telephone Triage

Medical answering services who also offer telephone triage systems can safeguard against liabilities for themselves and their medical clients by using a robust call center software. All-inclusive, highly interoperable healthcare software can integrate with electronic medical record (EMR) systems and use artificial intelligence (AI) to help ensure operators are talking to the correct patient; customized scripting ensures operators are asking and giving correct information; and they also offer critical call priority and improved call routing.

Effective contact center software also provides a customizable reporting function to keep track of metrics that enhance accountability with call logging and video screen capture, connect remote agents, and manage on-call scheduling. Because calls, messages, screen capture images, and more can be recorded, tracked, time-stamped, and stored, data from call centers can also help protect themselves, hospitals, and patients in litigious situations.

Medical answering services can also take advantage of running their call center software in a virtual server environment or in the cloud. This enables their staff to work from home by turning any personal computer into a professional agent workstation. All the tools used by an agent in a medical answering service call center are accessible to the virtual agent.

Secure Messaging and Telephone Triage

A secure mobile messaging app can help keep both medical answering service providers and their healthcare clients HIPAA-compliant in the event an agent needs to contact on-call medical personnel about a patient caller.

If an agent determines a patient’s doctor needs to be notified immediately about a critical situation, a secure messaging app that’s integrated with the agent’s call center software and on-call software can quickly contact the correct physician. End-to-end encryption ensures all communications are secure and protected.

Persistent alert settings can be set so important messages won’t be missed, and full reporting functions available via the app tracks messaging histories including if a message was received, opened, and replied to.

With today’s technological advances and secure HIPAA-compliant communication options, medical answering services can provide outstanding telephone triage services that result in better patient care while protecting against liability issues.

1Call, a division of Amtelco

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.

Remote Patient Monitoring and Nurse Triage


TriageLogic

By Dr. Ravi Raheja

Remote Patient Monitoring (RPM) is on track to be the future of healthcare, especially as the number of chronic care patients and the cost of healthcare increases annually. RPM is the use of technology to gather patient health data from an individual. A clinic or nurse call center electronically evaluates the information. RPM is gaining traction by many in the medical field because it improves patient care. 

Many of these devices can capture data that a patient may not necessarily observe. These regular readings give meaningful data that can help providers see the bigger picture when it comes to a patient’s condition and outcome. 

This technology, usually in the form of a device that goes home with a patient, can monitor important health factors such as blood pressure, blood sugar, and respiratory rate. It allows doctors and clinicians to regularly check patient vitals before a patient even presents a symptom that would require an office visit. 

Remote triage nurses help monitor patient data and ensure patient safety. After the patient returns home with their device, these nurses monitor all health information from it. Non-clinical staff make sure patients use the device properly and call them back if the data is not coming in as expected. 

Nurses review patient data and contact patients if they see concerning data. They ask patients questions to determine if physician intervention is needed. They also provide additional information or ask questions based on individualized physician instructions. Non-clinical and clinical staff are a bridge from patient to doctor, and they alleviate the burden on the providers.

In the United States, six in ten adults suffer from some form of a chronic disease, such as obesity, diabetes, or heart disease. Chronic diseases are responsible for 75 percent of the 3.5 trillion dollars spent on healthcare each year. Overall, an estimated widespread adoption of remote patient monitoring could save the U.S. as much as $6 billion annually.

For doctors and medical organizations, this translates into improved patient care while at the same time giving providers the ability to increase their annual revenue per patient. 

First, the regular monitoring of patient vitals provides efficient scheduling of follow up visits when necessary based on abnormal readings. 

Second, CMS reimburses doctors for the cost of the RPM device and for the time it takes to monitor patient vitals. The reimbursement amount allows doctors to earn extra income each month even after considering the costs of outsourcing the monitoring. 

RPM is on the forefront of healthcare. With the ability to closely monitor chronic patients in a safe, cost-effective manner, RPM is one of the fastest growing medical technologies in the medical field. The goal is to help both patients and physicians by providing tools to improve care while decreasing the burden on physicians.

TriageLogic

Dr. Ravi Raheja is the medical director at TriageLogic.

Patient Symptoms and Outcomes as the COVID-19 Epidemic Deepens in the USA


TriageLogic

Lessons from Nurse Triage Calls

By Dr. Ravi Raheja, MD 

As the coronavirus pandemic progresses, nurse triage plays a critical role in helping healthcare organizations, hospitals, and practices manage their overwhelmed systems. Triage nurses evaluate and direct patients to the best level of care for their symptoms. As the weeks passed since the original national emergency announcement, our nurse triage center has seen important trends on what callers experience. 

Traditionally, triage nurses use standardized protocols from Drs. Schmitt and Thompson to evaluate patients. Nurses can also use custom doctor orders to share handouts with patients, connect the patient to a doctor, or direct patients to appropriate local facilities such as drive-through testing centers. 

The coronavirus pandemic brought new concerns, new protocols, and new care advice that needed to be developed to help address patient symptoms. Nurses were quickly trained and given new guidelines to address patient questions as the problem unfolded. As we look back over these last several weeks, we’ve seen changing trends among callers and new issues arising that the healthcare profession will need to address.

The First Two Weeks

We quickly saw a 30 percent increase in patient phone calls to triage nurses as news of the Coronavirus broke. During the first weeks most callers were worried and trying to understand which symptoms to look for. They asked questions about the virus, what precautions to take, and where to go for further help if needed. Overall, there weren’t many reports concerning symptoms related to COVID-19.

As time went by and the media began to pay closer attention to the virus and air all the details on news networks, we saw a swell of anxiety in our callers. While there were still not many callers who reported concerning symptoms associated with COVID-19, we started to receive more phone calls related to anxiety, depression, and suicide.

Updates on Caller Issues for the End of March and Early April

Our nurses have now received several calls from distressed patients who show the concerning symptoms of the virus. The nurses used the protocols to determine which callers now have symptoms that require further evaluation by a doctor. But while patients with COVID-19 like symptoms are told to seek the appropriate level of care and go to the hospital, a new issue emerged.

Patients are avoiding the ER due to worry about virus transmission. Unlike anything seen before, nurses find that patients who have serious symptoms that require an ER visit are refusing to go. These callers are reporting that they do not want to go to the hospital for worries about catching the virus from a hospital setting, or that they don’t want to intrude on an already burdened system.

Compounding the situation, after the caller is convinced to seek medical attention, hospitals may turn them away. This is either because the hospital is unable or unequipped to help. Some cities may also have facilities that are focusing on COVID-19 cases. Because of this, they do not have the capacity to help other patients. The confusion among patients about where to go to get help can increase morbidity. This is especially true with health issues such as chest pains, which hospitals regularly address and evaluate.

Healthcare centers and hospitals are working hard to manage the extra care needed for the influx of COVID-19 patients. Many cities have developed hotlines to help alleviate the workload of healthcare professionals and determine which patients need to be seen by a nurse. New solutions are being implemented daily as we learn more about this epidemic and how it is affecting our communities.

TriageLogic

Dr. Ravi Raheja is the medical director at TriageLogic, a leader in telehealth technology and services. The company’s goal is to improve access to healthcare and reduce costs by developing technology for providers and patients, backed by high-quality nurses and doctors.

Vendor Spotlight On TriageLogic


TriageLogic

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

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

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

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

The following lists some of the solutions available for clients:

Nurse Triage On Call

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

Customized Coronavirus-Trained Hotline and Patient Triage System

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

Remote Call Center with a Phone System for Doctors and Nurses

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

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

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

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

Remote Patient Monitoring (RPM)

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

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

Reporting Portal

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

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

Good Clinical Documentation and the Telephone Triage Nurse


TriageLogic

By Heather Jarvis

When it comes to documenting triage calls, there’s always a fine balance between effective communications and liability risk. Nurses want to—and need to—effectively communicate information and directions to patients and those who may see their notes after the call. However, triage nurses must also cover themselves when it comes to liability.

So, what elements make good call documentation? Here are three tips to make sure your calls are well documented.

1. Make Your Communication Clear

Read your notes out loud and ask yourself, would this make sense to anyone else who reads it? Have I used the appropriate words? Does it have a definitive beginning and end?

2. Make Your Communication Concise

Think about what your narrative will look like to others. This applies not only to the next caregiver but six months or a year later when your instructions may face review. Are your communications direct and to the point?

3. Make Your Communication Credible

Use appropriate terminology, punctuation, and abbreviations. Make sure that others would view your documentation as written by someone who is knowledgeable. Always stick to the facts. Avoid jargon or slang. If a patient says she has a tummy ache, put that information in quotes so it’s known these were the patient’s words. Nurse triage documentation is not the place for personal views.

Conclusion

It’s important to remember that a nurse is judged by a reasonable standard: what a reasonable nurse would have done under the same or similar circumstances.

Every nurse wants to provide the best care, perfect care. But perfect care is not what the law requires. The law requires that a triage nurse provide reasonable care. Clear, concise, and credible documentation is always a best practice.

TriageLogic

Heather Jarvis is the communications and client engagement specialist at Triage Logic.

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. 

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