Tag Archives: telephone triage articles

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


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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

How Triage Nurses Can Help Patients with Mental Health Conditions


TriageLogic

By Ravi K. Raheja

Telephone triage nurses have a more important role than ever before. Nearly one in five U.S. adults lives with a mental illness (44.7 million in 2016), which is why many adults with mental illnesses go untreated (60 percent according to a report from USA Today). This article addresses the growing concerns for mental health awareness and education.

Telephone triage nurses are often the first point of contact for those struggling with a mental illness and can help a patient recognize the need for intervention. So, what can telephone triage nurses do to help?

Provide Accurate and Timely Triage

Telephone triage nurses are often the first point of contact for a patient with mental health symptoms and as a result, nurses should be patient, flexible, and have great communication and listening skills. The nurse must combine both clinical judgment and emotional connections to assess the patient’s situation to identify possible mental health issues. The telephone triage nurse’s role is to obtain the most accurate medical history and assessment to rule out medical symptoms that require immediate attention.

Remove Biases That Can Impact the Triage Process

Good telephone triage nurses always remove any biases and stereotypes. Having preconceived notions and distinctive sets of thinking can lead to error in the treatment of patients.

Assess the Environment

The Emergency Nurses Association recommends treating patient agitation as if it’s “the chest pain of behavioral emergencies.” Key phrases such as “I understand” can help place a patient at ease and give them the space to talk to the nurse. Throughout the call, the nurse should assess the patient’s environment and resources available to determine the most appropriate care plan.

Manage Uncertainty

Not all patients will be able to accurately describe their condition, history, medical conditions, or other pertinent information. It is up to the nurse to decipher this uncertainty.

  • Assess the situation: How is the patient presenting? Is his or her speech coherent? Are they answering questions appropriately? Hallucinating? Delusional? Rambling?
  • Address the whole patient: One common occurrence within mental health care is “diagnostic overshadowing.” This happens when the focus on a patient’s mental health diagnosis overshadows their physical health needs.
  • Be an advocate: Triage nurses are the first to communicate with, provide support to, and manage patients with psychiatric or mental health issues. Acting as a patient’s initial advocate can be life-changing for that patient

In Conclusion

Triage nurses always have the callers’ safety in mind. They combine both clinical judgment and emotional connections to assess the patient’s situation and to identify possible mental health issues. Nurses need to know the local emergency assistance numbers in case they need to reach out for more assistance. Just talking about their problems for a length of time can help a great deal for many callers who might be suffering from a mental illness.

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. The TriageLogic group serves over 7,000 physicians and covers over 18 million lives nationwide. For more information visit www.triagelogic.com and www.continuwell.com.

Using Device Data and Nurse Triage to Improve VA Healthcare


TriageLogic

By Ravi Raheja

New technologies are transforming how clinicians deliver healthcare. At the same time, digital solutions alone are not enough to help patients. Incorporating some human component increases patient compliance and education, further reducing healthcare costs. Medical call centers should be adopting software and increasing the role of triage nurses to complement traditional care settings, such as the VA. 

Device Data

For example, digital diabetes prevention and treatment platforms connect users with support communities and health coaches who can remotely monitor chronic conditions such as weight, blood sugar, diet, and medicine intake.

Thresholds and alerts can be set up to alert healthcare providers about abnormal and potentially abnormal or dangerous values. While the devices can collect and transmit data and even have a certain threshold, a medical professional still needs to interpret the data and then direct patients about the next steps based on the data and in the context of their symptoms and current health status.

Telephone Triage

Telephone triage nurses play a vital role in interpreting the data and providing appropriate follow up for patients who use these technologies. They act as the first line of screening when an alert or abnormal value is reported. They have the training to talk to patients, assess their symptoms, and determine the next best steps based on combining the data with the full patient assessment over the phone.

To assess patients and direct them appropriately, the nurses need triage protocols. Most medical call centers use the gold standard protocols from Schmitt-Thompson to assess symptoms. Call centers should also incorporate robust protocol builders, a technology that enables an organization to modify existing protocols to meet their needs and create new protocols when required.

Custom Protocols

By using custom-developed protocols, triage nurses can assess a patient using the data received from devices with appropriate next steps for medical care. As a result, triage nurses play a significant role in this new digital era, driven by value-based care. By combining the data from devices and other sources with innovative triage technology, triage nurses can act as the bridge between patients and providers. This creates a viable monitoring solution that provides cost-effective care.

In conjunction with the custom protocols, organizations should use platforms to put in custom workflows. As an example, once a nurse has determined the appropriate level of care, they can now further direct the patient to specific care locations, referral numbers, or provide handouts via text or email. This allows the triage nurse to serve as an effective first point of contact and get the patients to the appropriate next steps on the first call.

Mobile App

Finally, look for companies that can provide an optional mobile app to enable patients to take advantage of increased self-service, access to customized resources, and insight into their own information.

Summary

Technology is changing the access, monitoring and delivery of healthcare. Value-based solutions are now possible to optimize patient care and decrease healthcare expenses.

Call center solutions that incorporate effective communication using telephone triage nurses, coupled with valuable wearable device data, will be able to greatly improve the level of VA healthcare services for veterans and their families.   

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. The TriageLogic group serves over 7,000 physicians and covers over 18 million lives nationwide. For more information visit www.triagelogic.com and www.continuwell.com.

Using an Outsourced Telephone Triage Service for Suicide Prevention


TriageLogic

By Ravi K. Raheja, MD

Telephone triage nurses play a critical role in suicide prevention and serve as the first point of contact for callers in need of immediate assistance. According to the CDC, 123 Americans die by suicide every day, and for every person who dies from suicide every year, another 278 people think seriously about it but don’t kill themselves.

As the demand for mental health services grows, practices are turning to outsourced telephone triage call centers to support their practices. Call center triage nurses trained in treating patients with mental illnesses are better prepared to intervene and often alleviate lengthy interruptions to the normal call flow of a practice.

Common Warning Signs Of Suicide

  • Talking about wanting to die or to kill oneself.
  • Looking for a way to kill oneself.
  • Talking about feeling hopeless or having no purpose.
  • Talking about feeling trapped or being in unbearable pain.
  • Talking about being a burden to others.
  • Increasing the use of alcohol or drugs.
  • Acting anxious, agitated, or reckless.
  • Sleeping too little or too much.
  • Withdrawing or feeling isolated.
  • Showing rage or talking about seeking revenge.
  • Displaying extreme mood swings.

What Can Triage Nurses Do to Help?

In moments of crisis, connecting with a trained triage nurse can deescalate the suicidal crisis and provide immediate help. It is never easy to talk about suicide, but it is crucial for triage nurses to be comfortable talking about suicide in the same way they talk about chest pain. How they handle each call can be life-changing for the caller.

Triage nurses need to find a connection with the patient, find the patients local emergency assistance numbers, and be ready to involve all resources available to help prevent this patient from harming him/herself.

It is essential for the triage nurse to be sympathetic, non-judgmental, and accepting. The caller has done the right thing by getting in touch with another person. No matter how negative the call seems, the fact that it exists is a positive sign, a cry for help.

Triage nurses always have the caller’s safety in mind. They combine both clinical judgment and emotional connections to assess the patient’s situation to identify possible mental health issues.

Even though remote triage nurses typically can’t see their patient, they must develop that all-important trust quickly and by means other than visualization for the caller to open up and be honest with the nurse. Not all patients can accurately describe their condition, history, medical conditions, or other pertinent information. The telephone triage nurse must decipher this uncertainty.

Sometimes the patient needs emergency treatment, while other times they are reaching out for someone to talk with and work thru difficult situations like substance abuse, economic worries, relationships, sexual identity, getting over abuse, depression, mental and physical illness, and loneliness.

Just talking about their problems for a length of time gives some suicidal caller’s relief from loneliness and pent up feelings, an awareness that another person cares, and a sense of someone understanding them. Also, as they talk, they get tired and their body chemistry changes. These things take the edge off their agitated state and help them get through a bad night. Suicide calls can be difficult, but with proper training, protocols, and disposition, telephone triage nurses save lives, one call at a time.

TriageLogic

Ravi K. Raheja, MD is the CTO and medical director fo the TriageLogic Group. Founded in 2005, the TriageLogic Group is a URAC accredited, physician-lead 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 assists their clients with value based care and serves over 7,000 physicians and covers over 18 million lives nationwide. For more information visit www.triagelogic.com. and www.continuwell.com.

Oklahoma Medical Center Provides Innovative Triage Line to Manage Hospital Overcrowding


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An Effective Approach to ER Phone Calls

Dr. Charu Raheja

Emergency Room (ER) overcrowding is widespread in hospitals, creating delays and diversion from those who need care the most. According to a recent article, “Compounding the problem is the alarming trend of a decreasing number of ERs and an increasing number of ER visits.”

All too often, injury or illness appears without warning for patients. For hospitals trying to control overcrowding, the obvious solution is to redirect patients who don’t need to be in the ER to more appropriate paths for care. Who then determines if it’s necessary for a patient to go the ER? Most people aren’t trained medical professionals, and as a result, they worry and end up in the ER for non-urgent symptoms.

Patients faced with uncertainty about where to go, all too often, end up calling the ER department and receive a standard response: “We are not allowed to give advice over the phone. If you think you have an emergency, please hang up and call 911. If you think you need to see someone, you can come to the emergency room or call your doctor.”

So, who do you call?

Telephone Triage

One hospital in Oklahoma, with a similar issue, wanted to change this process. What if they provided a nurse triage line that would be available to receive calls from the patients calling the ER? Having the reassurance of a triage nurse could help decrease the number of people in the ER for non-emergency reasons.

This would provide patients with quick and easy access to a trained medical professional to assist in determining the appropriate next steps based on their symptoms and medical history. Also, since the nurses work independently from the hospital system, the nurses would provide an objective opinion increasing patient trust.

Results

The results were inspiring. The nurses significantly decreased unnecessary emergency room visits. A random survey of about 520 patients uncovered their plans before talking to a nurse. This helped determine the effectiveness of the system.

Out of 240 patients who were planning to go to the ER, 42 percent of them were diverted to a lower level of care, including 17 percent that received home care needing no additional follow up actions. This translated into a savings of at least 215,000 dollars in unnecessary ER visits, not to mention providing peace of mind for patients being able to stay home and rest.

Better Health Outcomes

The benefits didn’t just stop at ER costs savings. Consider the patients who called into the nurse triage line and were not intending to go to the ER. Some medical conditions are considered emergencies because they require rapid or advanced treatments.

Surprisingly, close to 20 percent of the patients who called into the nurse triage line had symptoms that were serious enough to warrant a visit to the ER. Without the nurse line, the outcomes for these patients could have been life threatening or fatal.

Conclusion

While nurse triage has shown significant effectiveness in an outpatient setting, this preliminary data shows even greater promise to expand this model to emergency rooms around the country.

Providing local communities with a nurse triage program not only prevents unnecessary ER visits and saves on healthcare costs, but it also ensures patients get appropriate care when a serious symptom arises. For the hospital, this increases goodwill in the community while addressing the overcrowding of the ER: a win-win all around.

TriageLogic

Dr. Charu Raheja is the co-founder and CEO of the Triage Logic Group. Charu’s personal struggles and triumphs with her health define both her personal and her professional mission. Most recently, her experience in overcoming a life-threatening health event led her to launch the Continuwell brand. The TriageLogic Group provides telehealth software, mobile communication solutions, and services to large medical centers and businesses around the country. It is part of the Women’s Business Enterprise National Council (WBENC), and it covers over 25 million lives nationwide. Visit www.TriageLogic.com or contact Amy Smith at 888-TEAMTLC for more information.