The Evolution of Telephone Triage

By Charu G. Raheja, PhD

Over the last seven years, new communication resources have dramatically shifted the way telephone medicine is conducted. No longer are nurses and managers required to drive to hospital or call-center basements and monitor fax machines, distribute calls, and be available to help each other and answer questions. Call centers no longer have to depend on nurses being present and assigned to take calls, and no longer must they delay calling patients back when the call volume surges unexpectedly.

The development of better software and communication systems has allowed telephone triage nurses and managers to work remotely. This model offers several advantages, including allowing call centers to manage call volume better by immediately calling for additional nurses if they have a sudden surge of phone calls and need backup help. Nurses also can work from home, saving themselves the time and expense of commuting, and they can choose shorter shifts if necessary because it is easier for other nurses to take over.

While there are several advantages of having more flexibility and allowing nurses to work from home, this new model also poses some challenges. For example: How will a manager monitor and maintain quality with nurses working remotely? Can a manager help nurses when he or she is dealing with a difficult case and they’re both working remotely? How do call centers continue emphasizing the seriousness of the job and the importance of following HIPAA regulations even though nurses are working from home?

In order to address the new issues that come with remote work, there is a need for new software designs and new training and guidelines for triage nurses.

Software Requirements for the New Model: First, new telephone triage software must allow triage nurses to work together in distributing and taking phone calls without being present in the same location. This means the software must have an entry point that a manager and on-call nurses are able to see at the same time and manage from their different locations. Managers need to be able to distribute calls to various nurses and, at the same time, be able to remotely oversee the calls nurses are currently handling. Following are some key features call center software needs for effective remote work:

  • Easy access from multiple entries:The software needs to be accessible from multiple computers. Although care must be taken to ensure that the software is secure from outside hackers, a Web-based system is ideal since it allows nurses to access the software from any computer or iPad.
  • Thorough documentation: Because the staff is working remotely, it’s even more crucial to document as much as possible and review cases if there are any issues or questions. Ideally, the system should have quick and simple ways to document, such as drop-down lists and checkboxes that allow nurses to record all the information but at the same time remain efficient while taking calls. It is also important for each staff member to log in with a time stamp and user ID, so it is possible to go back and verify all the changes each user has made to the system.
  • Remote monitoring of call volume and workflow: Supervisors need to be able to monitor and assign calls remotely. The system needs to allow managers to do their work without being in the call center – including, for example, remote access to calls in the queue, prioritizing by chief complaint, and sorting calls based on nurse specialty.
  • Reports: More and more often, our society uses data to learn about consumer behavior and wants. Medicine is no different. Having good reports of the phone calls is crucial to help the call center ensure effective patient care. Reports should provide data, such as call volumes at different points in time, the protocols used by the nurse, and demographic data on the patient callers.
  • Intuitive system: The job of a triage nurse is taking care of patients by determining the seriousness of their condition over the phone. Thus, while the system needs to be able to coordinate with all nurses and staff working remotely, it also must be easy enough so nurses can troubleshoot and use the system without requiring a lot of help.

It is important to keep in mind the continuously evolving nature of communication systems and technology products. Software must be flexible enough to adapt to new technology and allow integration with other electronic health records and systems.

Nurse Education and Training for Remote Work: Telephone triage nurses are regularly faced with difficult call situations. Callers are often worried, stressed, and unsure what to do. To efficiently triage a patient, nurses must be free of distractions in order for them to focus on assessing the caller’s symptoms. This need for a lack of distractions when working remotely can be a problem.

When training nurses to work remotely, it is important to emphasize they are expected to work in a separate room, away from distractions and fully engaged in the calls. Nurses also need to understand they are bound by the same HIPAA rules as in an office or a hospital call center, and the remote call center needs to have specific training and education on how to remain HIPAA-compliant while working from home. According to one of our nurse triage call center managers, Marci Lawing, RN, “Many nurses going into telephone triage do not realize that it is just as risky as working in a hospital setting.”

Working remotely has both positives and negatives for the nurses. On the positive side, the autonomy that comes from working remotely can be appealing, and most nurses enjoy the luxury of working from home. Depending on the call center policies, nurses may also have the freedom of choosing their own schedule, and they may be able to choose to work shorter shifts, which can make it easier for them both mentally and physically.

On the negative side, since the nurses work remotely, they do not see their co-workers in person, which can lead to isolation. This isolation makes it crucial for nurses to communicate with each other regularly. That means either making phone calls to each other or communicating through email, text messaging, or Web meetings.

Managers also need to find ways to effectively communicate with the nurses remotely. New technology has made this easier, and software that allows nurses to see each other’s faces while communicating can significantly help improve their connection with one another.

Healthcare is part of our rapidly evolving communication world, and new resources allow us to work more efficiently in better work environments. It is important to develop new telephone triage software, solutions, and training to allow us to take advantage of the new resources.

Charu G. Raheja, PhD, is the CEO and Chair TriageLogic. Founded in 2005, TriageLogic is a URAC accredited provider of quality triage solutions, serving over 3,000 physicians and covering 6.5 million lives. For more information, contact her at

[From the Dec 2014/Jan 2015 issue of AnswerStat magazine]