By Ravi K. Raheja, MD
How do you ensure patient care quality when it comes to nurse telehealth triage? Whether you use an outsourced nurse triage service or want to license software and use your own team, follow this checklist when addressing every patient caller.
Not only do these important items minimize liability with remote care, but they also ensure a high quality of care for patients and a decrease in overall healthcare costs. We’ve seen firsthand how successful these items have been in our own nurse triage call center, which is why we want to share them with you to improve your own patient health outcomes.
Develop Detailed Nurse Triage Training
To be effective at telehealth triage, nurses must remain focused on each patient’s needs, obtain the appropriate information about their symptoms, know how to handle difficult calls, and document all information thoroughly.
At TriageLogic, we use a 10-step approach to training nurses, which can be found in our learning center course: “Critical Steps to a Triage Call.” You can also read a related article on training triage nurses.
Broadly speaking, when it comes to triaging patients over the phone, nurses must remember to smile, show empathy, and remain calm and confident while they are addressing patient questions and concerns. They must also use three types of listening—active, reflective, and empathetic—to fully understand each patient’s symptoms and guide them to the appropriate care.
Along with the potential for angry or distressed callers, triage nurses must also know how to handle patients whose symptoms call for emergency services.
Use National, Standardized Protocols
Nurse triage protocols developed by Drs. Schmitt and Thompson are the gold standard for patient care quality. When integrated with nurse triage software, they provide the most intuitive means of establishing caller dispositions by using yes/no questions to determine symptom severity.
A group of independent medical professions review these protocols annually and update them during important health-related events (like the COVID pandemic).
Give Answering Service Operators Their Own Protocols
Answering service operators (ASOs) are the first people to interact with callers on a nurse triage line. Their purpose is to greet patients and ask them about why they’re calling.
This helps identify urgent versus non-urgent issues and passes each caller’s request along to the right triage nurse. However, it’s become clear that ASOs also need their own protocols to avoid delays in patient care.
ASOs don’t always ask detailed questions. For example, if a patient calls for a medication refill, the ASO should verify if the patient has also started to experience any withdrawal symptoms, rather than simply assume the request is non-urgent.
Establish Average Patient Callback Times
When a call comes into an ASO, they will pass those caller requests along as emergent, urgent, or non-urgent. Each of these groups come with different requirements on how soon triage nurses should call them back.
A quality nurse triage program should have established time limits. Sticking to these time limits is vital to patient care quality.
For emergent, that’s five minutes or less. Urgent requires fifteen minutes or under. And non-urgent should be within thirty to sixty minutes.
Staggering calls in this manner not only prioritizes patients based on severity, but it also avoids overwhelming your triage line depending on how many nurses you have scheduled.
Record Calls for Quality Assurance
Recording your nurse triage calls is an important part of any quality assurance program. Doing so keeps your nurses accountable and less likely to deviate from using the Schmitt-Thompson protocols.
It also mitigates liability against your nurses. In case of a poor health outcome, these records corroborate the actions a nurse took, the reasons why, and whether those were correct.
Finally, recorded calls provide oversight and identify potential training needs. Evaluating them will indicate whether a nurse is struggling in a particular part of the triage process and allow managers to create opportunities for improvement.
Implement Secure Texting
Secure texting is an HIPAA-compliant option that allows nurses to chat with doctors without having to download an app or additional software. Nurses send messages to doctors’ phones over browser encryption, and doctors are required to click a link to acknowledge each message before accessing patient data.
This ensures patient confidentiality and speeds up responses from doctors depending on the severity of each patient’s symptoms—all of which leads to greater patient care quality. All messages are then documented in the patient’s file for reference.
Ravi K. Raheja, MD is the CTO and medical director of the TriageLogic Group. Founded in 2007, TriageLogic is a URAC accredited, physician-led provider of high-quality telehealth services, remote patient monitoring, nurse triage, triage education, and software for telephone medicine. Their comprehensive solutions include integrated mobile access and two-way video capability.
Contact them if you have questions regarding any of the items from the above checklist or you’d like to discuss how to implement them within your own nurse triage.