Hello, we have a centralized nurse triage team that does triage for about 75% of our clinics in our system.
a. When we complete a triage call, we route the note to the PCP and the nurse group. It is then up to the clinics to manage from there.
b. Unfortunately, I'm not sure how the clinics manager their messages.
c. we do not require the provider to sign off on the note. We are independent of the clinics and follow the Schmidt and Thompson triage protocols that allow us to practice nurse triage autonomously. But if a provider disagrees with our disposition, then their clinic group is responsible for calling the patient.
d. we have a list of ways to "get the patient to yes" that we utilize in our note. a. call the clinic nurse, sbar given, transfer the patient to that nurse to try and convince the patient. We've found just that phone call can convince the patient. b. Explain to the patient "you called for a reason, and you were concerned about...." c. Discuss with patient "as a nurse for many years and my experience, your symptoms are concerning and I'm concerned about....stroke, heart attack, blood clot etc." We call that the "right to scare." d. use anyone in the household that is available to group discuss. e. we'll say to the patient, "If I was your mother, sister, friend, I would tell you to call 911 too, or ED." f. 911 services are free typically and once we explain there is no cost, unless they use the ambulance they feel a little better about calling 911.
e. It took us many years to build trust, we've been doing triage ever since 2022. At first the trust happened with a champion provider and quarterly meetings to discuss any concerning situations. Also stating how we do our quality checks, triage competencies, consistency and standardization. Finally, with any tricky situation, we brought up immediately with the clinic's leadership to find a resolution quickly, versus waiting for them to say something.
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Mary Jennissen RN
Black Hawk SD
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