Open Forum

Are there RN's that work in primary care practice offices that triage calls? If so, how do they address urgent and emergent issues? Are there any policies or procedures related to RN phone triage and urgent/emergent care that anyone is willing to share? Thank you.

At a large private group multispecialty practice where I worked primary care for 10 years the office nurses at each clinic site answered the nurse hotline for their clinic. The phone tree would direct people to nurses for advice or if requesting appointments sooner than next available for acute issue. (Refills go to a voicemail, not nurses). Our Epic install had hundreds of triage scripts, based on the chief complaint filed SmartSets would trigger in the body of the telephone message. Our SmartSets triage protocols were based on Lippincott's   

https://shop.lww.com/nursing-telephone-triage/c/308?sortBy=createDate+desc

The FQHC I'm at now uses Barton Schmitt triage book. https://www.aap.org/Pediatric-Telephone-Protocols-17th-Edition-Paperback

Related to triage, we developed order sets for nurses to take care of common acute issues. You can learn more about practice efficiency steps like this with AMA's STEPS Forward program. 

Our FQHC has a centralized Triage Nurse built into our Call Center - but all our RNs are trained on Triage and we use Lippincott book as a reference for them. I do have a basic triage protocol I'd be happy to share if you want to email me 

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Keri Urquhart MPH BSN RN

Director of Nursing 
Covenant Community Care- FQHC Detroit 

kurquhart@covenantcommunitycare.org

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Currently all of the offices handle their own triage.  We have a mix of RNs and LPNs on the phones.  If there is something urgent or emergent they often consult with the provider in the office or if it is an LPN they will consult with the RN as well.  We do have some triage guidelines that they can follow but nothing built within EPIC like I have seen from clear triage or anything like that. All of our guidelines are based on the Barton Schmitt book.  

Hello ! 

At our organization we created a 6-7 hour class for onboarding nurses that review how to effectively triage calls. It is a didactic portion where we review content via powerpoint and then we incorporated a simulation portion where nurses triage emergent/urgent calls. I took the AAACN's telephone triage course which helped to successfully build this program (https://www.aaacn.org/practice-resources/telehealth/telephone-triage-course). Our organization also uses Schmitt Thompson Clear Triage which is a decision support software with adult and pediatric protocols that assist nurses with specific initial assessment questions to ask, it identifies the urgency of calls, and helps to identify appropriate disposition. Here is the link: https://www.cleartriage.com/. 

Hello Holly,

One resource I have seen utilized across many Ambulatory Care settings includes: Telephone triage protocols for nurses (1-975136-87-X, 978-1-975136-87-1), Sixth edition. / Briggs, Julie K.Wolters Kluwer Health, 2020.  The AAACN has Telephone Triage as Professional Nursing Practice Courses as well - Module 1 - Telephone Triage: What is it? Essentials of Safe Care - Activities - American Academy of Ambulatory Care Nursing (aaacn.org).

V/R,

Hi All,

We are reviewing the policy and it is need of some work and rather than start from scratch, hoping anyone be able to post their policy and or procedure for the RN Triage Nurse Role.

B