Open Forum

Hello - Looking to offer our schedulers guidance. Does anyone have a list of visits that can "just be scheduled" when a patient is calling? If a patient calls with a symptom on our red flag list our scheduling staff does get that patient to a nurse to triage, however, at times they are not sure if a patient should be seen earlier which results in a lot of triage by our department nursing staff which may not be necessary. Looking to see if any areas have any guidance surrounding this topic.

Thank you - 

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Emily Newbury
Gundersen Health System
Tomah WI
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I'm wary of this, though I work in a specialty clinic and the patient complaints might be a little more specific. 

Since our scheduling staff doesn't have medical training or a license to make clinical judgments, I would say that it's ok to just schedule in the next available routine slot if a patient is asking for a recommended routine follow up and does not have any new or worsening symptoms since their last visit to report. 

We also have a tight schedule, so our nurses usually make recommendations for the scheduling timeline - even knowing the patient can wait two weeks can be helpful at our clinic. Our scheduling staff does have a list of red flag symptoms that trigger them to message us urgently, and they know to call 911 if a patient is having emergent symptoms in the lobby. 

Our clinicians have two types of scheduling slots - routine slots, and a few urgent slots which they try to keep open for urgent appointments, and which they can fill with more routine requests if they don't fill up. 

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Ingrid Hawkinson
RN, MSN, AMB-BC
UCSF Otolaryngology
San Francisco CA
415-353-2148
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My organization is currently working on this now as well.  We are currently backwards- we have a list of symptoms that should be triaged and a list of symptoms that should call 9-1-1 immediately vs talk to a nurse. We want to flip this and create a short list of symptoms that do not need to come through a nurse. If the call comes to a nurse, we use ClearTriage to triage the call. This is, of course, tricky because without speaking with a patient with symptoms and asking questions, you don't have the full picture. My personal stance is that 99% of patients with symptoms need to be triaged. It seems prudent to utilize the nursing process to ensure waiting to be seen is appropriate. I know that our nurses get bogged down with "sniffles" and "cold symptoms," but sometimes you talk to a patient and realize they have a cough AND there is blood-tinged sputum which they didn't realize was a big deal, etc. Not catching these key details can create a liability for your organization. 

I recommend looping in your legal department if you have that resource. Our legal counsel has been an intricate part of protocol development, ensuring we are giving patients what we need to from a legal perspective in terms of access to a licensed professional to triage their symptoms. 

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Torie Bonnet MSN RN NE-BC NPD-BC
Associate Director of Nursing
Piedmont Health
Raleigh NC

bonnett@piedmonthealth.org
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Hi Emily, 

We originally used a red flag list but now use SymptomScreen.  This online tool has been a game changer for us and I would recommend you look into it.  It goes through questions about if the symptom is new, if they have been seen for it, and if it is getting worse.  After that it asks specific symptom based questions and then guides next steps - including timing of nurse triage and scheduling an appointment.  We have had to do some customizations and education to make it work for our organization and our teams are very happy with the tool.

Angela

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Angela Hall MN RN
Neighborhood Health Center
Oregon City OR
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