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Telephonic Nurse Triage Decision Tre

  • 1.  Telephonic Nurse Triage Decision Tre

    Posted 10-17-2024 17:33

    Hello,

    We are currently building out a telephonic nurse triage program at my organization. We are shooting to go with a tiered approach where a call center rep will first answer the patient call and transfer to triage if appropriate (or whatever resource the patient needs). I'm curious if anyone has a decision tree or is willing to share what their organization utilizes to help the call center rep decide if something is urgent and must be 'warm' transferred to a nurse or if something is non-urgent and can be an inbasket message for a return call.



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    Kera Arias MSN RN NI-BC PHN
    Eisenhower Heath
    Indio CA
    (760) 834-3542
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  • 2.  RE: Telephonic Nurse Triage Decision Tre

    Posted 10-18-2024 09:48
    Edited by Mariah Foster 10-23-2024 12:03

    Hi Kera,

    This is certainly a much-needed workflow. I practice at a NP-led primary care clinic as a Clinical Nurse Specialist, where I also happen to be assisting with two DNP student projects and one of them I have focusing on just this! They have developed a workflow around some of the most common inquires and will be implementing their project this month. I will touch base with them and share your inquiry!



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    Mariah Foster
    Michigan State University
    East Lansing MI
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  • 3.  RE: Telephonic Nurse Triage Decision Tre

    Posted 10-18-2024 11:06

    Can you please share with me as well? Our organization has a need to create something like this.  Any help would be greatly appreciated.



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    Leighanne Stapleton MSN, BSN, RN
    Clinical Service Director
    Skagit Regional Health
    Skagit Regional Clinics
    Mt Vernon, WA
    360-814-6570
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  • 4.  RE: Telephonic Nurse Triage Decision Tre

    Posted 10-18-2024 12:26

    HI Mariah, I too am a Clinical Nurse Specialist, but working in a manager role - I'm grateful for my CNS competencies!  If possible, could you please share your workflow with me as well. Thanks so much. 



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    Heather Zak MS, RN, ACNS-BC, CCM
    Clinical Nurse Manager
    Lummi Nation Health Center
    Bellingham WA
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  • 5.  RE: Telephonic Nurse Triage Decision Tre

    Posted 10-25-2024 12:13

    Please share with our organization also.  Much appreciated.

    Maureen Migliaccio-Rega RN MSN, BSN

    Atlanticare

    EHT, NJ 



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    Maureen Migliaccio-Rega
    AtlantiCare
    Egg Hbr Twp NJ
    (484) 433-4680
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  • 6.  RE: Telephonic Nurse Triage Decision Tre

    Posted 10-18-2024 11:44

    Hi Kera,

    We used to use a decision tree but in the last year we switched to using SymptomScreen (https://www.symptomscreen.com/).  It has been so helpful to our processes and given all staff more confidence in handing calls.  We started out with our call center staff but it has been so successful that we plan to add our front desk and MAs in 2025.



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    Angela Hall MN RN
    Neighborhood Health Center
    Oregon City OR
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  • 7.  RE: Telephonic Nurse Triage Decision Tre

    Posted 10-18-2024 11:49

    Hello,

    Thank you for posting this request, I'm very interested in learning what others do as well. We have three nurses designated to triage and are looking to add 1-2 more for our primary care clinic. Our call center staff take all incoming calls and our front desk staff assist patients walking-in for same-day services. At this time everything is routed to our triage nurses, this becomes very overwhelming for them. We're in the very early stages of putting together decision trees for our call center and front desk staff; I'm still in the assessment phase and gathering telephone encounter examples. 



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    Heather Zak
    Clinical Nurse Manager
    Lummi Nation Health Center
    Bellingham WA
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  • 8.  RE: Telephonic Nurse Triage Decision Tre

    Posted 10-18-2024 14:25

    I actually just responded to another thread with information... I have pasted it below...

    Clinical Advice at our organization is defined as a "phone call regarding a new or worsening symptom(s). All Clinical Advice calls are ran through a non-clinical algorithm called SymptomScreen (that we have customized) by our Call Center staff. SymptomScreen then classifies the call as Emergent, Urgent, Semi-Urgent, Non-Urgent or Routine. The following workflows are then followed:

    Emergent: Call Center direct transfers to 9-1-1, if the patient or caller refuses it follows the Urgent workflow

    Urgent: Caller is directly transferred to the RN team, if all of the RNs are unavailable, it goes to the MA who then goes directly to a Provider for disposition

    Semi-Urgent: Call Center attempts to schedule a Same/Next Day visit, if unable, Epic encounter is routed to the RN team as a High priority message. The RNs then outreach to the patient with a goal of Time to First Outreach being 2 business hours

    Non-Urgent: Call Center attempts to schedule a Same/Next Day visit (within next 24 hours), if unable, an Epic encounter is routed to the RN team as a message. The RNs then outreach to the patient with a goal of Time to First Outreach being 6 business hours

    Routine: The Call Center attempts to schedule the patient for the next available office visit.

    At this time, we only have slots for Same/next Day visits or Condition/Symptom visits which are typically weeks away. We are a smallish Medical Group and we currently have 2 nurses in each Primary Care Clinic, 3 in Cardiology/EP, and 1 in Urology who are dedicated to Telephone Triage. We have a ratio of 6-10 providers/RN.

    Let me know if you have any questions or want to chat further on what we are doing. 



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    Dotty Parker
    Montage Medical Group
    Salinas CA
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  • 9.  RE: Telephonic Nurse Triage Decision Tre

    Posted 10-23-2024 12:01
    Edited by Mariah Foster 10-23-2024 12:02

    Hello everyone, just as an update. I am working with our nursing faculty to determine how we can best expedite disseminating the amazing work of our students, to be able to share with you all how we went about enhancing this workflow!



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    Mariah Foster
    Michigan State University
    East Lansing MI
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  • 10.  RE: Telephonic Nurse Triage Decision Tre

    Posted 10-28-2024 10:39

    This is an interesting discussion that does resurface often.  I'm following closely.

    We may want to set up a future Zoom meeting for our SIG to discuss.  

    Symptom checkers, phone trees, and workflows done with patient phone calls before a Triage Registered Nurse touches them have always been a debated subject.  Patient safety and satisfaction could be impacted.

    I'm interested Mariah in the DNP student's work. 

    Exciting to know our sub-specialty is getting the attention of graduate students.



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    Sheryl Bartlett
    Telehealth SIG Chair
    Nurse Manager After-Hours Triage
    UT Southwestern Medical Center
    Dallas, TX
    214-633-3907
    Sheryl.Bartlett@utsouthwestern.edu
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  • 11.  RE: Telephonic Nurse Triage Decision Tre

    Posted 11-05-2024 16:48

    Carol Rutenberg does a great job explaining nurse telephone triage-it is symptom-based and timely. We recently built a guideline that follows this guidance.  Clear Triage has some great triage video shorts on its website from Carol. Below is a link to a transcript and videos.

    https://www.cleartriage.com/resources/blog/what-is-nurse-telephone-triage/ (transcript)

    https://www.cleartriage.com/resources/carol-rutenberg/ (videos)



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    Best Regards,

    Linda Jackson, MSN, RN
    Children's Health
    Sr Director, Clinical Support Programs
    214-456-9208
    linda.jackson@childrens.com
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