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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Original Message:
Sent: 06-11-2025 14:20
From: Autumn Freiburger
Subject: Centralized Triage
Our Primary Care Team has implemented centralized RN Triage over the last year with the final few clinics going live the end of this month. Overall, it is going well but have had questions arise and wanting to see how others may be working through these things.
- What system to you have in place to assure all messages have been addressed?
- How do you handle message pools? Are specific nurses assigned to this or does the group all work them?
- Do you require providers to sign off on all triage notes?
- What is your process if patient declines disposition to call 911 or go to the ER?
- What ways have you work to promote trust with providers and patients?
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Autumn Freiburger, RN
Director of Nursing
Cox Medical Group - CoxHealth
Springfield, MO
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