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Telephone Triage Nurse Hoban Pepper
1. Telephone Triage
Outcomes
Larry Hoban, RN, White Earth Service
Unit
LT Deanna Pepper, White Earth
Service Unit
2. Objectives
Define Role of Telephone Triage
Nurse
Establish Telephone Triage
Protocols
Identify How Telephone Triage
Affects Patient Outcomes
3. Definition of Telephone Triage
safe, effective, and appropriate disposition
assessment, patient education, and crisis
intervention.
new subspecialty, controversial – is it telephone
advice, telepractice or telehealth?
interaction between patient and nurse that takes
place via phone.
Reference:
http://www.nursingceu.com/courses/290/index_nceu.
html Retrieved 05/31/2011
4. WESU Telephone Triage
Nurse
Facilitate access to care
Provide consultation and
assistance to patients and
their families
Crucial to the delivery of safe
and effective health care
5. White Earth Service Unit
•Located on White Earth Reservation in
Northern MN
•Primary care and same day clinic
•Two field clinics (NTW and Pine Point)
•User population is 13, 093
•Reservation population is 9,562 (2101
census report)
6. White Earth Service Unit (WESU)
Variety of services
New facility in 1998
Same day clinic opened 06/2000
Many changes in process since Same Day clinic
opened
Triage nurse position began in 2000
7. Triage at WESU
Dedicated Triage nurse
Utilizes nursing judgment as well as triage
protocols
Same day appts, future appts, home measures
Collaborative effort with entire clinic staff, outside
entities
Orders labs and x-rays with standing orders
Policy for triage pending
8. Nurse Triage Standing Orders
LAB CIRCUMSTANCE ORDERED
HCG For late menses, prior to starting contraception
Urinalysis For dysuria, frequency
Urine C&S + nitrites and blood in UA
STD screen For pt concern, STD symptoms
Rapid strep test For sore throat w/fever, exudate or pt concern
Blood sugar For hypo/hyperglycemia symptoms
Cardiac panel For acute chest pain
Wet prep For vaginal discharge, itching
Serum HCG Pregnant pts with vaginal bleeding
TSH Hx or sx of hypo/hyperthyroidism, or med refills
CBC S/sx of infection/anemia/RLQ abdominal pain
X-ray of extremity Obvious deformity
9. How telephone triage affects patient
outcomes
TTN can assess a patient over the phone who
may be reluctant to come in to the clinic.
TTN can give that caller home care advice or
instruct the patient on the rationale for a clinic
appointment or an UC visit.
TTN can potentially reduce deteriorations of the
patient’s condition.
10. How telephone triage affects
patient outcomes
Added benefits:
-TTN has access to pt’s EHR record
while speaking to the pt.
-Can advise pt of any upcoming or
overdue preventive care, such as
immunizations or women’s health appts.
11. Triage nurses in IHS :
Facilitates access to care
Provide consultation and assistance to patients
and their families
Triage via phone, walk in
Collaborate with family members, CHR, home
health nurses, etc.
Some with certification from NCC
12. Focus of Telephone Triage
Focus is assessment and disposition
Data collection Telephone triage aids in
getting the patient to the right level of
care with the right provider in the right
place at the right time (AAACN, 2007).
Benefits of Triage
Reference: http://www.nursingceu.com/courses/290/index_nceu.html
Retrieved 05/31/2011
13. Who Performs
Telephone Triage?
RN
Clinical experience
triage experience preferred (walk-in or
telephone)
Current BLS certification
High levels of experience or expertise
in:
Crisis intervention
Teaching/coaching
Diagnostic/monitoring
good judgment and critical-thinking skills
14. Telenurse Functions
The helping function
The diagnostic function
The crisis-intervention function
The monitoring function
15. Teletriage and the Nursing
Process
Modified version of standard nursing process
-assessment,
-diagnosis
-planning and intervention
-evaluation
16. Establish Telephone Triage
Protocols
Are protocols decision-making or decision-
support tools?
-critical thinking skills
Resources for protocols:
-Adults: Telephone triage Protocols for Nurses by
Julie Briggs; Telephone Triage Protocols by
Sheila Wheeler, Telephone Triage Decision
Support Tools doe Nurses by Dale Woodke
-Peds: Pediatric Telephone Advice by Barton D.
Schmitt, MD
19. RESOURCES
American Academy of Ambulatory Care Nursing
(AAACN)
http://www.aaacn.org
Emergency Nurses Association
http://www.ena.org
Teletriage Systems (Author Sheila Wheeler's
website)
http://www.teletriage.com
20. Questions?
Thank you for attending this presentation. We
appreciate your time and attendance. Have a
wonderful day.
Notes de l'éditeur
-safe, effective, and appropriate disposition of health-related problems via telephone by experienced, trained RNs using physician-approved guidelines or protocols (Wheeler, 2009). -Telephone triage interactions may require assessment, patient education, and crisis intervention.-controversial – is it telephone advice, telepractice or telehealth?
Nearest hospital is 30 miles away in Detroit Lakes, MN or Mahnomen, MN BLS ambulance in White Earth, ACLS ambulance in Detroit Lakes, Life Flight is in Fargo, ND
EHR. Template available with prompts, scheduling GUI available to schedule primary provider as well as BDG provider
-Focus of telephone triage is on assessment and disposition of patient -presenting problem and medical histories, recognize and match symptom patterns to those in the protocol, and assign acuity. -, recognize and match symptom patterns to those in the protocol, and assign acuity. Telephone triage aids in getting the patient to the right level of care with the right provider in the right place at the right time -Telephone encounters, if handled sensitively, can reduce inappropriate appointments, reduce anxiety, educate clients, and increase client satisfaction levels in addition to reducing risk when there are medical complications. Patients value the care that they receive. In fact, one study showed that reassurance was more important than the relief of symptoms (Wheeler, 2009). Clearly, reassurance and thoughtful attention to client concerns—whether medical, informational, or even administrative—often meet patients' needs and satisfy them.
-Articulate Able to communicate well at fifth- to eighth-grade level Engaging telephone manner Concise, clear documentation skills Proven typing skills at 30 WPM Computer literate (as appropriate-Works effectively with: Culturally diverse populations Educationally diverse and illiterate populations High-risk populations -Tolerates ambiguity well -Demonstrates compassionate and caring manner with clients -Functions well in a high-stress environment and under time pressure -Excellent communication skills (written and verbal) Excellent negotiation skills Works well independently -Life experience as parent/caregiver
-. In telephone triage, the key functions of the helping role are creating a healing relationship through (1) attending to (listening) or "presencing" (i.e., being present), (2) maximizing clients' control, and (3) providing comfort through the voice (rather than touch). -cannot diagnose , However, within limits, nurses can detect and document significant changes in the client's condition, perform pattern recognition and matching, anticipate problems, and formulate treatment strategies. -monitor patients at home- what is blood pressure, blood sugar, how are they feeling
- Modified version of nursing process occurs with triage, dx consists of formulating a working diagnosis or an impression. Assessment is the most important and substantive step of telephone triage, since pattern recognition is dependent upon the systematic collection of data. Always start the assessment process with the documentation form rather than the protocol. Once you have a general sense of the problem(s), use the protocol that best matches the patient's presenting problem. When patients present with multiple symptoms, use the protocol that has the highest likelihood of leading to an appointment, or ask the patient which symptom is the most bothersome. diagnosis" step requires interpreting and analyzing patient data, identifying patient resources, and formulating a working diagnosis, or impression. Planning and intervention looks at protocol disposition and advice. level of acuity, or disposition: emergent, urgent, acute, and nonacute levels. The nurse prevents, reduces, or resolves problems identified by adhering to the protocol disposition and directives.The treatment plan is composed of two parts: the disposition and the advice.Disposition: Always advise the patient when and where to come for treatment. The site of care may vary depending on the hour and day of the call. After hours, patient may need to be seen in the ED. Keep abreast of changes in clinic hours, which may be expanded to include evenings, weekends, and holidays. Advice: Home treatment advice often includes information related to over-the-counter (OTC) medications and common home treatments. Evaluation is carried out with pt teaching and self eval for follow up instructions.
-While protocols are an important component of the telephone triage system, the bottom line is the experienced, well-trained RN. Current standards of practice stress that RNs should perform decision making because protocols alone cannot guarantee safe practice.-
Emergent-level calls. Generally speaking, these calls require paramedic transport. They involve severe, life-threatening symptoms. Patients must be kept NPO (nothing by mouth). Whenever possible, try to remain on the line with the caller or implement a three-way conference call as appropriate with services such as suicide prevention, 911, poison control, or rape crisis. When callers are advised to go to the ED or to labor and delivery, always call and notify the department of the impending patient arrival. Urgent-level calls. Urgent-level callers should be seen within 1 to 8 hours. However, some urgent symptoms may need to be seen as soon as possible at the most appropriate site. These patients must be kept NPO and will require paramedic transport if there is no readily available car or if the driver (caretaker/parent) is alone and/or too anxious to drive. Acute-level calls. In this model, acute-level calls are seen within 8 to 24 hours or given a next-day appointment. Nonacute-level calls. Generally speaking, nonacute-level callers are directed to come in as appropriate. Nonacute symptoms usually can be managed with telephone advice and/or an appointment.
always err on the side of caution" is a cardinal rule in telephone triage. Nurses must rely on their best professional judgment and use every means at their disposal to ensure that patients are treated in a timely manner. Time frames designated on the template are intended as a general guide. When in doubt, have the patient come in sooner rather than later.Nurses may upgrade dispositions as appropriate (from urgent to emergent, nonacute to acute). However, nurses must never downgrade (urgent to nonacute) without physician consultation. If the patient is noncompliant, always seek advice from the physician advisor.
