Clinical Update by Schmitt-Thompson for Telephone Triage Nurse Call Centers

Important Metrics to Increase Safety and Satisfaction

Barton Schmitt MD, one of the authors of the Schmitt-Thompson Protocols, has released a clinical update for the telephone triage nurses. This update is focused on the call center metrics for meeting The Quadruple Aim framework for optimizing the performance of health care systems.

To review, the 4 aims are:

1. Improve Health Quality and Safety
2. Reduce Costs
3. Improve Patient Satisfaction/Experience
4. Improve Provider Satisfaction/Experience

The update goes over each aim and what to focus. It also provides the metrics to use to determine if the call center is meeting the 4 aims.

1^st Aim: The first aim objectives are divided into Quality and Safety.

• Improve Health Quality

The triage protocols have been tested and reviewed multiple times. It is important for call centers to teach triage nurses on how to use the protocols to provide the appropriate level of care. If nurses want over-ride a decision, make sure they can justify it. Compare the call volumes, length, and outcomes with the benchmarks to promote a consistent level of care. Provide coaching if the criteria are not met.

• Improve Safety Using Risk Management and Call Reviews

Teach the importance of not missing a serious disease to new nurses as it could have an adverse medical effect later on in the patient’s life. Continue their education by reviewing a severe disease and how it will be presented via phone. Document any feedback received from the ED for delayed referrals to set a strategy for coaching and improvement. Not everyone will take the time to provide negative feedback. As a call center, you should do the research on calls where the disposition chosen was for the patient to wait more than 24 hours and to make sure that the patient was not admitted to the ED for a serious condition (this suggesting that a wrong disposition may have been selected by the nurse). Also, review over the Risk Management Checklist to ensure safety for all.

2^nd Aim: Reduce Costs and ED Over-Referrals

Teach new nurses how to identify normal and safe symptoms that do not require ED after-hours. Continue their education by reviewing a symptom every quarter. Document any feedback received from the ED for over-referrals to set a strategy for coaching and improvement. Asses if everyone is meeting the benchmarks and not over-referring to ED. TO asses QA, pick a symptom with high call volume and review 100 reports for accuracy of the disposition based on the symptoms. With the PCP permission, put back “go to ED Now and See PCP within 4 Hours disposition calls are to on-call PCP for re-triage.” In addition, by asking the caller if they intended to go to the ER at the beginning of the call will help determine the cost saving. Similarly, by providing parents with a pediatric symptom checker, they can self-triage and thus the call volumes for the nurses will be reduced.

3^rd Aim: Improve Caller Satisfaction and Experience

Parents appreciate the nurse call centers because it saves them time and money. They value the easy 24/7 access to a nurse that save them time driving and waiting at the ED. They appreciate the nurses caring about their concerns as well as the logical, detailed care advice that is provided.

To ensure their satisfaction, provide a community service line for callers who do not have a medical home. Additionally, by giving out care advice handouts, parents will have a guideline to follow for continual care after the call ends. Reduce the wait time for the callers by have nurses on call for high call volume times. If there are complaints, review the call and address their concerns punctually.

4^th Aim: Improve Provider Satisfaction/ Experience

In addition to providing peace of mind to the parents, a thriving call center needs to satisfy the practice and triage nurse needs as well. A call center ensure that the members of the practice get uninterrupted family time, unless an absolute emergency. The call center also ensures that the nurses have a work/ life balance while empowering them to create a meaningful difference in the patients’ lives. Creating satisfaction surveys will help improve the call center.

It is essential to review the benchmarks and create a strategy to improve your call center. With the Call Center Solution, TriageLogic helps their clients meet these 4 aims. Request a free consultation to set up a plan for your call center.

View the full update with the metrics for each objective here. (LINK TO PDF)