By Charu Raheja, PhD
A nurse triage system is a basic first step in helping practices manage patient phone calls and decrease overall care costs. It is also an important way to improve patient care (see related research on the benefits of nurse-triage-on-call). This article focuses on practices interested in setting up a nurse triage system for their office.
First, your practice needs to consider two types of calls: day calls and night calls. Day calls are simple because offices are open, and nurses can ask patients to come in if needed. As a result, day time protocols are shorter and simpler to document. Night calls are more extensive because doctor’s offices are closed and patients that need urgent care have few low-cost options. These calls require more extensive protocols and documentation, so they take longer and the protocols are more in-depth. They also require nurses to be able to contact the doctor on call if necessary.
Second, the evolution of new technology has made it a lot easier to document and take calls using protocols. Investing in some simple, cost-effective technologies can be a major step in improving call-care.
Day phone calls:
Many physician practices have nurse staff in the office available to take phone calls during the day. So the easiest thing is to have your own staff nurses take calls using daytime triage protocols. These protocols are available in book form (such as Dr. Schmitt and Dr. Thompson’s books) or in electronic format (such as www.triagelogicnurse.com). Having your own nurses take call also gives your staff the flexibility to perform multiple tasks in addition to triage such as scheduling the patients who need to seen.
Making some investments in setting up your office triage can save you a lot of time and money. First, you can ensure that your nurses are asking the right questions and not missing anything when nurses use triage protocols. Second, you decrease your liability because you can document the call and the protocols used. Books require the least amount of upfront cost. The books are updated every two years. At the same time, books are cumbersome and difficult to use. In most cases, nurses end up leaving the books in the shelves instead of using them because of the time it takes to follow guidelines with books.
Electronic guidelines require some continuing investment. The advantage of the electronic format is that the vendor is responsible for updating the questions for you, and they can save a lot of valuable nursing time in following the protocols and in documenting the information. The savings on nursing time will likely offset all the additional costs that the practice will incur in using electronic guidelines.
What questions do you ask day-time protocol vendors?
1. Is the software using the day-time gold standard protocols (Schmitt-Thompson protocols)
2. What is the hardware and IT staffing requirements for the practice?
3. How easy is it to learn the software? What is the training time to learn the software?
4. Who trains your office nurses? What happens if you have a new nurse? Do you need to pay extra to train in new nurses that join later?
5. Can the triage information integrate securely with the office’s electronic medical records (EMR)? If you are using paper, can the software integrate with any EMR?
6. Can the software be customized to the needs of the organization and the doctors that they serve?
COST ISSUES TO CONSIDER:
7. What is the cost of the software? What is the setup cost and the ongoing cost? Are there costs associated with updating the protocols?
8. Is there an additional cost per call? (note: you should try to estimate your number of calls if a vendor charges per call to estimate your budget and compare across vendors)
Questions or comments? Please contact me at firstname.lastname@example.org. Feel free to post your comments belows.
Charu G. Raheja is Chair and CFO of TriageLogic Management