Issue 5 | September 2016 Issue 5 | September 2016The Stetho-Scoop

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PHONERN STETHO-SCOOP

Manager’s Note

Take a few minutes and finish this sentence, “I went into nursing because…”. The answers may vary, but I can almost guarantee that no one will answer “for the glory” or “for the money” or “for the fame”! Nursing is hard work and sometimes it seems like no one is appreciating all that you do.

Believe us when we say that it doesn’t go unnoticed when you stay late to help clean out the queue after a busy night because you don’t want to leave the oncoming shift with a messy queue, or you page the doctor “just one more time” before signing off because your patient lost his wife earlier and needs something to help him sleep tonight, or the long distance hugs and support you give when a coworker is on a difficult call.

Our success is a direct reflection of your hard work, commitment and professionalism. It is not handed to us, but is something we earn every day. I wanted to talk about the current health news, like the Zika outbreak or the Hepatitis A scare in Virginia and how telephone triage nurses are helping to calm patients fears and anxiety, but instead I will close with this thought:

This year our PhoneRN family has welcomed 4 perfect bundles of joy into this world and then comforted others as they went thru painfully difficult times. With each event, I have watched us get closer and become more connected. We not only comfort and protect our patients, we comfort and protect each other- we are a family! - Lori and Marci

Adults Underestimate Their Symptoms

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In this issue: Letter From The CEO

Nurse Spotlight: Kay WillisSudoku PuzzleCurrent Events New Team Members

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Hey ladies! I am having difficulty expressing all the emotions that are churning inside me as I write this. Lori and I talk about this all the time, so I know she mimics my words when I say how very proud we are to be a part of this TEAM and to be working alongside each and every one of you.

Without being in the same brick and mortar location, each of you has still found a way to connect with each other and form a Super Team. Without knowing anything about your co-workers, not their age, race, political views, religion or other barrier that might have kept you apart if you had met in person, you all found things in common and formed bonds and friendships.

We can’t imagine a profession we would rather work in, nor a TEAM we would rather work with.

Scenario Questions: Answered06

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Dear Nurses,

I can’t believe that Winter 2016 is around the corner! Thank you for your commitment to patient care, and to the unique and ever evolving field of telephone triage.

We have also appreciated your patience while we have been evaluating our human resources needs. As it has always been one of our goals to offer the best work-life balance possible to all of our associates, we have used this time to carefully consider which options we can potentially provide, while still successfully meeting the needs of the business.

Some nurses will remain as contractors, while some may be eligible to apply for an employee position, as these positions become available. We are in the process of updating the policies and procedures on employees and contractors. Below are some highlights of our policy regarding employee nurse positions and independent contractor nurse positions:

Employees are required to work during assigned hours in a location designated by their Manager or Supervisor. Those hours can change with notice. Working hours vary depending on the job title of the employee.

Contractors may be hired to perform certain tasks for the company. These may include for example, editing documents and marketing material, providing medical information, and taking patient phone calls.

Contractors are allowed to work at their own location of choice, as long as the choice does not conflict with any applicable law such as HIPAA and HITECH. Contractors are also allowed to determine their own hours. Contractors will be given a list of company needs and the contractor can chose which items they would like to work on. In addition, contractors may engage in work outside of the TriageLogic group.

As laws change from time to time, such changes may require the company to reclassify your status as an employee or contractor.

For nurses who continue as independent contractors, there are three links to information that may be of help to you. Please click for more resources: 1 2 3

We look forward to your continued service to the TriageLogic Group. Please feel free to contact me if you have any questions.

Sincerely,Charu Raheja, PhDChair and CEO

Letter From the CEOCharu Raheja

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Often times, as adults, we think that we are better than children at determining if our symptoms are serious enough to require further care. As a result, many of us deny very serious symptoms. We think the severe headache is just a migraine. Or that the chest pain is not caused by a heart attack – that only happens to other people.

The truth is that it is difficult to be objective about our symptoms and we don’t always want to interrupt our day or “bother” our doctor to find out that we have a minor symptom. We also don’t always know how to recognize the warning signs of something serious or sometimes we may simply be scared to find out that we have a dangerous condition. As one of our Nurse Managers, Marci Lawing, observed, “Adults will try everything without any assistance and usually only call their doctor or nurse triage line as a last resort. Parents, on the other-hand, tend to be a lot more proactive about calling right away if their children experience unusual symptoms.”

We studied treatment advice data from our nurse triage call center for the months of April, May, and June 2016. In those 3 months, our nurses triaged close to 42,000 callers. Out of these callers, about 9,200 (22%) were adult callers. Table 1 shows the disposition results for all the callers and table 2 shows the data for the adult callers.

Surprisingly, adults had a significantly higher rate of ER referral and a much lower incidence of home care advice. Compared to the entire population, here is what we discovered about patients 18 years and above:

Less than ¼ of adults are given home care, in comparison to closer to ½ of the overall population.Adults also show the highest amount of cases where the patient is sent to the ER: Close to 1/3 were told to go to the ER, as compared to only 1/6 of the overall population.In both groups, about 1/3 of the patients needed to follow up with a doctor office in the next 24 to 48 hours.The data in this blog post seems to align with the general observation that adults tend to wait until they are decidedly sick before calling for professional medical advice. Our next goal then, is to try to understand the main reasons why adults are referred to an ER.Top Reasons why adults are referred to the ER or Urgent Care

People are sent to the ER for several different symptoms such as injuries, blood in the stool or suicide concerns, among others. However, the results on the higher incidence of adults being sent to the ER as compared to the entire population highlights the need for education about the warning signs of a serious condition.

The top 5 reasons why adult callers are sent to the ER are:Chest PainAbdominal Pain (females)Back PainBreathing DifficultyPost-op Symptoms/questions

While not everyone calling with the above symptoms needs to go to the ER, when patients have contact with their primary care providers, they need to be told that these top 5 symptoms could be the sign of a serious illness and that they need to contact a medical professional for assessment. Nurse triage is a perfect bridge to provide 24/7 access for patients to ask questions without adding a significant burden for the doctors. In addition, patients tend to be more comfortable calling a nurse because nurses are trained to provide comfort and evaluate if a symptom even requires a doctor visit. Doctors, on the other hand, tend to be seen as someone you call when you are truly sick, further discouraging patient phone calls.

If medical facilities implement proper education in the office and access to high quality nurse triage or another form of telemedicine, patients are able to access a trained medical professionals and get directed to the appropriate level of care, providing reassurance or preventing morbidity and mortality. In addition, providing a telehealth advice line when the office is closed allows the patients to stay with their providers and receive continuity of care.

Adults Underestimate Their Symptoms – Nurse Triage Saves

Lives

Graph 1: Disposition given by Triage Nurses to 41,883 patients that called for the months of April, May and June 2016

Graph 2: Disposition Given by Triage Nurses to 9,229 Adult Callers (ages 18 and above) for April, May and June 2016, Includiang Top 5 Reasons for ER Disposi-

tion

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+Nurse Spotlight: Kay Willis, RNQ: What is your education background?A: I am an ADN /RN with certification in education and IBCLC

Q: What is your past work experience as a nurse? A: I have worked for a year or more in each of the following fields: Oncology, Home Health care, forensic case management, with a brief stint in dialysis. I have worked for more than 20 years in women’s services, primarily L&D but also postpartum, nursery, NICU and perinatal education as well as diabetic educator. I have worked as house supervisor at Baylor Grapevine and Spent 10 years in private practice running The Nestingplace in Grapevine Tx, as a lactation consultant perinatal educator and cpr instructor. It was a wonderful dream come true and as a lactation consultant and perinatal educator, I was able to provide assistance from pregnancy through children to 2-3 years old, with classes of the “Happiest Toddler on the Block” and added the curriculum of “Love and Logic” to the classes.

Q: What inspired you to become a nurse?A: I loved being of service to people and nursing was the one profession that I could share my compassion and love without people questioning my motives.

Q: Why did you decide to start working in telephone triage nursing? A: I was sorry to sell my company after 10 years, but at 64 I started thinking about retirement instead of working 24/7 as an lactation consultant. Then I found Ravi and Triage Logic. It is an excellent way to keep my hands and heart in nursing and be able to be semi retired at the same time.

Q: What is the most enjoyable aspect of telephone triage nursing? A: Empowering people and helping new mommies and babies still. All of the wonderful nurses I have met, including my Besties Marci and Lori, have transported me back to my favorite hospital days of camaraderie and co-workership.

Q: What are some of your hobbies and interests?A: I like organizing, gardening, and tending to my chickens. I work weekly for my church and I am the stage manager for our statewide church functions four times a year.

-Thank you Triage Logic for making my retirement all it could be.

The goal of Sudoku is to fill in a 9×9 grid with digits so that each column, row, and 3×3 section contain the numbers between 1 to 9. At the beginning of the game, the 9×9 grid will have some of the squares filled in. Your job is to use logic to fill in the missing digits and complete the grid. Don’t forget, a move is incorrect if• Any row contains more than one of the same number from 1 to 9• Any column contains more than one of the same number from 1 to 9• Any 3×3 grid contains more than one of the same number from 1 to 9

Enjouy a quick brain exercise!

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Join us in welcoming our PhoneRN nurse Jennifer Valentin’s new daughter to the the world.

She arrived 5 weeks early on August 21st at 1950. She weighed in at 6 lbs and 11 oz and 19 inches long. Her parents and three older brothers are in love.

WelcomeLuna

Isabel Valentin Triage Logic In The News

• Atlanta Children’s Hospital went live with TriageLogic Call Center Software

Amber ShookPediatric nurse for 5

years

Be sure to welcome our new team members! Paulette Davis

Working in telephone triage since 1996

• Continuwell App LaunchContinuwell works with employers to provide access to a nurse or doctor directly via a smartphone app or the website.

KudosThis was for Kudos given for getting a 100 on the August QA –

“Thank you so much. I cannot express how wonderful it is to work in a place where one’s efforts are appreciated, where the entire team is just that -- a TEAM --- that works together and encourages one another and, yes, appreciates each other. I love this place!”

-Liza Franklin

“Nurses dispense comfort, compassion, and caring without even a prescription.” -Val Saintsbury

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Scenario Questions: AnsweredPatient: Morgan is a 32-year-old female that is calling you tonight. She complains of a sore throat. You notice that her voice sounds muffled. She says that since waking a few hours ago she has had the sore throat and difficulty swallowing. Her current temperature is 100.8 and she is tachycardic with a pulse of 112. When asked, she states her sore throat is “pretty bad”, she would rate it at an 8 out of 10. She tells you that she has been “fighting off a respiratory infection” the last four days, that wonn’t go away.

You notice that when Morgan breaths in there is a positive stridor. She says she can swallow, but the pain is such that she prefers to spit out her saliva. The longer she is on the on phone with you the more anxious and restless her voice and behavior becomes. Her voice is becoming hoarser the longer she tries to talk. She states she is able to breath but is slightly more labored and is more comfortable when sitting up or leaning forward. She also says her cervical lymph nodes appear slightly swollen and are tender.

PMH: Generally good health. No chronic health conditions and no daily medications

Medications: multivitamin

Check out the TL Blog or Learning Center for the full articles here!

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Management: You decide pretty quickly that your patient needs emergency care and tell her to call 911.

At the ED: In the ED, your patient is now unable to swallow secretions and is spitting into a cup. Her temp is 103.9 now. She is able to breath, but her voice is extremely muffled now and you notice that she is still sitting up and leaning forward.

It is noted that she has cervical lymphadenopathy when the doctor examines her neck. Her pharynx appears normal. Her lungs are clear. The doctor orders an x-ray of the soft tissues of her neck which shows a “thumb sign”. Morgan’s breathing is becoming more difficult and she is intubated. Morgan spends 24 hours in the ICU and is extubated. She is on IV antibiotics, IVF, and oxygen. After 48 hours, Morgan is discharged to home and made a full recovery.

Question: What condition is Morgan most likely suffering from?

Answer: Epiglittotis