1. Telephone TriageOutcomesLarry Hoban, RN, White Earth ServiceUnitLT Deanna Pepper, White EarthService 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 crisisintervention. new subspecialty, controversial is it telephoneadvice, telepractice or telehealth? interaction between patient and nurse that takesplace via phone.Reference:http://www.nursingceu.com/courses/290/index_nceu.html Retrieved 05/31/2011 4. WESU Telephone TriageNurseFacilitate access to careProvide consultation and assistance to patients and their familiesCrucial to the delivery of safe and effective health care 5. White Earth Service UnitLocated on White Earth Reservation inNorthern MNPrimary care and same day clinicTwo field clinics (NTW and Pine Point)User population is 13, 093Reservation population is 9,562 (2101census 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 clinicopened Triage nurse position began in 2000 7. Triage at WESU Dedicated Triage nurse Utilizes nursing judgment as well as triageprotocols Same day appts, future appts, home measures Collaborative effort with entire clinic staff, outsideentities Orders labs and x-rays with standing orders Policy for triage pending 8. Nurse Triage Standing Orders LABCIRCUMSTANCE ORDEREDHCGFor late menses, prior to starting contraceptionUrinalysis For dysuria, frequencyUrine C&S+ nitrites and blood in UASTD screen For pt concern, STD symptomsRapid strep test For sore throat w/fever, exudate or pt concernBlood sugarFor hypo/hyperglycemia symptomsCardiac panelFor acute chest painWet prep For vaginal discharge, itchingSerum HCGPregnant pts with vaginal bleedingTSHHx or sx of hypo/hyperthyroidism, or med refillsCBCS/sx of infection/anemia/RLQ abdominal painX-ray of extremity Obvious deformity 9. How telephone triage affects patientoutcomes TTN can assess a patient over the phone whomay be reluctant to come in to the clinic. TTN can give that caller home care advice orinstruct the patient on the rationale for a clinicappointment or an UC visit. TTN can potentially reduce deteriorations of thepatients condition. 10. How telephone triage affectspatient outcomes Added benefits: -TTN has access to pts EHR record while speaking to the pt. -Can advise pt of any upcoming or overdue preventive care, such as immunizations or womens health appts. 11. Triage nurses in IHS : Facilitates access to care Provide consultation and assistance to patientsand their families Triage via phone, walk in Collaborate with family members, CHR, homehealth nurses, etc. Some with certification from NCC 12. Focus of Telephone Triage Focus is assessment and disposition Data collection Telephone triage aids ingetting the patient to the right level ofcare with the right provider in the rightplace at the right time (AAACN, 2007). Benefits of TriageReference: http://www.nursingceu.com/courses/290/index_nceu.htmlRetrieved 05/31/2011 13. Who Performs Telephone Triage?RN Clinical experience triage experience preferred (walk-in ortelephone) Current BLS certification High levels of experience or expertisein: 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 NursingProcess Modified version of standard nursing process -assessment, -diagnosis -planning and intervention -evaluation 16. Establish Telephone TriageProtocols Are protocols decision-making or decision-support tools? -critical thinking skills Resources for protocols:-Adults: Telephone triage Protocols for Nurses byJulie Briggs; Telephone Triage Protocols bySheila Wheeler, Telephone Triage DecisionSupport Tools doe Nurses by Dale Woodke-Peds: Pediatric Telephone Advice by Barton D.Schmitt, MD 17. Four-Tier Triage Emergent-level calls. Urgent-level calls. Acute-level calls. Nonacute-level calls. 18. When In Doubtalways err on the side of caution"Upgrade, never downgrade. 19. RESOURCES American Academy of Ambulatory Care Nursing(AAACN)http://www.aaacn.org Emergency Nurses Associationhttp://www.ena.org Teletriage Systems (Author Sheila Wheelerswebsite)http://www.teletriage.com 20. Questions?Thank you for attending this presentation. Weappreciate your time and attendance. Have a wonderful day.