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“We are able to calm fears, provide home care advice, prevent ED admissions, and provide our callers with education, an area that I especially love,” Heer says.

By phone or computer

At Blue Shield of California, telephone triage nurses are offering advice over the Internet.

Not only can patients obtain medical advice via phone, they can access “Nurse Chat” on the Blue Shield website, https://www.mylifepath.com/.

“Many of our members frequently use the Internet and find this a more convenient way to obtain medical advice,” says Catherine Stoppani, RN, nurse liaison program manager for Lifepath nurse advisers in El Dorado Hills, Calif.

Blue Shield rolled out its nurse telephone triage program in July 2002 and operates the service around the clock.

“Our most frequent calls are patients with back pain, sore throats, cold and flu symptoms, allergies, pediatric fevers, insect bites, and asthma,” says Barbara Taylor, RN, supervisor of special programs at the El Dorado Hills call center.

The Blue Shield program operates as three separate call centers, with the primary call center in San Antonio, Texas.

The service provided by telephone nurses is strictly informational. Lifepath advisers can’t schedule appointments, and the service is not linked to a particular medical group.

High satisfaction

Blue Shield reports high satisfaction among both its members and the Lifepath nurse advisers.

“Our members love knowing they can call at any time and immediately speak to a knowledgeable nurse,” Taylor says. “And our nurses appreciate the incredible amount of teaching they can provide callers, something they don’t always have the chance to do when working in a hospital setting.”

Blue Shield prides itself on having an average 30-second hold time for callers, and for providing members with the option of talking with nurses either face-to-face through office visits, on the advice line, or through its website.

“I remember one college student who linked to our website and was asking one of our nurses for advice on headaches,” Taylor says. “The Internet is so widely utilized that it makes access to our services easier for members, and some like that they can use the service and remain anonymous.”

At Group Health Cooperative in Seattle, telephone triage nurses have the added benefit of having a physician present at all times in the call center.

Nancy Wittman, RN, BSN, a consulting nurse for Group Health, says this practice offers additional benefits to members.

“We always have the option of transferring a caller to our physician on duty for further assessment,” Wittman says. “In addition, many callers are in need of a muscle relaxer or a medication the physician can call in to a local pharmacy.”

Group Health has long offered advice services after hours, but nine years ago it began to offer telephone triage 24 hours a day.

“I find my job to be very rewarding,” Wittman says. “I’ve been a nurse for over 24 years, but in this job, I truly use my critical thinking skills to assist patients.”

Wittman also appreciates that she no longer has to multitask as she did while working in a clinical setting. “I can give each caller my full, undivided attention,” Wittman says.

Access to records

Consulting nurses at Group Health have access to each patient’s electronic medical record to help them in their assessment.

If they determine a patient needs to be seen by a physician, they will transfer the caller to a call center receptionist who can schedule an appointment.

The HMO prides itself on the seamless manner in which the call center is operated. In June, 32,157 calls were received, and 86% of calls were answered in 30 seconds or less.

“Our patients love the consulting nurse service,” Wittman says. “I’ve had many callers tell me they feel reassured knowing they can pick up the phone anytime of day or night and obtain reliable and accurate medical advice.”

Linda Childers is a freelance writer.

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