Just a Call Away
Telephone triage nurses offer patients access
to health services around the clock
By Linda Childers
November 1, 2004
It was early evening when the woman called the telephone triage line explaining that her infant son seemed inconsolable and was experiencing long crying jags.
Star Heer, RNC, BSN, a telephone triage nurse at St Joseph’s Medical Center in Stockton, Calif., put the caller at ease while gathering information on the infant’s health. In talking with the new mom, Heer discovered the baby engaged in irritable crying every evening, usually after his afternoon feeding.
Heer asked a series of questions and assured the mother she was doing everything right. She told the caller it sounded as if the baby might have colic, and she suggested several soothing strategies. Because the baby had no other symptoms, she recommended that the mom practice the techniques for the next several days, and encouraged her to call back at any time if she had any other concerns or if the baby exhibited other symptoms.
For patients, telephone triage or advice nurses such as Heer offer a virtual lifeline to health services 24 hours a day, seven days a week. These nurses, who have specialized training and experience, offer callers everything from symptom assessment to home treatment advice, referrals, and crisis intervention.
“Unfortunately, many of our nursing colleagues still think telephone triage isn’t real nursing,” Heer says. “Since what we do is a relatively new area of nursing, I’m not sure everyone fully understands our function or potential.”
Valuable service
Yet patient satisfaction surveys and the sheer volume of calls seem to indicate these nurses provide a valuable service. HMOs that offer advice nurses report enhanced patient satisfaction, and nursing advice lines are being offered by many health plans as a standard benefit for members.
At St Joseph’s Medical Center, nurses answer between 15,000 and 17,000 calls each month.
The call center, founded nine years ago, contracts with local Catholic Healthcare West medical facilities, acting as the community call center for the Stockton area.
In roles that could be compared to air traffic controllers or emergency dispatchers, telephone triage nurses often are required to make valid assessments under conditions of uncertainty and urgency.
Although nurses have established protocols for a variety of conditions and ailments, they must have a minimum of five years’ nursing experience and are required to have excellent assessment skills and be able to work under
pressure.
Challenging calls
“The psychiatric calls are among the most challenging,” Heer says. “You have a patient who may be anxious or depressed, and it takes a great amount of time just to calm them down to obtain relevant information.”
Although the St Joseph’s call center has a benchmark of calls lasting eight minutes, psychiatric calls can often take up to an hour.
Telephone triage nurses at St Joseph’s cannot make appointments for patients, but they can advise patients to go to the emergency department or connect them to their physician’s office to schedule an appointment.
Two years ago, Heer became one of the first nurses at St Joseph’s to achieve certification in telephone triage.
Nurses must pass an exam to achieve RNC (registered nurse certified) status.
“It’s gratifying to see the field become a recognized area of certification,” Heer says.
“I hope to see our roles expand even more with telephone triage nurses being utilized more as a point of patient contact and assisting with the need to triage for ED visits.”
Heer has been a nurse for 29 years, and has worked as a telephone triage nurse for the past eight years. She hopes to work at the call center until she retires.
“I enjoy the diversity of calls, and I’m very proud of the service we provide,” she says.
“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.