Researchers strategic use of advanced practice nurses to resolve patient triage issues can speed clinician response time to clinically-relevant phone calls in a high-volume pediatric otolaryngology practice. Over the course of 40 months, 4,839 clinically relevant phone calls were received, an average of 128 calls per month. The baseline mean was 101 monthly calls and the post-intervention mean was 130 calls. The study was published in JAMA Otolaryngology-Head and Neck Surgery,
Linda Payne, otolaryngology clinic lead nurse at Nationwide Children's Hospital in Columbus, told Reuters Health, "Telephone triage in a busy pediatric ear, nose and throat clinic such as ours poses unique challenges due to the sheer number of calls our nurses receive each day from families that have concerns about their child's healthcare. This project created clear channels of communication and expectations that helped our nurses to facilitate patient access to quality healthcare in an efficient and cost-effective manner," she said by email.
Researchers conducted a quality-improvement study in their practice, which includes more than 32,000 clinic visits and more than 9,000 surgical patients yearly. They created a collaborative team in 2014 to determine the optimal time for triage callback to families and define a process allowing for more rapid response time for calls that needed to escalate to a patient's managing surgeon.
Before implementing the collaborative team approach, only 42% of calls were being addressed within two hours, the authors note. After the intervention, the average time for caregiver callback within two hours decreased from 15.3 hours to 3.9 hours and caregivers received clinician callback within two hours 76.7% of the time.
Outcomes were sustained for three years and continue to be monitored, according to the authors. The most effective intervention," they state, "was using advanced practice nurses to efficiently resolve patient triage concerns that were outside the scope of practice of the registered nurse.
Our entire team of registered nurses, nurse practitioners, and ear, nose and throat surgeons worked collaboratively to ensure that delivery of patient care was enhanced and that patient expectations for resolution of their concerns were met or exceeded. To our knowledge, this is the first published study to objectively track response times to parent/caregiver phone calls, design a novel process, and to successfully sustain that process over time.
Quality Of Life
The quality-improvement project requires considerable planning and attention. However, the process resulted in enhanced patient outcomes, so the time invested was well worth it. Larger institutions, especially academic medical centers, have the resources and expertise to implement these types of improvements. It may be much more difficult for the smaller or solo practices to do. Doctor of Nursing Practice advanced practice nurses are in an ideal position to lead these types of initiatives.
They have created a team-based model of care that allows for a more timely response to parent questions and care concerns and a timely escalation of care to the physician, thus improving the perceived quality of the care experience by the parent.
With the utilization of advanced practice providers at upper scope of practice, they demonstrate rapid resolution to care concerns, and ability to recommend self-care, whereas an RN following a care protocol would be more likely to schedule a follow up appointment or emergency department visit that ultimately adds more cost to the delivery of care and plugs access for another patient.
The team-based communication algorithm escalates care appropriately to the attending surgeon in an optimized and timely fashion. Physician involvement in process-improvement and quality initiatives such as this will be essential for the creation of sustainable solutions that improve quality and decrease costs in a value-based care reimbursement model.