Call a Nurse
Monday June 30, 2003
Print This- Select Text Size:
Comments
advertisement
About five years ago, Rhea M. Morris, RN, MSN, CEN, CNA, senior associate director of Nursing at Woodhull Medical Center in Brooklyn, and staff, developed a nurse phone line - to provide one way for easy access to needed care. "We hypothesized that many unnecessary ED visits might be avoided if patients could phone a healthcare provider for information and guidance," she says. They were being deluged with patients with non-emergent conditions. When these patients were surveyed, the staff discovered that many were coming to the ED, including the fast-track ED, because of the extended hours of operation, rather than going to clinics or primary care providers.
It's a Success Story
During March 1998, the first month of operation, the staff received 70 calls through the nurse line at Woodhull Medical Center. Now nurses answer approximately 3,000 calls every month. They answer questions, make assessments, and triage patients to the level of care they need - emergent, urgent, nonurgent, routine, self-care. Triaging connects patients with needed services, practitioners, education, or referrals.
J. Pegues, senior vice president, Intracorp Marketing and Business Development, a national healthcare and disability management solutions provider, says, "The goal of nurse-line programs is to empower consumers with medical information so they can make educated decisions about their health. [Our] nursing professionals are trained to ensure that the most appropriate levels of care are given, which results in better clinical outcomes and ultimately saves employers money on both costs of care and lost productivity costs."1
Studies have shown that there is a high level of satisfaction with telephonic-based nurse triage services (see sidebar), and the Emergency Nurses Association maintains a position statement about telephone triage programs (see sidebar).
How Can We Help You?
Karen Huntzinger, RN, Intracorp's group manager for Operations for Health Facilita-tion/Nurseline, says, "Some patients call because they have recently been given a new diagnosis such as diabetes or irritable bowel syndrome, and they want to learn more. In symptom-based calls, patients may request help in understanding what their symptoms mean and in determining whether to see a healthcare practitioner or to self-treat." Other callers request information about treatments to relieve common conditions, such as menstrual cramps or fever. Home care instructions may include heat or ice applications to an area of minor injury or dietary suggestions for conditions such as diarrhea or constipation.
Huntzinger finds that some of the most frequently asked questions are about newborn colic, gastrointestinal problems (particularly in the elderly), pregnancy, and chronic diseases, such as COPD or heart disease. She also sees that in cases of bioterrorism or other forms of warfare, nurses are on the front line for detecting patterns and trends and must be alert for an increase in calls from patients who have similar or unusual symptoms.
At Woodhull Hospital's nurse line, other common topics include asthma and headaches. They also receive many calls from adolescents who have questions about caring for their newborns, sexually transmitted diseases (STDs), and birth control. Morris notices that their call volume increases drastically when health issues receive a great deal of media attention. They've been bombarded with questions about anthrax, SARS, smallpox, and the West Nile virus. Morris keeps the nurse-line RNs aware of health alerts received from the Health Department, the CDC, or other government agencies, and provides them with constantly updated information so they are prepared to handle these calls.
Because the nurse-line staff works from the Continuum of Care Center at Woodhull, they also follow up on all recently discharged inpatients and those who had specified procedures performed on an outpatient basis. They are able to schedule appointments for callers who need to be seen.
When the Phone Rings
"When a call is received, the nurse does an assessment of the client's need, beginning with the ABC's - airway, breathing, circulation - to determine the urgency of the situation. Symptom-based protocols are used to guide further in-depth assessment," says Huntzinger. Depending on the facility, protocols vary from loosely structured guidelines to peer-reviewed, standardized, computer-based systems marketed by health-related technologies companies that offer clinical and management support services and materials.
Many of these protocols include numerous symptom-specific, age/gender-specific, algorithms that feature a logically structured question sequence with specific guidelines. For example, a patient complaining of abdominal pain will be asked about any preexisting medical conditions, the severity, location, quality, and duration of pain, if nausea/vomiting/fever are present, and other pertinent factors. Other questions that will follow are determined by the caller's answers, which enable the clinician to hone in on the clinical picture, make an assessment, and interpret symptoms before directing the caller to the appropriate level of care or self-management.
For callers who need general information on disease or symptom management, call-line nurses can quickly access materials on everything from disease management to medication databases and diagnostic testing. Nurses at Intracorp have access to a unique drug interaction tool, and from that they give clients evidence-based information from a database that covers more than 5,000 health-related topics. "When patients are able to read the material at their own pace, it reinforces our nurses' telephonic advice, improves the patient's retention of the information, and supports adult learning and empowerment," says Lynne Harsha, Intracorp's senior product manager for Health Facilitation.
Experience Necessary
"A typical phone call to the nurse line lasts between 10 to 15 minutes, and our nurses obtain a tremendous amount of information in that time. Clinicians are often able to pick up subtleties in a caller's responses, allowing them to clarify a difficult diagnostic picture," says Morris. Because telephone assessment requires complex listening skills and clinical expertise, Morris hires only experienced nurses with broad backgrounds to work on the nurse line.
To train for the position at Woodhull, nurses must work several weeks in the ED with a preceptor doing critical care triage, pediatric triage, and adult acute-care triage. Nurse-line staff learn about the hospital system and its continuum of care and are taught about assessment protocols, guidelines, and crisis intervention resources, such as suicide hotlines and domestic violence shelters. They are precepted by an experienced nurse-line RN before working on their own.
When an experienced nurse trains for the phone line position at Intracorp, she or he begins with a four-day introduction to telephone triage and symptom-based assessment, followed by five weeks of training and preceptorship with a seasoned RN. "Our nurses get great satisfaction in helping patients navigate the healthcare maze," says Huntzinger. The rewards are there - for nurses and their patients.
Barbra Williams Cosentino, RN, is a contributing writer for Nursing Spectrum.
References
1. Intracorp Survey finds information consumers receive from Nurseline influences the decisions many make about their healthcare. Intracorp Public Relations Bulletin. March 13, 2003.
2. O'Connell JM, Stanley JL, Malakar CL. "Satisfaction and patient outcomes of a telephone-based nurse triage service." Managed Care. July 2001. Available at: http://www.managedcaremag. com/archives/0107/0107.peer_triage.html. Accessed June 11, 2003.
3. Emergency Nurses Association Position Statement: Telephone Advice. Available at: http://www.ena.org/about/position/telephoneadvice.asp. Accessed June 11, 2003.
Reader Comments
Login