Nursing Telehealth Triage has become increasingly important as a way to improve the healthcare process and overall patient satisfaction. Nursing Telehealth Triage is currently one of the most utilized entry points for clinical care in the 2021 continuum of care. COVID put telehealth front and center as the solution for patient care, but for thousands of virtual care nurses it was business as usual.
This approach is not without its challenges as nurses are asked to adapt their knowledge and skills to a less personal interaction with patients. Though telephone and online channels can be a very efficient tools to streamlining medical care, they also limit your access to the patient. You can’t see, smell, or touch the individual and must rely on the information you can draw from the person on the other end of the phone.
Let’s discuss a few suggestions for how to best connect with the callers in an effort to provide clinical care that is equal to if not better than that received in person.
Being an effective Communicator is an essential skill that is often overlooked when hiring triage nurses. Sending messages that are received as intended is imperative when practicing virtually. This essay offers some helpful tips for any clinicians involved in telehealth.
LINK TO -- Triage Nursing Won’t Play Second Fiddle to Telemedicine
If you walked into a car dealership and the salesperson loped over to you dressed in a baggy suit, avoided eye contact, barely spoke above a whisper, and slouched, how would you feel about purchasing a car?
While your patients cannot see your posture or attire, confidence can be heard in your tone of voice or relayed in your word choice. A lack of confidence is anything that indicates “I can’t help you,” or “I can’t do anymore for you.”
Therapeutic rapport is about building trust. The first step of trust is a confidence rooted in your capabilities to help the patient.
Projecting Confidence Over the Phone:
Last time I called my internet provider, I started by telling them I’d reset my router and modem but my internet still wasn’t working. I had a deadline to submit a report and needed fast service. You can imagine my frustration when the representative blandly said he would help me, collected my account information, and then asked me to reset my router and modem. Not only was there no urgency his demeanor, the representative clearly did not hear anything I had said.
Understanding and sympathy is key to communication. You offer the caller reassurance and clarify that you understand what he or she relayed. Military protocol always requires at least a “Roger” to indicate the message was received. It is crucial that you acknowledge the problem and offer some sign of empathy.
Summarize what you heard. If they’re emotional, start with an empathy phrase:
Sometimes patients may not understand the severity of their situation or they may be focused on the wrong details. Sometimes they have a hard time communicating what’s really going on. Do you remember the story about the abused woman who dialed 9-1-1 and ordered a pizza to notify the police her life was in danger? What if that officer had discounted her as a prank caller and disconnected the call before understanding why she was really calling?
You need to pay attention to queues and follow your gut. Trust your experience and your training to guide you toward the correct nursing assessment. It took years and a lot of money after all! It’s not necessarily in the best interest of the patient to hand him or her off to the next level of care until you’ve gained all of the information you need, even if it seems cut and dry. Take the extra few minutes to pull up the patient’s medical record and ask the pertinent questions because it can save precious time in the long run. Remember, some patients understand their conditions better than others. Those with chronic medical conditions may be able to communicate in a more educated manner because it is a part of their everyday lives. Not all callers operate on that same level so it is imperative that you consider the caller’s level of understanding and word your responses accordingly.
With that in mind, also use your brain. If you end up with a call outside of your comfort zone, approach it as logically as possible but don’t ignore your instincts. For example, maybe you have little or no mental health experience but you are dealing with a caller who is seeking immediate treatment for depression. Before disconnecting the call and/or handing the caller off to the next level of care, take the time to make sure the patient is safe just as you would any other crisis call.
Protocols are in place for a reason. Passengers on a plane would be frightened if their pilot suddenly abandoned the safety checklist for their flight. Patients should similarly worry if their nurses stopped adhering to protocols and clinical decision support. Protocols are necessary because they:
Proper use of protocols is to ask the patient general questions, and select the relevant protocol choice yourself. For example, instead of asking 5 protocol questions about the wound site, ask the patient to describe the wound site. Some protocols will ask about the patient’s temperature many different times. Simply ask the patients’ temperature once and choose the appropriate protocol answer yourself.
You’re not a robot, and your patients don’t want to speak with somebody reading from a protocol checklist. We see far too many nurses turn off their brain and their training, and use the protocol as their only guide.
Just as pilots don’t learn to fly from a safety checklist, nurses don’t learn triage by reading protocols.
Protocols and checklists are problematic for a number of reasons. They tend to utilize close-ended questions, avoid gathering situational information that could be relevant, and ignore the caller’s expectations. Checklists have a place in telephone triage but tend to be most effective when used as a safety-net for expert users already knowledgeable about clinical content. Instead, practice the following interview techniques:
That woman can give an interview and so can you. She rolls with the feel of the interview but never loses control of it. She's very present in the interview.
When you’re on a call, keep control but pay attention to what your caller is trying to tell you. Take note of strange speech patterns, bizarre comments, and outlying information that doesn’t fit with the rest of the patient’s medical record. Find out where the patient is. How accessible is emergency medical treatment or urgent care? Is the patient alone? Is the patient safe? Does the patient have access to transportation if the situation changes? Are there language or intellectual barriers?
Think back to the last frustrating interaction you’ve had with a customer service representative. Compare it to the last time somebody gave you incredible news over the phone. How did each person sound? How did these phone calls differ?
Smiling seems simple but sometimes it can be difficult. When you smile on a phone call, your voice just sounds warmer, friendlier, and more receptive to your caller’s plight. This may be a lot to ask for at the end of a long day or when dealing with a less than cooperative patient, but that may be when you need it the most. Need a little reminder to smile? |
Our Practical Suggestions:
Your patient will appreciate the extra effort.
Obviously, nursing assessment, diagnosis, and disposition are handled entirely different over the phone than in person. When working with patients via telephone, you must rely far more on the person on the other end than your own senses and that can complicate things a good deal. It may help to visualize the steps you would follow for an in-person assessment and ask corresponding questions in layman’s terms. It can be challenging to obtain the information you need from an untrained individual but they are your eyes, and sometimes ears, in a telephone triage situation.
A large part of the telephone triage process is helping your patient accurately describe symptoms and symptom severity. This may require some creativity on your part – perhaps asking a patient specific questions to gauge their level and location of pain or having the phone held against a patient’s chest in an attempt to hear breathing patterns. Keep in mind that there is a tendency for patients to minimize or underrate their symptoms.
Once you have adequate information, or as much as you’re likely to gather, the diagnosis and disposition becomes a whole new challenge as you must determine not only where the patient should be seen but how dire the circumstances are. This is far simpler in a face-to-face nurse assessment but by utilizing your training, instincts, and company protocols, you are well-equipped to make the correct decision!
Research shows that listening is where most telephone triage nurses struggle. The prevailing issues involved missing cues to ask for more information that would prove relevant to the call. There are three types of listening: |
There are generally four levels of calls and each requires a different level of care or follow up. Make sure you know where to send your patient before transferring him or her.
Nurses do an excellent job of appropriately managing patients, often leaving them with higher levels of satisfaction than the physicians. But, that doesn’t mean nurses are immune to common mistakes during triage.
Have you ever called a doctor’s line to explain a complex issue only to be disconnected forcing you to call back and have to explain the entire situation to a new person? It’s frustrating and time-consuming. If only that representative had taken notes on your call and explained the situation in your record.
Proper charting improves the efficiency of patient care and ultimately, the patient’s satisfaction with treatment. Lack of documentation leaves you vulnerable to legal liability. Proper documentation in the patient’s medical record will also alert any other medical professionals to what is going on with that individual. Capturing all of the relevant data you receive from a caller will expedite the process when they call back.
The most important thing to remember is that you are the first person the patient is talking to about his or her problem. It may be routine or it may be an extreme crisis but your job on the call is to facilitate the right care while making the patient feel important, calm, and cared for.
Historically, nurses have a tendency to naturally provide holistic service to patients. Many parents remember that one amazing nurse who made childbirth easier but couldn’t tell you what doctors checked in on them or even delivered their child. Cancer survivors can tell stories of the nurses who sat with them and encouraged them through their battles. Nurses have always occupied that most relevant position in a patient’s medical treatment and the transition to phone triage should be no exception.
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Care Desk is patient triage software that facilitates every step of a triage call. It pulls contact information, health history, and visit information from the electronic health record, to provide context for the call. Custom and branching protocols provide checklists and automated documentation. Clinical decision support supplements the nurse’s logic, and documentation back to the patient’s health record is automated. Advanced reporting and automation features are available. To learn more request a demo.