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Telehealth Nursing: How To Build A Powerful Telephone Triage System


August 5, 2022

What does a telephone triage nurse do?

Telephone triage, also known as telehealth nursing, has existed since the 1960s—but it has never been more important, relevant, and respected than it is today. And for good reason: telephone triage and virtual triage are vital components of modern and holistic healthcare services, much of which are now delivered remotely.

Telephone triage nursing shares many similarities with in-person triage nursing—although there are key differences. Telephone triage nurses are specially trained, registered nurses who work for healthcare providers remotely. Telephone triage nurses work at a variety of locations: healthcare call centers, urgent care centers, emergency departments, and other medical facilities.

To become a telephone triage nurse, attending nursing school or an accredited nursing program is required. Telephone triage nurses are expected to deliver the same quality of care as nurses who work in-person at emergency rooms or physicians' offices.

Telephone triage nurses give care and consultation, over the phone and online, to patients seeking medical treatment. A telephone triage nurse, through a series of questions, assesses the patient's condition, then directs the patient to appropriate medical services.

The telephone triage nurse is responsible for evaluating the patient's symptoms—fever, abdominal pain, cough, chest pain—then making an appropriate and safe care recommendation. Telephone triage nurses, like in-person registered nurses, must adhere to established guidelines, protocols, and procedures: escalation, duty to terrify, therapeutic rapport.

A telephone triage nurse must accurately assess the patient's condition, as quickly as possible, without actually smelling, seeing, and touching the patient—which requires a specific set of skills. Not all registered nurses are fit to become a telephone triage nurse.

Why telephone triage nursing is extremely important for healthcare providers

Many patients now seek medical services remotely. It's called telehealth, and it has become enormously popular in the last few years.

Telephone triage nurses therefore have one of America's most essential professions. They are the key cog in the telehealth machine.

As such, it is vital that telephone triage nurses are properly trained—because the health of millions of people depends on it.

For telehealth nurses, achieving the golden trifecta of safety, efficiency, and care quality is made much easier with the help of healthcare CRM software, which centralizes all patient and provider data into a single platform, so that it is automatically available to the telephone triage nurse whenever a patient calls.

Without healthcare CRM software, telephone triage nurses must navigate a labyrinth of disparate systems, electronic medical records, and apps—which cripples efficiency, care quality, and patient satisfaction.

The telephone triage nursing process

During their consultations with patients, telephone triage nurses evaluate the patient's symptoms and medical history. The telephone triage nurse then offers treatment advice or directs the patient to healthcare services, including:

  • A specialist physician's office who treats the patient's specific medical needs.

  • Emergency medical facilities—if the patient's condition calls for it.

  • The patient's primary care physician, regular doctor, or other local doctors.

  • Telehealth services (a remote appointment with a physician).

  • An alternative medical facility, doctor's office, or urgent care clinic.

A telephone triage nurse's patient assessment, if executed effectively, increases the likelihood of a positive patient outcome. An inaccurate or incomplete patient assessment, conversely, can lead to a poor patient outcome.

It is thus imperative that telephone triage nurses are equipped with the skills and credentials needed to successfully perform their jobs and deliver the best possible patient care.

Key telehealth nursing skills & credentials

To ensure every telephone triage nurse hired by your organization will excel in the role, look for these attributes:

  • A degree from a nursing school or an accredited nursing program.

  • Stellar verbal and non-verbal communication skills.

  • Experience answering calls, and a keen ability to communicate effectively with patients over the phone.

  • Willingness to work nontraditional hours, including night shifts.

  • Experience working in emergency treatment.

  • Critical thinking skills, and a talent for accurately assessing a patient's condition quickly.

  • A deep commitment to delivering quality patient care.

  • The ability to create, when talking with patients over the phone, a mental image of the patient. This allows the nurse to offer personalized care.

  • Willingness to work for a typical telephone triage nurse salary: roughly $30/hr.

  • Telephone triage nurses—all medical professionals, really—need common sense and good instincts. Telephone triage nurses must stay calm and prudent, in a high-pressure environment, so that they can confidently and correctly direct patients to the appropriate level of care. Telephone triage nurses generally take on a higher patient load than do in-person nurses, so exercising keen judgment, in the moments that matter, is essential.

  • Because telephone triage nurses work over the phone, astute listening skills are imperative, for obvious reasons.

Providers, when building and refining their telephone triage system, must commit to a core set of principles. The following 5 axioms should serve as the foundation of your telephone triage operations:

The 5 Telephone Triage Truths

#1: Telephone nursing is safe & effective.

Telephone triage services are grounded in the Standards of Care, developed by the American Association of Ambulatory Care Nurses (AAACN).

The telephone triage process should be performed by specially trained, registered nurses, who have an average of 5 - 10 years of experience in Emergency Treatment and Primary Care, Medical Surgical Nursing, and Pediatrics.

The telephone triage practice is guided by evidence-based clinical guidelines, which are physician approved and updated annually.

But decision support tools are just that, guidelines, not algorithms. Qualified registered nurses understand that each patient encounter is unique. They have critical thinking skills—which are incredibly important when caring for patients remotely—because observing, smelling, and palpating are not an option. Expertise in astute active listening and therapeutic communication is critical.

Quality assurance monitoring of triage phone calls indicates that, in 97% of encounters, telephone triage nurses recommended patients to the appropriate level of care. This extraordinary number illustrates that telephone triage nurses can be trusted to accurately assess patients.

#2: Telephone triage contributes to optimal patient outcomes.

The Institute for Healthcare Reform (IHI) identifies three core objectives for healthcare in the United States:

  1. Enhance the patient experience and patient care.

  2. Improve the population health of certain groups.

  3. Reduce the per capita cost of healthcare.

Telehealth nursing helps fulfill these goals. Telephone triage nursing is a healthcare service that, for each patient, is done on a 1:1 basis. Because of this, telephone triage nursing is:

  1. Foundational to most primary care practices.

  2. Extremely cost effective.

  3. Consolidates services and information across enterprises. 

To lower your expenses, streamline your workflows, and improve your patient care, building and refining a sophisticated telephone triage system, one that optimizes the delivery of telehealth services, is crucial.

#3: Telephone triage nurses' work creates an exceptional patient experience.

Telehealth nursing helps providers achieve their patient engagement goals. An organization committed to exceptional patient experiences is an organization that gives patients 24/7 access to telephone triage services.

Healthcare consumerism trends are transforming the healthcare marketplace. Studies indicate that modern consumers demand seamless digital access to all services—including healthcare services.

In the recent past, to receive acute medical care, patients' only option was to go to the emergency room. But thanks to increasingly sophisticated telehealth software, patients can now access healthcare services anywhere and anytime.

Telephone triage nurses don't just evaluate the patient's health; they also provide a timeline for care. Telephone triage calls often don't result in a trip to the emergency room because patients get the care they need from the telephone nurse. Patients don’t need to drive across town to medical offices, nor wait in a crowded waiting room for hours.

Telephone triage greatly enriches the patient experience—which ultimately means more patient acquisition/retention for healthcare organizations.

#4: Telehealth nursing reaps big financial benefits for healthcare providers.

Executive leadership at healthcare organizations should consider investing in AI-powered triage and call support software. Outsourcing calls to a well-regarded contact center is another option.

ROI valuations for providers who invest in an AI-powered call support system are impressive. Telephone triage operations equipped with AI-powered software are far more efficient and effective than operations that are not. A standard telephone nurse handles 2 calls per hour; an AI-equipped telephone nurse handles 4 calls per hour. At a $30/hr salary, that is an exceptional bargain.

For providers hesitant to invest in triage software, one way to dilute the initial expense is to partner with an outsourcing call center company. Many healthcare organizations have made permanent outsourcing arrangements, reaping all the benefits of a telephone triage system with no capital expenditures. It's important for providers to remember that telephone triage is an investment—not an expense.

AI-powered telehealth nursing is a fantastic solution to the alarming nurse staffing shortages—a crisis that keeps the C-Suite awake at night. Thanks to triage software, 24/7 medical care is available to patients, which lowers their risk of escalating to a higher acuity simply because their provider’s office is closed.

And because AI-powered telephone triage creates an integrated care system, it not only improves outcomes; it also boosts internal referrals.

#5: Telephone triage nurses' work helps medical providers better utilize scarce resources.

This is particularly important for overcrowded emergency medical facilities and overburdened primary care providers. Many trendy readmission prevention programs managed by telephone triage nurses are proving successful. Continuous care improves the bottom line in the current fee-for-value reimbursement system. This is just one example of the positive impact a fully-optimized telephone triage system can have on your organization.

To best serve the medical needs of your patients, and to ensure your organization maintains its competitive edge, your leadership must view telehealth nurses as a necessity, not a luxury.

Telephone triage services are being skillfully and compassionately performed by thousands of registered nurses across the country. There are several different models of telephone triage that can be customized to the needs, strengths, and goals of your organization.

Below I've outlined some training techniques and strategies that providers can utilize to get the most out of their telephone triage operations.

Telephone triage training, techniques, & education

Comprehensive Relevant Training is the responsibility of the organization. It is owed to triage nurses, and it is essential for success. When training and hiring your telephone triage nurses, follow these 13 guidelines:

  1. For every new hire, ingrain this belief: Optimal patient outcomes supersede all benchmarks.

  2. Trainers should make no assumptions. They should train every new hire, even if the new hire has ample in-person nursing experience, as if they were fresh out of nursing school. Telehealth nursing requires a different skill set than in-person nursing—so every new employee must be trained thoroughly.

  3. Clearly define expectations: knowledge needed, performance and productivity metrics, time frames, etc.

  4. Offer specific examples of what a successful telephone triage nurse looks like.

  5. Create a checklist which documents the training plan/progress. Regularly share updates with the new hire.

  6. Within the organization, broadcast the value of the telephone nurses. This keeps morale high and encourages collaboration. 

  7. Have new nurses observe experienced nurses in clinics and practice sites. This enhances  their understanding of patient expectations.

  8. Proven communication techniques, such as therapeutic rapport, must be taught and monitored. Without effective communication skills, optimal patient outcomes are impossible.

  9. Create a weekly or daily schedule for telephone triage training. The goal of this training is to continually develop relevant skills.

  10. Train and utilize dedicated preceptors whose primary responsibility is teaching the art and science of nurse triage. They should be proficient in the role and a recognized asset to the program.

  11. Orientation for new telehealth nurses is most beneficial if preceptors are not included in department staffing—or in a position where they risk being called away for other duties—because the new hire might be left with nothing to do.

  12. During training, if situations occur that require trainers to handle live phone calls, the new hire should listen and observe. Teach in real-time—then ask the new hires questions about what they've learned.

  13. If a preceptor rotates shifts, the new hire should also rotate. Hands-on, real-time learning is the best way for new nurses to quickly develop their skills.

In my next blog, I’ll take a deeper dive into telehealth training manuals. Until then, keep telehealthing!

Posted By

Gina Tabone

Gina Tabone, MSN, has 25+ years of experience in telehealth. She has consulted for physicians, health systems, call centers, & other healthcare entities.

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