Is anyone using this model?

[cleo]

My department chair and I have been talking about changing the role of our telephone nurses. We are in ambulatory care and I have four RN's that do telephone nursing. She has suggested that reception be responsible for scheduling acute visits along with all the other duties they no do. She stresses that it would take intense training for the front desk staff, such as knowing when a call would go to a nurse for further assesment. The RN's would continue to use thier critical thinking and nursing assement skills as phone nurses when needed and in addition take on a role of care managment for chronic diseases or chronic issues. When I presented this to the nurses they were not buying it. I'm not sure I am either. My department chair tells me this model is used in other ambulatory care settings. I cannot find any data. Has anyone out ther heard of this or is anyon using this model?

[Fonenurse]

Hi Cleo

I am from the UK so my experience is different - I work for a service that triages by telephone for OOH doctors.

Whilst I can see that this might be useful to improve the amount of work your nurses get through, I would be asking more questions - do you have a system that will give the receptionists a tool to ask the right questions - expecting untrained staff to triage is asking for a serious adverse event unless the right systems are in place to protect both staff and patients.

We use unqualified call handlers to assess our calls first - but they have a 4 week induction, have a system of computerised algorithms they have to utilise to triage the calls AND they are given teaching on critical thinking, acute illness etc etc.

We are also developing long term conditions case management by telephone but different staff do this as it requires a different set of experience and skills to acute triage.

[pedsallergynurse]

Hi. I work in a multi physician pediatric office. We have 2 dedicate aphone traige nurses every day w ith anothe 1-2 nurses helping out during the busy 2 hours of the morning. We are just changing over to using Barton Schmidt's telephone triage protocols, in order to ensure uniformity in our phone advice. this also makes it easier for new nurses to acclimate to phone triage. My office is adament about only having licensed personnel doing phone triage/ acute visit scheduling. From a liability and patient care standpoint this only makes sense.

What happens when a clerical person misse a situation when a patient should be sent to the ER or seen immediatly instead of scheduled for later in the day because the patient requested a late appt? You cannot discount that "feeling" an experienced nurse has a times. Sorry - patient issues need to be addressed by a nurse, PERIOD>