Quality/Length of Call

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    Our call center of 7 RN's perform nursing triage in addition to physician referral for the general public. Our focus has been on quality of care and customer service. We use medically approved algorithms, computer based. We have been under great pressure financially as we are supported through our health system's marketing departement, which in turn supports 14 hospitals. We are having to shift focus on cost per call and length of call. Our avg length of call is 15-20 minutes and we are being told to cut out part of our usual process (which includes taking a brief health history for all triage callers), rush through calls, and go to an average of 6-7 minute length of call. I would like to hear if any other call centers are facing these same challenges. Concerns are safety and legal risk as well as compromising good customer service. Our legal dept is telling us that telephone triage nurses do not have a "nurse patient relationship" with callers and so risk is minimal. My understanding is that as soon as a nurse identifies herself as a nurse and gives care advice over the phone, there is established a nurse-patient relationship and she can be accountable for care just as a nurse in any other setting would be. Comments?
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  5. 0
    Holy Toledo !! I could not resist...no nurse-patient relationship...H-e-l-l-o...I have done pediatric telephone triage for 5years and done 1 year of adult triage/pathways etc.once some calls I have established an obligation(at least in NY state)check out some sites on the web, here in Rochester HarrisBeach and Wilcox(law firm) has one or the nurse/lawyer for NCC Carol Stock from Seattle is a GREAT resource. Best of luck
  6. 0
    :angryfire :angryfire
    Quote from kst
    Our call center of 7 RN's perform nursing triage in addition to physician referral for the general public. Our focus has been on quality of care and customer service. We use medically approved algorithms, computer based. We have been under great pressure financially as we are supported through our health system's marketing departement, which in turn supports 14 hospitals. We are having to shift focus on cost per call and length of call. Our avg length of call is 15-20 minutes and we are being told to cut out part of our usual process (which includes taking a brief health history for all triage callers), rush through calls, and go to an average of 6-7 minute length of call. I would like to hear if any other call centers are facing these same challenges. Concerns are safety and legal risk as well as compromising good customer service. Our legal dept is telling us that telephone triage nurses do not have a "nurse patient relationship" with callers and so risk is minimal. My understanding is that as soon as a nurse identifies herself as a nurse and gives care advice over the phone, there is established a nurse-patient relationship and she can be accountable for care just as a nurse in any other setting would be. Comments?
  7. 0
    Quote from Funny girl
    :angryfire :angryfire
    I have worked for three different call centers in northern california. we are also under pressure to cut the length of our calls to fit "the national standard." I am not sure who sets the standards but different call centers do additional things over and above advice. The long and short of it is "the powers that be" want us to have 6 calls minimum per hour.
    It is my understanding that the minute you answer the phone and a pt admits to a problem he or she becomes "your problem". You have established a pt/provider relationship. If the pt states "I don't know why I was transferred to you I just want a routine physical and I have no problems" that is different and you can transfer the pt to make a routine appt. But if the pt states " I don't know why I was transferred to you I just want an appt for abdominal pain" this pt is still your responsibility unless he refuses triage and you can document that the patinet refuses triage/ advice.
    Shoulder pain can mean a lot of things including an MI. If you do not know the history or medications you may not pick up on that.
    Our group was involved in a law suit for that very reason several years ago. I would not have a lot of confidence in your legal department and I would carry my own malpractice insurance no matter what your employer tells you. It is your license and your employer will not stand behind you if you get into trouble... it is amazing how even statements made by supervisors or administrators with a full department of witnesses can be denied. I have kept myself out of trouble for over 25 years by being a cautious optimist.
  8. 0
    6 calls per hour. WOW!!! now that is some volume. We are only expected to make 2-3. OUr charting system would never allow for that kind of volume per hour. It just takes to long to chart and I am fast on the puter. Do you all have check off list type charting that allows you to keep up that pace?

    Oh back to the original question. We do not gather background info on every call. No where in our algorythm does it ask us to get relevent history. Now, do we yes, if it is needed.
  9. 0
    UNBELIEVABLE!
    The national standard for calls is 8-15 minutes. Carol Rutenberg, a nationally known speaker and instructor on telephjonme trioage says that is you are doing a call in less than 7 minutes you are not doing a good job.

    It's time for you to do your own research and take your own information to your managers and your attorneys. There are people who are the cutting edge information leaders in this field and most of them are willing to speak to you on the phone. I'm off til next week but when I get to work I will email you contact information on Carol Rutenberg.

    Telephone triage nurses clearly DO have a relationship with their patients and getting their history is important.
    For example: a three cm open lesion on a great toe (from a broken blister) that is surrounded a by red, swollen area and is nontender, can wait til tomorrow to be seen in a healthy young adult or could even wait to be reassessed tomorrow)--but in a 50 year old diabetic w/ a history of poor circulation and prolonged wound healing might need to be seen within 4 hours. BIG DIFFERENCE!
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    I, too, am in a call center that is part of a hospital system's marketing dept. We include adult triage as one of our services but have been focusing more on health info, phys. referral & class registration. One of the areas that TPTB have been focusing on is the return on investment (ROI). Does your group have any way of tracking your patients to determine if they choose your hospital system for their care? This could help to provide info proving the value of what you & your colleagues contribute to the system.

    Also, have you consulted your state board of nursing to determine what constitutes a nurse-patient relationship? Their opinion & documentation will be what matters in court (heaven forbid). The opinion of your system's legal system will be worthless to you if it disagrees with the state's BON.

    Kind of makes me wonder if the legal & marketing depts don't consider your work to be true nursing care. Grrrr!
  11. 0
    "Our legal dept is telling us that telephone triage nurses do not have a "nurse patient relationship" with callers and so risk is minimal. My understanding is that as soon as a nurse identifies herself as a nurse and gives care advice over the phone, there is established a nurse-patient relationship and she can be accountable for care just as a nurse in any other setting would be. "

    The legal department is correct in that the risk is minimal FOR THEM. (If you want to double-check my statement, request their opinion IN WRITING and see what happens.)

    YOU certainly do have a nurse-patient relationship and, if you value your license, your patients, and your financial assets it would be wise to keep that clearly in mind.

    And of course, as in ANY nursing job, you need your own malpractice insurance.
    Last edit by sjoe on Mar 2, '04
  12. 0
    I work in a call center for doing Pedi triage. We too are funded by the hospital so they want to keep our calls at 6/hr at the least. We have a computer program that we follow and we take a hx for each pt(at least we should be). The advice has to be tailored to fit each child. I do believe that we have a nurse/patient relationship as those parents rely on what we are telling them to do. Our guidelines are set and we must follow them or document why we changed some of the advice given. All of our calls are recorded and can be listened to by our managers(and are all the time for QA purposes). It also protects us if a parent wants to sue us over what info we provided that may have been incorrect. We also are able to review calls if we have a problem/child abuse situation arise that needs to be reported. I can get most of the calls close to what they want/hr but then sometimes I may have a 20 min call that you could not do in less time. New parents need the most support and teaching as they seem to recieve very little teaching on newborn care at the hospital. I love the automity(sp) of my job. I have always enjoyed teaching. We have parents who use us all the time and don't know what they would do if we were not available. During the busy winter months, we take as many as 400-600 calls/day. I think it is a wonderful community service and wish it had been available when I had my children!!
  13. 0
    UNBELIEVABLE!
    The national standard for calls is 8-15 minutes. Carol Rutenberg, a nationally known speaker and instructor on telephjonme trioage says that is you are doing a call in less than 7 minutes you are not doing a good job.


    Wow, I had to read this twice to comprehend what I was reading. Under 7 min. means not a good job? My boss rates us how how fast we can do the calls. Her standards are as follows-

    fantastic- 3min talk with 3 min. afterwork time
    good -4 min talk with 4 min. afterwork
    passable -5 min talk with 5 min. afterwork
    poor- anything slower than passable.

    She increased our requirements for gathering med hx. before we can triage the call recently but did not increase our talk/work time allowance. Example for a call on a 7 month old the following has to be gathered no matter what the call is about...
    1- med hx./past hospitalizations
    2- meds-
    3- allergies-
    4- activity level-
    5- # of wet diapers in the last 8 hrs
    6- last bm
    7- fontanels?
    8- sleep habits
    9- birth weight
    10- present wt
    11- temp.
    12- immunizations
    13- gestational age
    14- fluid intake
    15- food intake
    16- breast/bottle
    this is what we have to ask if under 1 even if the mother is calling because the baby has pinkeye! Then after that we can assess. the syptoms to recommend level of care needed.
    It is even sillier for age 1-15- just minus the fontanels, breast/bottle, gestational age, # of wet diapers is changed to # of urinations and ya still have to ask a mother # of BM's her 15 yr old son had!!!! This takes the 3 min. alone just to get all this stuff answered and I haven't even gotten to the assess. yet! Sometimes I lose the caller because they want to know what all this has to do with the call and maybe some of it does but the rest is total nonsence.I tell them my employer requires it as that is all I can think to say.
    This was per URAC's recommendations during their recent recert. visti. Do all of you have to ask all this stuff before you triage a caller?


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