How are your patients scheduled?

[cleo]

I work in a very busy pediatric office. We are looking at new ways to schedule same day appointments. The goal is to have our telephone nurses freed up from taking phone calls that have nothing to do with nursing. ie: "When is Mary's next appointment?" or "Can you tell me how to get to your office." One of the ways we are looking at is having our receptionists book these appointments. The receptionists would have a list of provider approved symptoms that they would be able to book, ie: ear ache, temperature. They would be given certain buzz words or complaints that would automatically be put through to a nurse to further assessment. ie: abdominal pain. The triage nurses are feel that this is not the way to go. They feel the receptionists will miss or not know when something is serious and needs to be seen immediatly. They feel there is a legal componant to this, such as giving advice. This is such a cultural change for our department. How do others in busy offices schedule thier same day appointments? I'd like to hear some other options.

[Little Panda RN, ASN, RN]

I agree that the receptionist should not make the decision if a patient should be seen. The are so many different signs and symptoms that it would be impossible for to teach these to a receptionist. A list is helpful, but with no medical background it does become a liability. I work in a very busy orthopedic department and our receptionist will give the call to the nurse if the patient is complaining of pain, a cast to tight, numbness in extremeties and so on. It is best in my opinion to always have a nurse triaging the patients.

[Nurse Ratched, RN]

I do also agree that one runs into risks having receptionists essentially triaging. Physical symptoms are very squishy to define at times, and it seems like a nurse should be the one asking the questions to elicit additional information for determining likely acuity.

Particularly in the pediatric population when they can turn so quickly, I would recommend continuing to have nurses field those calls. The receptionist can do a mini screen to determine if it's a clerical question, but anything that has to do with, "Little Johnny fell and hurt his arm a few minutes ago," should go to the nurse.

[KidsRNstill]

I second what's already been said....I manage a very busy peds practice and we don't allow the non-clinical folks to give out any advice, including whether a child should be seen--all questions go through the triage nurse. However, our parents CAN simply make an appointment without going through the nurse--if they really want their child to be seen.

We do inservices for our non-clinical personnel, though, to teach them what to listen for that should alert them to transfer parents to the triage nurse promptly, rather than going to voicemail--things like wheeze, constant cough, falls, etc. Our receptionists are excellent at picking up symptoms or worried tones of voice and getting the nurse pronto--we encourage them to get the nurse to talk to the patient right away whenever they're unsure--better to over-react than miss something.

[J Lynn]

When I called in to my peds office, they would fit me in without asking why and I would usually see the NP when one was available. Fortunitly, my peds office hardly has just "check ups" so I'm always able to get in, even if there will be a wait.

Now, in my office, we fit people in what ever the symptom. I usually let the doc handle how severe something is. We leave a few spots open during the day for those people.