Quality/Length of Call - page 2

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... Read More

  1. by   hipab4hands
    You get 15 minutes per call? I want to come work with you
    At our call center, I have to average 8.5 minutes- total time for assessment, documenting, etc., If our work times are longer than that, we get counselled for not being fast enough.

    When our calls are reviewed- there is a 4 page quality checklist that is used by the supervisor for "quality review" for each call.

    The funny thing is that I've asked to have a copy so that I know exactly what
    we are being scored on. The higher ups refuse to let us have a copy because they say it's "restricted material". I've pointed out that its impossible to improve, when you don't even know what your being graded on.
  2. by   hipab4hands
    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?[/QUOTE

    No,we don't have to get that specific info before we start to triage the patients. However, we are supposed to open the patient's electronic chart and look at hx/meds during the call.

    We work off of a written protocol that may have as few as 5 questions to some that are 20 or more questions. You're right in that this tick's off a lot of parent when they want to get simple directions such as taking a temp or how much otc tylenol to give their child.
  3. by   laurasc
    8 to 15 minutes per call eh? Gee, I wish! I work the telephone triage desk at a large family practice clinic where we not only triage patients from our clinic and call group (ie other docs when they are not in their ofice) but we also book appointments, chase down results, refill rx's over the phone and deal with a myriad of other problems. Calls come in fast and furious with an average of 80 incoming calls per 7.5 hour day. It's not uncommon for us to be on the phone and have our second line ringing or to pick up 15 voice mail messages at a time. Often the receptionists will keep an eye on our lines and transfer a call to us the moment we hang up from another call. If I spend 5 minutes on the phone with someone then it's a long time and charting consists of either our notes in the telephone message pad or in the case of something serious I have to run to the file room and pull the paper chart.

    No, it's not safe. Yes, it scares me to half to death. No, I haven't made a mistake yet. And yes, I will eventually go looking for something else.
  4. by   mattsmom81
    Wow. Reading the posts on phone triage has given me new insight. As nurses it seems we are never free from supervisors pressuring us to do more work faster with less.

    I would also want to know how my BON defines phone triage and what standards of care I accept in that role. I would not like being time limited so severely...not if I am the one taking the responsibility.
  5. by   mcdicarlo
    Quote from Shotzie
    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!
  6. by   mcdicarlo
    here you have only several minutes to determine what is the appropiate course of action.
    i am lucky because i have worked with my patients for many years and know their historys.
    but if you spend more than 15 minutes with the call you are doing too much talking
    you should be able to get to the root of the problem quickly and decide on your course of action
    i too was fortunate enough to spend the day with Carol Rutenberg and she agrees
  7. by   intellicareRN
    I have you beat. We are expected to have our calls done in under 12 min with an average of 8 min calls and it can be done but it takes work
  8. by   saskrn
    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?
    There definiely is a relationship. It starts as soon as you assume your nurse role.

    Our goal is to have our calls be 10 min with 2 min clean up time.
  9. by   daubney
    I think you are right re duty to care from a legal asspect. I share your concern re omitting a history and rushing calls. Tell me more.
  10. by   wincha
    6 minute calls? 6 per hour? thats just unsafe and yes you can get sued for your medical advice. We were encouraged on the triage line for 3-4 per hour. we had protcols to follow and if EVER in doubt the call went back to the pediatrician. we had clear guidelines for 911 or ED now, there was also a loop hole for nursing judgement. i was able to do 6 an hour easy since i had done this for 15 years but only in a crunch. we had our system pretty set up for flu season, nurses taking call from home, a nurse on call to come in if someone called in sick for flu season, if we got 1 hour behind calls went back to the pediatrician.
  11. by   daubney
    Using the McKesson system where the nurse /opens the file(time dated) Records the name and data of the client as well as that of the parent if parent is caller/then links the two together in the data base/then types the presenting problem/Then completes a history screen/ Then asks triage questions using a yes-no or ana button. Once a yes button is pressed the screen progresses to a predetermined outcome page that indicates what the client should do ie 911/ER/family Doc/Home care and may also have advice. If anyone is familiar with this process PLEASE RESPOND I have critical questions.
  12. by   daubney
    I have had employer allegations of unsafe practice in regard to telephone triage. The chart time was used ie. the time the file was open from beginning of call to the end of the discussion with a supervisor - long after the call had been dispatched. The phone time record or the time on the chart of advising the client to be seen was not considered. Used the system for 4 months.