IN BRIEF

QI Project Improves Response Time to Nurse Triage Phone Calls in Busy ENT Practice

July 17, 2018
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A high-volume pediatric otolaryngology practice receives a lot of phone calls from patients and families. The practice at Nationwide Children’s Hospital, which sees 32,000 clinic visits and 9,000 surgical patients each year, averaged more than 200 triage calls per week over the last 5 years.

The response times to those calls needing clinician input ranged from several hours to days.

“Telephone triage in a busy pediatric ear, nose and throat clinic such as ours poses unique challenges due to the sheer number of calls our nurses receive each day from families that have concerns about their child’s health care,” says Linda Payne, MSN, RN, lead nurse in the Pediatric Otolaryngology Clinic at Nationwide Children’s.

In 2014, Payne and a collaborative team of nurses, advanced practice nurses (APNs) and ENT surgeons began work on a quality improvement (QI) project that objectively tracked response times to caregiver phone calls, designed a novel process to improve clinician callback response rates and then sustained that process over time. The results of the project were recently published in JAMA Otolaryngology – Head & Neck Surgery.

“Monitoring timely health care services we provide patients is critical to ensuring that we are consistently offering the highest quality care,” says Kris Jatana, MD, director of Pediatric Otolaryngology Quality Improvement (QI) at Nationwide Children’s and senior author of the study. “It is our hope that with the dissemination of our practice outcomes, others can either adopt or adapt a similar process in other healthcare settings.”

At baseline, only 42 percent of calls were being addressed within 2 hours. After the intervention, caregivers received clinician callback within 2 hours 76.7 percent of the time. These outcomes were sustained for 3 years.

“This project created clear channels of communication and expectations that helped our nurses to facilitate patient access to quality health care in an efficient and cost-effective manner,” says Payne, who was the lead author of the study.

The channels include an algorithm for nurse triage phone calls to streamline and minimize variation in how the calls were handled.

“Through several plan-do-study-act cycles, we identified additional interventions through feedback from the participants in the initiative,” says Dr. Jatana, who is also assistant professor of Otolaryngology – Head and Neck Surgery at The Ohio State University. “For example, we learned that questions related to hearing-impaired patients or those with tracheostomy tubes need expertise from the APN who actively treats them. We began routing those calls directly to the specialized APN rather than the on-call APN for consistency of care.”

Payne and Dr. Jatana credit the success of the program to several factors: a highly motivated and experienced team of nurses, APNs and surgeons in a large tertiary care children’s hospital with a strong QI department. Additionally, weekly reporting and analysis enabled efficient troubleshooting of issues as they occurred. Finally, the support of two full-time nurses dedicated solely to triage duties Monday through Friday was crucial to timely triaging phone calls.

“No additional staff were hired to implement the changes. Instead, utilizing the staff we have and their experience was a big component of our success,” says Dr. Jatana.

The team suggests that future steps focus on the development of additional triage protocols to support nurse decision-making and the implementation of an electronic medical record documentation flow sheet to streamline communication further.

“Our families with chronically ill children or those that must travel far distances or take valuable time off from work or school to bring their children to face-to-face clinic appointments were particularly grateful for the improved phone triage processes,” says Payne. “We are dedicated to ensuring that patients and caregivers have access to the resources they need to navigate their health care.”

 

Reference:

Payne L, Justice L, Lemie S, Elmaraghy CA, Ruda J, Jatana, KR. Interventions to improve response time to nurse triage phone calls in a tertiary care pediatric otolaryngology practice. JAMA Otolaryngology – Head & Neck Surgery. 3 May 2018. [Epub ahead of print]

 

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