Nurse Telephone Triage Reduces Unnecessary ER Visits

Patients may sometimes have health concerns that may make them seek emergency room (ER) care directly when they are not sure about the cause of their symptoms. However, the use of nurse telephone triage has reduced unnecessary emergency room visits (Roivainen et al. 2020). Telephone triage is a multifaceted process by which equipped nurses identify a patient's problem, determine the level of urgency, and advise the patient over the phone. In this system, nurses use standardized protocols to evaluate some of the patients' symptoms over the phone, determine the suitable cause of action and eventually give appropriate medical advice or precautions that could help the patients (Roivainen et al. 2020). Quality telephone triage schedules are composed of five integrated components that work mutually to implement a reliable, timely delivery of care or access to care. These include qualified and experienced clinical staff, training, guidelines or protocols, sufficient documentation, and evidenced-based Standards (Keizer et al. 2016). To achieve quality documentation, triage nurses must be well trained in assessment skills that would help them evaluate patients without having actual physical contact (Keizer et al. 2016). Nurse telephone triage can thus be a useful and helpful technique that can be used to give medical advice in various situations, for instance, in any case of a total lockdown, as was in the case of Wahun city in China due to COVID-19 pandemic (2020). The training enables nurses to use their medical knowledge of symptoms and disease processes along with evidence-based protocols. Thus achieving an accurate understanding of the patient's symptoms and providing the best care plan based on the specific symptoms while keeping sufficient records of patient's information (Keizer et al. 2016).

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The consistency and quality of documentation and telephone triage services at many health facilities are increasingly being reviewed due to the inconsistent absence use of established protocols (Chan 2016). In the past, there has been an increasing interest in health centers acquiring established evaluation protocols for triage nurses to use (Keizer et al. 2016). Community health centers within the United States have thus begun developing strategic plans to improve documentation telephone triage encounters that are reliable, accurate, and cost-effective.

Implementing a telephone triage with a sufficient documentation system is, therefore, an opportunity to train and educate patients and patient's families on how to manage their health care by guiding them to an appropriate level of care (Delaney 2017). Usually, triage calls that are answered immediately and in good time increase patient satisfaction, quality care and thus reduce inefficiencies in the nurse triage and documentation process. Effective implementation of sufficient triage documentation encounters improves lives through education, care, and community awareness (Delaney 2017). The quality of nursing documentation is, therefore, an essential issue for nurses both nationally and internationally. Nursing documentation should thus be adopted worldwide. Several frameworks are currently available to assist with nursing documentation, including narrative charting, problem-orientated approaches, clinical pathways, and focus notes. However, some of the nurses still experience barriers to maintaining accurate and legally prudent documentation, especially telephone triage documentation (Delaney 2017). Therefore, this paper outline the benefits of sufficient telephone triage documentation and structures a curriculum that can help in training non-experience nurses on the skills and protocols of sufficient nurse telephone triage documentation.

Background

Nurse triage emerged in the early 1800s, where it was seen as a system for attending to wounded soldiers (Farris 2015). In the time of Napoleonic Wars, Baron Dominique-Jean Larrey, a French surgeon, realized that the first-come-first-serve practice was resulting in many losses of lives (Farris 2015). He suggested that lives could be saved if the soldiers were prioritized concerning their severity of conditions Gaul, A., 2016. After that, various organizations began utilizing nurse triage and documentation in different venues; outside the military field, nursing triage was first used in emergency rooms of health facilities in the United States by the early 1900s and was later adopted nationally (Farris 2015). In the 1960s, the first nurse triage call center was established and brought about the availability of computerized guidelines and documentation in the mid-1980s Gaul, A., 2016.

The use of nurse documentation of telephone triage encounters requires conscientious regard to the organizational culture and configuration, staff experience, and abilities (Farris 2015). It also involves staffing issues, observed need and expected outcomes, and physical location in which the system will be introduced. Sufficient documentation usually includes the patient's name, date, time, and name of the caller or the relationship to the caller (Farris 2015). Apart from improving patient satisfaction, telephone triage, and sufficient documentation also reduces costs and provides a high standard of patient care.

Sufficient documentation enables better integration of information between triage nurses and physicians and creates a more straightforward method for patients to access and communicate with nurses. In a case study, at a Sacramento health center, the internal call center manages two clinics during regular business. After-hours calls are usually operated by nurses that generally work for a contracted call service provider. Nurses can do one of the following with the incoming calls. First, they can schedule patients for an appointment during the health center's business hours; second, they direct patients to urgent care, and they can also lead the patients to the emergency room. The facility's call center with ten employs generally managed approximately 8300 calls during February 2018; nearly 2000 of those calls needed protocol-based nursing advice (Mays 2018). However, those patients received unstandardized information from nurses based on their own experience and training, therefore the need for education and training in the field of nurse telephone triage and documentation that could improve the level of healthcare to the patients.

The importance of nursing documentation of telephone triage using evidence-based protocols to give patient advice includes coordinated care, better patient access, and cost-saving. Some studies have shown that nearly 70% of emergency room visits can be avoided with access to sufficient nursing staff who use evidence-based and telephone triage documentation protocols to advice patients (Mays 2018) effectively. In recent studies, it is evidenced that appropriate documentation, and nurse telephone triage have been useful are have help reduce unnecessary trips to the emergency rooms. When asked what they could do if they are not able to access a telephone triage nurse, out of 35,409 patients who were surveyed, 11,135 (31.45%) said they would go to the emergency room (Mays 2018). Also, 22, 273 (63%) said they would have remained at home; the remaining patients would have preferred going to a local urgent care center (Mays 2018). The results were then compared to survey results of what a telephone triage with proper documentation would tell patients to do. Out of 11, 135 patients who initially said they would have preferred going to the emergency room, only 3,222 of the patients said they would have gone emergency room (Mays 2018). The remainder preferred to get home care. It thus proves that access to nurse telephone triage can reduce unnecessary emergency room visits by 70% (3,222/11, 135). Training and educating nurses on appropriate nurse documentation of telephone triage will help improve health outcomes for most patients (Mays 2018). As evidenced in the case study above, nurse triage reduces not only unnecessary emergency room visits but also lower costs.

Therefore, nurses in all settings and levels of service should be provided comprehensive training and education in the technical elements of sufficient documentation and the organization's procedures and policies that are related to literature. This training and education should include staffing issues that take into account the time needed for documentation work. This ensures that each nurse is capable of (1) Competence in the use of the computer and its supporting hardware, (2) practical and skillful use of the global documentation system, and (3) Proficiency in the use of the software systems such as PLY version of EPIC software in which documentation. Other relevant patients, documents, data, nursing, and health care reports are also captured (Greenberg and Rutenberg, 2020).

Curriculum Development and Training Need Analysis

Before scheduling the workshop, nurses will be encouraged to access and complete the online VARK questionnaire available at https://vark-learn.com/the-vark-questionnaire/ and provide a printed copy of their results. Non-experienced nurses will also receive a brief survey to assess their general knowledge, understanding, and requirements for sufficient documentation as well as to identifying their expected learning outcomes of the workshop (Skogevall et al. 2020). The workshop outline and activities shall be determined based on the overall results of both the VARK and assessment questionnaires (Skogevall et al. 2020).

Target Audience

Telephone triage nurses working in the clinical contact center at a tertiary hospital, other clinical professionals, doctors, and clinic nurses that would also benefit from this service improvement are welcome to participate in the workshop.

The Purpose of the Workshop Training

Feedback obtained from both the Nurse Triage (NT) quality monitoring committee and other clinical professionals who refer to triage nurse encounters to get information regarding patient's past interactions with the NT department identified the following main concern:

Lack of a standardized framework to guide nurses' document their telephone triage encounters, as evidenced by disparities in both the quality and quantity of documented information.

Nurse triage quality and monitoring committee highlighted discrepancies between the oral and written aspects of the telephone triage encounters. Whereas, other clinical professionals described how missing information caused a gap in knowledge relevant to the patient's treatment timeline, which in turn affected patients' experience and outcomes in general.

Nevertheless, there is a need to improve the quality of telephone triage nurses' documentation to level up to all the standards of sufficient information delivery that are emphasized by the SBAR tool (Neilson and Reeves 2019). Furthermore, the emphasis here would not only introduce the SBAR tool as the framework for the documentation but work around a set of specific guidelines. Hence it would guarantee not only the sufficiency of information that is being documented but also its significance to other caregivers and on the patients' future treatments (Magee and Coop 2018).

Sufficient documentation is a crucial factor in every health facility; currently, there is an increase in the use of nurse telephone triage encounters. However, some nurses still experience barriers to maintaining accurate and legally prudent documentation, especially telephone triage documentation (Magee and Coop 2018). Therefore there is a need to train and educate telephone triage nurses working in the clinical contact center at a tertiar...