NEW YORK (Reuters Health) – Strategic use of advanced practice nurses to resolve patient triage issues can speed clinician response time to clinically-relevant phone calls in a high-volume pediatric otolaryngology practice, researchers in Ohio say.
Linda Payne, otolaryngology clinic lead nurse at Nationwide Children’s Hospital in Columbus, told Reuters Health, “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 healthcare.”
“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,” she said by email.
Payne and colleagues conducted a quality-improvement study in their practice, which includes more than 32,000 clinic visits and more than 9,000 surgical patients yearly. They created a collaborative team in 2014 to determine the optimal time for triage callback to families and define a process allowing for more rapid response time for calls that needed to escalate to a patient’s managing surgeon.
As reported online May 3 in JAMA Otolaryngology-Head and Neck Surgery, over the course of 40 months, 4,839 clinically relevant phone calls were received, an average of 128 calls per month. The baseline mean was 101 monthly calls and the post-intervention mean was 130 calls.
Before implementing the collaborative team approach, only 42% of calls were being addressed within two hours, the authors note. After the intervention, the average time for caregiver callback within two hours decreased from 15.3 hours to 3.9 hours and caregivers received clinician callback within two hours 76.7% of the time.
Outcomes were sustained for three years and and continue to be monitored, according to the authors. “The most effective intervention,” they state, “was using advanced practice nurses to efficiently resolve patient triage concerns that were outside the scope of practice of the registered nurse.”
“Our entire team of registered nurses, nurse practitioners, and ear, nose and throat surgeons worked collaboratively to ensure that delivery of patient care was enhanced and that patient expectations for resolution of their concerns were met or exceeded,” Payne said.
Principal author Dr. Kris Jatana, Director, Pediatric Otolaryngology Quality Improvement at Nationwide Children’s Hospital, added by email, “To our knowledge, this is the first published study to objectively track response times to parent/caregiver phone calls, design a novel process, and to successfully sustain that process over time.”
Dr. Stephen Ferrara of Columbia University School of Nursing in New York City told Reuters Health that barriers to quality-improvement programs such as this one include lack of time and resources.
“The quality-improvement project requires considerable planning and attention”” said Dr Ferrara, who is also Editor-in-Chief of the Journal of Doctoral Nursing Practice. “However, the process resulted in enhanced patient outcomes, so the time invested was well worth it.”
“Larger institutions, especially academic medical centers, have the resources and expertise to implement these types of improvements,” he added. “It may be much more difficult for the smaller or solo practices to do. Doctor of Nursing Practice advanced practice nurses are in an ideal position to lead these types of initiatives.”
Dr. Dana M. Thompson, Division Head, Otolaryngology, Head and Neck Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago told Reuters Health by email, “The Nationwide Children’s Group has done something that we all should aspire to do . . . They have created a team-based model of care that allows for more timely response to parent questions and care concerns and a timely escalation of care to the physician, thus improving the perceived quality of the care experience by the parent.”
She continued, “With the utilization of advanced practice providers at upper scope of practice, they demonstrate rapid resolution to care concerns, and ability to recommend self-care, whereas an RN following a care protocol would be more likely to schedule a follow up appointment or emergency department visit that ultimately adds more cost to the delivery of care and plugs access for another patient.”
“The team-based communication algorithm escalates care appropriately to the attending surgeon in an optimized and timely fashion,” she added. “Physician involvement in process-improvement and quality initiatives such as this . . . will be essential for the creation of sustainable solutions that improve quality and decrease costs in a value-based care reimbursement model.”
SOURCE: http://bit.ly/2wzRstn
JAMA Otolaryngol Head Neck Surg 2018.
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