An average pediatric office receives dozens of calls every day. Many are requests for appointments, referrals, letters for school, or prescription refills. Others are for nurse or physician advice. It is important that when parents call regarding ill children, practices have a triage system in place to ensure that patients receive the appropriate level of care (office, emergency department [ED], home care) and are seen in a time frame appropriate for their medical condition (immediately, same day, within 3 days). This article describes how a mobile application, a “web widget,” and an office triage support tool can expedite and improve your existing office triage capabilities.
Call centers vs office triage
Many pediatricians assign after-hours calls to a pediatric call center to ensure that parents concerned about their ill children receive accurate recommendations. These calls are recorded for quality purposes, and are staffed by pediatric nurses who utilize standardized telephone triage protocols. As discussed in last month’s article “Pediatric call centers fast-track urgent care” (Contemporary Pediatrics, April 2017), about 25% of after-hours triage calls result in the recommendation that the patient be seen in an ED; 50% are assigned to receive home care; and the remainder are seen in the physician’s office the next day or within a few days.
During office hours, approximately 50% of calls are for appointments, 30% of calls request nurse triage, and the remaining 20% request prescription refills, health forms, referrals, and so on. (Source: Greenwood Pediatrics and Advanced Pediatrics, Denver, Colorado). Keep in mind that most practices train receptionists to ask office nurses to triage certain calls before an appointment is made. These would involve young infants with fever; children with any trouble breathing; possible dehydration; seizures; injuries; or head trauma.
Office triage nurses will log the call as a phone message in the practice’s electronic health record (EHR), detailing the symptom or symptoms that concern the parent. They will use their telephone triage protocol book to quickly locate the appropriate protocol, and determine and document the patient disposition and the protocol or protocols used. Prudent nurses will place follow-up calls if home advice is given or if the patient is sent elsewhere for urgent evaluation. The Table lists the most common triage protocols used in the office environment in order of decreasing frequency.
Following triage by an office nurse (Figure), 57% of patients need just home-care advice; 21% are seen the same day; 16% are seen within 3 days; 3% are sent to the ED or urgent care; and just 0.1% are told to call 911. The remainder are given other dispositions (seen in office within few weeks, call specialist, call dentist). Although this office triage is sometimes time consuming, it is the best method to identify the level of care needed for the child of a concerned parent. This is not only good care, but it also reduces liability of the practice.