INFORMATICS:TELETRIAGE

PRESENTERS:

Jennifer Bustamante

Jennifer Matthews

Stella Ezeamama

QSEN & INFORMATICS

QSEN Definition: Use information and technology to communicate, manage knowledge,

mitigate error, and support decision making.

Apply technology and information to support safe care

Document and plan patient care in EHR

Use information management tools to monitor outcomes of care

Protect confidentiality of EHR

Recognized by the ANA as a specialty for registered nurses in 1992.

Care and attention of information began with Florence Nightingale, 1873.

Organization of information could help decide questions.

Show how money was being spent.

Determine what good was really being done.

PROBLEM: OVERUSE OF THE ED Insured patients over utilizing the ED with non-emergent medical problems

Habitual users: chronically ill, medi-cal insured

80% of non-emergent cases treated at ED

– Acute respiratory infections

– Acute bronchitis

– Otitis media

– Acute pharyngitis

– Headache

– UTI

– Lower back pain

WHY IS THIS IMPORTANT?

Average wait time SBC/Riv Co 3.5hrs

Lower quality of care especially for chronically ill

ED visits use up financial resources

ED beds delay holds up ambulances

Lack of education and resources provided on primary care options

Four key factors in driving avoidable

users to ED

Possible strategies for reducing

excess use of ED

i. Lack of access to medical care outside of

ED

ii. Lack of advice from physicians on how to

handle sudden medical conditions

iii. Lack of alternatives to the ED

iv. Positive attitudes toward the ED

i. Improving access to PCP, urgent care, nurse

advice lines, sources of regular care

ii. Expanding hours of service and access to

primary care into evenings and weekends

iii. Improve processes in order to handle patients

more efficiently

Tele-Triage

Nursing

Tele-Health

Tele-

Medicine

SUGGESTIONS FOR CHANGE

TELE-TRIAGE NURSING

What is triage?

Sorting of patients according to the urgency of their need of care.

Clinical risk management.

Patient flow begins at triage.

Three stages of triage

i. Pre-hospital

ii. Triage at scene by first responder

iii. Arrival at hospital in the ED

POTENTIAL FOR SUCCESS

Consult-a-nurse healthcare.

Intervention to help alleviate overcrowding within the ED.

Personable service to the community

assessment tools and guidelines

Experienced and trained nurses

CARING ENCOUNTER

MODEL

Perception of an quality care encounter is perceived as

good when the staff is friendly, supportive, respectful,

composed. Compliance and acceptance of the advice was

increased when the caller was allowed to take an active

part in the consultation. (Strom, Marklund, & Hildingh,

2009)

INTERDISCIPLINARY TEAM

Project Manager

Medical Staff Representative

Department Managers

Information Technology Representative

Financial Officer

Human Resource Representative

Legal Representative

Quality Improvement Representative

RESOURCE OF TIME / COST

Implementation: 6 months

Evaluation: 1 year

Fiscal Budget: $830,000

Staff

Training cost

Documentation forms

Standard-based protocols

Tele-Triage Nurse Training:

3-days training for 30 hours CE units

2-4 weeks one-on-one training with the

unit preceptor

EXPERT TELE-TRIAGE NURSE

Qualification:

A well-trained RN who excels in process skills; clinical knowledge; critical thinking; and listening skills.

About 5-10 years of clinical experience in medical-surgical, pediatric, or other specialty units to cover the range of patients.

Salaries: The cost of retaining a tele-triage is estimated at $65,804- $78,190 in the San Bernardino county (salary.com)

MARKETING STRATEGIES

Brochures in Doctors Office / Public

Health Organizations / Schools

Print-Advertising (Billboard &

Newspaper)

Media (Radio / Social Media)

Addition to RCH Web Site in a banner

style

Creating partnership with medical

providers / PHN

PROJECT SUMMARY

Integrate current systems and departments to add an tele-

triage program to enhance hospital services within our

community.

Alternative approaches and probabilities for future use:

Upgrade to video and utilize modern technology such as cell phones (FaceTime)

and computers (skype)

Interdisciplinary approach: Social workers, public health nurses….

EVALUATION OF CONSEQUENCES

A- Overuse, overcrowding concern

D-Misuse of the ED for non emergent

cases results in overcrowding and

waste of hospital resources.

P- Tele triage will enable immediate

attention to more severe cases to the

ER

I- One year of implementation

• For our one year evaluation, we

will use AAPIE

CHANGE THEORY: HOW PLANNED CHANGE BECOMES PART OF A

SYSTEM

Within all aspects of change:

Driving forces

(facilitators)

Restraining forces

(barriers)

UNFREEZING

People become discontented enough with status

quo to support change

Data gathering

Assessing/diagnosing problem

Decide if change is necessary

Make others aware of the need for change

MOVEMENT

Identifies, plans, and implements strategies

Develop a plan (team-based, inclusive)

Set goals/objectives

Identify areas of support and resistance

Confront resistance

Evaluate change

Modify change, if necessary

REFREEZING

Stabilize change so it becomes the

new normal

3 - 6mos for change to cement

Requires support and positive reinforcement of new behaviors

NURSING TELE-TRIAGE

The future is NOW…..

REFERENCES• Aacharya, R. P., Gastmans, C., & Denier, Y. (2011). Emergency department triage: an ethical analysis. BMC

Emergency Medicine, 11(16). doi:1471-227X/11/16

• American Nurse Association. (2014). American Nurses Credentialing Center - ANCC. Retrieved January 27, 2015, from http://www.nursecredentialing.org/default.aspx

• Barber, J.W., King, W.D., Monroe, K. W., & Nichols, M.H. (2000). Evaluation of emergency department referrals by telephone triage. Pediatrics, 105:819-21

• Bayer, E., & John, J. (2010). Innovations in reducing preventable hospital admissions, readmissions, and emergency room use.

• Bearden, M.B., Brown, T., Kirksey, K.M., Dansby, M., & Hilliard, M. (2008). Easing the Chaos in emergency departments: Implementation of the 'Ask your nurse' Teletriage program. Journal of Emergency Nursing, 34:3 Retrieved from AHIP Center for Policy and Research website: ahipresearch.org

• Cronenwett, L. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131. Retrieved from http://dx.doi.org/10.1016/j.outlook.2007.02.006

• ER wait time in Riverside County hospitals - Riverside, CA - HospitalStats. (n.d.). Retrieved from http://www.hospitalstats.org/ER-Wait-Time/Riverside-County-CA.htm

• ER wait time in San Bernardino County hospitals - San Bernardino, CA - HospitalStats. (n.d.). Retrieved from http://www.hospitalstats.org/ER-Wait-Time/San-Bernardino-County-CA.htm

• Fogt, A. (2015, January 26). Officials call long ambulance unloading times 'serious issue'. Retrieved February 3, 2015, from http://www.hesperiastar.com/article/20150124/NEWS/150129885/10082/NEWS

• Learning module 7 | QSEN. (n.d.). Retrieved from http://qsen.org/courses/learning-modules/module-seven/

REFERENCES

•Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing (8th ed.). Philadelphia, PA: Wolters Kluwer Health.

• Overuse of emergency departments among insured californians - CHCF.org. (n.d.). Retrieved from http://www.chcf.org/publications/2006/10/overuse-of-emergency-departments-among-insured-californians

• Pre-Licensure KSAs | QSEN. (n.d.). Retrieved from http://qsen.org/competencies/pre-licensure-ksas/#informatics

• Purc-Stephenson, R. J., & Thrasher, C. (2010). Nurses' experiences with telephone triage and advice: a meta-ethnography. Journal of Advanced Nursing, 66(3), 482-494. doi:10.1111/j.1365-2648.2010.05275

• Singh, K., & Warnock, C. (2013). Assessing the value of a nurse-led telephone advice and triage service. Cancer Nursing Practice, 12(4), 30-35.

• Strom, M., Marklund, B., & Hildingh, C. (2009). Callers' perceptions of receiving advice via a medical care help line. Nordic College of Caring Science, 23, 682-690. doi:10.1111/j.1471-6712.2008.00661.x

• Wheeler, S. (2013, November 5). Telephone triage & ED gridlock: Back to the future? - teletriage systems. Retrieved January 27, 2015, from http://teletriage.com/articles/ed-gridlock/

• Wheeler, S., & Ness, S. M. (2014). Telephone triage nursing course | affordable continuing education. Retrieved February 1, 2015, from http://www.nursingceu.com/courses/465/index_nceu.html

• Williams, B., Warren, S., McKim, R., & Janzen, W. (2012). Caller self-care decisions following teletriage advice. Journal of Clinical Nursing, 21, 1041-1050. doi:10.111/j.1365-2702.2011.03986.x