Practice Change in the Ambulatory Care Clinics to Improve Management of Patient Telephone Calls and Messages

Background: Ambulatory care clinic staffing model lacks registered nurses (RNs) and quite often include unlicensed personnel such as medical assistants (MAs) and licensed vocational nurses (LVNs). Due to the scope of practice, unlicensed personnel and LVNs are unable to triage and assess patient calls and messages, whereas it is within scope for RNs. As a result, mishandling of phone calls regarding the appropriate triaging of symptoms was a common occurrence. There is also a lack of guidelines to successfully triage patient calls resulting in potential patient care delays. Practice change was needed to improve the management of patient calls to provide safe patient care in a timely manner.
Purpose: To develop a standardized, evidence-based call team utilizing established resources.
Methods: Data collection and analysis were completed using Excel spreadsheet. The following interventions were performed in collaboration with and support from information technology (IT), clinical support (physician and nurse leads), and leadership teams: 1) Identified best practices through literature review for guidelines regarding triage call teams, 2) identified departments not staffed with RNs to assess needs, 3) identified common reasons for calls and messages, 4) developed 116 standardized algorithms for triaging symptoms, 5) prioritized top 12 reasons for patient calls to develop algorithms and smart phrases, 6) identified experienced staff to cover the call team and assist with training, 7) rotated training schedules to ensure each call member is exposed to all assigned departments, and 8) conducted weekly meetings to review action plans and pending actions.
Results: Data for 13 different specialties were reviewed between August 1, 2021, and July 31, 2022. A total of 116 reasons were identified for patient calls. There were 72 urgent and 44 non-urgent reasons identified. The top 12 reasons included male abdominal pain, female abdominal pain (menstrual cramps), anaphylaxis, anxiety and panic attack, back pain, breathing difficulty, chest pain, COVID-19, dizziness, headache, blood pressure, and leg edema.
Conclusions: The development of the call team utilizing established resources was cost-effective and contributed to the success of the implementation. The new standardized algorithms lead to improved management of patient calls, which resulted in appropriate escalation of urgent symptoms and appropriate triage. A barrier identified was the competing time between usual clinical duties and phone triage commitment. Time was allocated for each commitment to balance the employee’s responsibilities. This practice change can be applied to other ambulatory care areas that have limited RN staffing model.