With the overarching goal to meet healthcare demands of Americans, it is essential to understand who could benefit from health care via telehealth. Telehealth offers the opportunity to achieve quality aims, addressing barriers to care through innovative means and leveraging technology use in an increasingly technology-centric population. Nursing can play a key role in telehealth to improve care of patients in their organization. This is one organization’s example of the critical role nurses play in telehealth to improve assessment and access for patients awaiting evaluation in our neurology clinic. We will overview a nurse-led innovative program to screen, triage, and educate patients with chronic headache symptoms.
Telehealth at our institution is comprised of a team of experienced registered nurses (RNs). Our team applies high-level knowledge to each telehealth visit to support specialty clinic patients. In collaboration with physician partners, we developed and implemented an evidence-based protocol to assist the nurse in triage, disease management, and education and referral to correct specialist. For example, the neurology clinic receives more chronic headache referrals than they can accommodate on a monthly basis. In fact, patients with chronic headaches were waiting up to 18 months for an appointment in the neurology clinic. On further evaluation of patients seen in the neurology clinic, it was determined that many patients had symptomatology easily managed by the primary care provider. After review of the data, and given the identified limited access for these patients, a project team formed to develop a solution for chronic headache patients: a telehealth nurse program.
First, team education was critical. Education sessions focused on 1) clinical updates on current chronic headache assessment/treatment and evaluation, 2) overview of EMR technology tailored for chronic headache protocols for use by telehealth nurses, 3) collaboration with neurology clinic to understand work flows, e.g. registration and scheduling new referrals, 4) determination of criteria to enroll patients in the program, and 5) integration of key established practice processes in reviewing referrals. Second, marketing materials were created/sent to referring providers. Evidence-based chronic headache management tip sheets were created for providers and families. Non-clinical schedulers who are part of the team were educated on the chronic headache program and how to engage families and schedule the nurse screening calls. Finally, the team identified outcome measures to report success of the program.
Since implementation, we have identified more urgent needs of patients to communicate to providers and gathered additional information not included in the referrals from families to enhance clinic visits. Numerous patients meeting migraine and chronic headache criteria were identified. We educated families on basic headache management and general lifestyle adjustments. The RNs have established evidence to influence protocol changes. Meeting with families by telehealth has also substantially reduced the wait list, with necessary referrals still made. Also noted was increased family participation through higher percentages of answered calls and shortened call lengths. Utilizing case review, we continue to assess the program to identify areas for process improvement.