The purpose of this project was to compare the effectiveness of answering emergent symptom pediatric telephone calls by triage nurses in a centralized pediatric operations center versus triage nurses in their individual pediatric practices.

The centralization of the unlicensed assistive personnel (UAP) and the practice’s predilection to retain triage RNs on site proved to be problematic due to multiple factors. Phone calls with emergent symptoms from patients were answered in regional call centers by the UAP and warm transferred to triage RNs in their individual practices. If the practice triage RN was not able to answer the phone, the call was transferred to a centralized triage RN in the pediatric call center. This resulted in a delayed response.

The practice triage RNs, besides handling phone triage, were expected to triage walk-in patients, administer vaccines and medications, and assist with patient care and treatments. In addition, there was not a process in place for when the triage nurse(s) were out sick, on vacation, or on LOA.

The UAPs were on hold with the patient for extended periods of time waiting for a triage RN causing a delay in their ability answer more incoming calls. Frustrated patients abandoned their call while waiting for a nurse.

A process change was initiated to have all phone calls with emergent symptoms to be answered by the triage RNs in the centralized call center starting in May 2018.

A qualitative study was used to analyze the data pre- and post-implementation of the process change to verify the effectiveness of the project. A total of nineteen triage nurses in the practices including ten on site and nine centralized RNs were involved in the study. Pre-initiative data showed that on a normal business day an average of 20-25 calls were received by the centralized triage RNs because the practice triage RNs were unavailable. Post-initiative data showed that every emergent symptom call was taken as a warm transfer without interruption at the centralized pediatric operations center which provided the patients with timely care.

Multiple implications for best practice of emergent symptom triage calls are noted in this study. It proves that centralized triage is a more efficient and lean process when compared to a traditional model of placing calls directly to the pediatric practice. It is evident that the multiple responsibilities inherent in a pediatric practice prove to be obstacles for efficient triage. Ultimately, the first call resolution and quicker triage response time results in safer care for pediatric patients. As more pediatric practices become centralized this model provides an effective and safe way to care for the pediatric patient.

Elizabeth Jones BSN, RN

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