Faith Jones, MSN, RN, NEA-BC, Care Coordination and Lean Consultant, HealthTech
Updated: 04/22/25
Updated: 04/22/25
This project focused on improving access to behavioral health integration (BHI) and collaborative care management (CoCM) in rural health clinics in Wyoming, utilizing a consortium model to streamline care, enhance coordination, and ensure financial viability.
To integrate behavioral health into primary care, we researched Medicare regulations for BHI and CoCM in rural clinics, ensuring compliance and proper billing practices. Partnering with CrossTx, we helped design software to meet Medicare billing requirements and serve as a registry for collaborative care. Additionally, we collaborated with the Wyoming Medicaid medical director to include CoCM billing codes in the Medicaid fee schedule, making CoCM services more accessible to Wyoming’s rural populations.
The project team developed a business plan to ensure the cost-effectiveness of CoCM services for rural clinics, surpassing the fees for the contracting psychiatric provider. This included hiring a Wyoming-licensed psychiatric nurse practitioner and establishing a consortium of enrolled clinics. We trained care coordinators on presenting case reviews concisely, optimizing the psychiatric provider’s time while fostering collaborative learning. Zoom meetings were set up to facilitate workflow, streamline case reviews, and reinforce the collaborative model.
Project structure: The project started by having care coordinators review patients in the chronic care management (CCM) program to identify those with concurrent behavioral health needs. Patients with identified behavioral health conditions were enrolled in the BHI program, allowing care coordinators to strengthen relationships with these patients through dedicated care coordination time. Care coordinators selected validated screening tools appropriate for each patient’s needs, conducting screenings regularly to monitor trends in behavioral health.
Project process: For patients identified for CoCM, care coordinators used the CrossTx platform to initiate a clinical consult, uploading relevant patient data such as problem lists, medications, and lab results. The psychiatric provider could access CrossTx to review patient cases without requiring access to multiple electronic health record (EHR) systems used across the consortium clinics.
Weekly consortium meetings allowed each care coordinator to present a brief case review to the psychiatric provider, who would then lead discussions, clarify points, and provide written recommendations in CrossTx. This collaborative format ensured that the care coordinators could access timely psychiatric guidance while supporting primary care teams with updates and medication adjustments. The psychiatric provider also logged time spent on each case review, while care coordinators tracked their own monthly patient interactions.
Patients enrolled in CoCM continued to participate in the consortium’s weekly case reviews until the behavioral health exacerbation was resolved. Once resolved, all patients remain in BHI program to ensure consistent support and monitoring with the ability to be elevated to CoCM if needed.
Project outcomes: Consortium data showed that 34% of enrolled CCM patients had behavioral health conditions, underscoring the need for integrated care in rural settings. Financial tracking revealed that the consortium participation fee accounted for just 21% of total CoCM revenue, affirming the program’s sustainability. Beyond financial metrics, the project highlighted the benefits of a team-based, whole-person care model with rural patients receiving comprehensive support and close psychiatric oversight, ultimately improving behavioral health outcomes.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 04/22/25
Updated: 04/22/25
According to Yang et al. (2021) “the artificial intelligence (AI) revolution is building momentum in health care. It presents an opportunity for primary care to ride the wave of technology development and plow an innovative pathway of modernization to improve population health.” This poster presents a transformative approach to leadership, focusing on the integration of artificial intelligence (AI) in primary care. Nurse leaders are crucial in leveraging technology to enhance patient care and streamline healthcare processes. This initiative explores the strategic use of AI to improve population health outcomes and optimize the role of registered nurse care managers.
Chronic health conditions pose a challenge in health care, often leading to substantial morbidity and mortality. Patient outreach, laboratory testing, and routine monitoring often hinder effective management of these conditions, causing open care gaps. Leadership has acknowledged the growing prevalence of texting capabilities to reach a larger patient population. Utilizing these capabilities, we implemented AI technology to support the closure of care gaps, facilitating adherence to testing and monitoring, to promote improved health maintenance.
Digital technology is an essential tool necessary for primary care to carry out its basic functions. This AI platform is designed to analyze discrete and indiscrete data within the electronic health record to ascertain whether patients have completed the necessary elements to close care gaps. In instances where a care gap persists, the system initiates electronic outreach to patients via mobile device. The technology provides patients with the convenience to schedule appointments or request services. Based on the patient’s response, they may be offered a nurse visit appointment, laboratory testing, or referral. The initiative showcases success measures, including a 98% patient satisfaction rate, care gap closure, and streamlined care management processes. The phased approach to implementation across 22 primary care clinics and collaboration with interdisciplinary teams underscore the effectiveness of integration. This technology has outreached to more than 28,000 patients, with 27% of those patients engaging via smartphone. Over 3,200 appointments have been scheduled, making this a successful implementation.
In summary, nursing leadership was instrumental in the transformative approach to integrate AI in the primary care setting. Nurse leaders have the unique ability to engage and understand nursing scope, patient care and patient experience and leverage improved patient health outcomes to optimize the role of the registered nurse care manager in the outpatient setting. Looking ahead, the potential for AI in health care is vast. Continuous advancements in AI promise even greater improvements in patient care and management, paving the way for a more efficient and effective healthcare system.
Chronic health conditions pose a challenge in health care, often leading to substantial morbidity and mortality. Patient outreach, laboratory testing, and routine monitoring often hinder effective management of these conditions, causing open care gaps. Leadership has acknowledged the growing prevalence of texting capabilities to reach a larger patient population. Utilizing these capabilities, we implemented AI technology to support the closure of care gaps, facilitating adherence to testing and monitoring, to promote improved health maintenance.
Digital technology is an essential tool necessary for primary care to carry out its basic functions. This AI platform is designed to analyze discrete and indiscrete data within the electronic health record to ascertain whether patients have completed the necessary elements to close care gaps. In instances where a care gap persists, the system initiates electronic outreach to patients via mobile device. The technology provides patients with the convenience to schedule appointments or request services. Based on the patient’s response, they may be offered a nurse visit appointment, laboratory testing, or referral. The initiative showcases success measures, including a 98% patient satisfaction rate, care gap closure, and streamlined care management processes. The phased approach to implementation across 22 primary care clinics and collaboration with interdisciplinary teams underscore the effectiveness of integration. This technology has outreached to more than 28,000 patients, with 27% of those patients engaging via smartphone. Over 3,200 appointments have been scheduled, making this a successful implementation.
In summary, nursing leadership was instrumental in the transformative approach to integrate AI in the primary care setting. Nurse leaders have the unique ability to engage and understand nursing scope, patient care and patient experience and leverage improved patient health outcomes to optimize the role of the registered nurse care manager in the outpatient setting. Looking ahead, the potential for AI in health care is vast. Continuous advancements in AI promise even greater improvements in patient care and management, paving the way for a more efficient and effective healthcare system.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 04/22/25
Updated: 04/22/25
Purpose: Transitioning into ambulatory care nursing presents unique challenges for experienced registered nurses (RNs). Despite the common assumption that experienced RNs can seamlessly adapt to any healthcare setting, a substantial number report a limited understanding of the role and expectations of an RN in ambulatory care. This transition is similar to post-licensure transition to practice, but lacks the support typically provided through formalized nurse residency programs. Observations show that many RNs return to their previous practice settings within 3-12 months of transitioning into ambulatory care. There is a solution to this challenge that can aid experienced RNs in successfully navigating this transition period and remaining in their roles as ambulatory care RNs. This solution comes in support like a residency program.
Description: A large multi-site health system in the Midwest has implemented an innovative custom multimodal program titled “The Ambulatory Nursing Fellowship” in January 2023. This program is designed to provide targeted education and support to experienced RNs during the critical role transition period. The curriculum for the ambulatory nursing fellowship was developed using the American Academy of Ambulatory Care Nursing’s (AAACN) RN residency program as a blueprint. This six-month program comprises monthly asynchronous didactic courses delivered through a learning management system and monthly in-person peer group meetings. The didactic content is designed to equip RNs with knowledge specific to the ambulatory care setting. This includes a wide range of topics, such as telehealth, care coordination, models of care, scopes of practice, compliance with regulatory bodies, ethical practice, health literacy, cultural competence, leadership, and certification preparation. These topics are all crucial for RNs practicing in ambulatory care. The monthly peer group meetings offer education on health system-specific ambulatory care workflows such as organizational improvement, electronic medical record use optimization, comprehensive behavioral health patient care, and more. They also provide networking and social support among RNs experiencing the role transition simultaneously allowing RNs to share their experiences, support, and learn from each other.
Outcome: As of June 2024, 30 RNs have completed the program. 97% of these RNs remain in their roles as ambulatory care RNs. This retention rate serves as a reminder that even the most experienced RNs can benefit from targeted support and education when transitioning into a new specialty. Multi-site expansion, NCPD, and virtual attendance options are planned for program enhancement. The program’s success highlights the value of targeted support during role transitions, and plans for multi-hospital expansion, NCPD, and virtual attendance options further enhance its impact.
Description: A large multi-site health system in the Midwest has implemented an innovative custom multimodal program titled “The Ambulatory Nursing Fellowship” in January 2023. This program is designed to provide targeted education and support to experienced RNs during the critical role transition period. The curriculum for the ambulatory nursing fellowship was developed using the American Academy of Ambulatory Care Nursing’s (AAACN) RN residency program as a blueprint. This six-month program comprises monthly asynchronous didactic courses delivered through a learning management system and monthly in-person peer group meetings. The didactic content is designed to equip RNs with knowledge specific to the ambulatory care setting. This includes a wide range of topics, such as telehealth, care coordination, models of care, scopes of practice, compliance with regulatory bodies, ethical practice, health literacy, cultural competence, leadership, and certification preparation. These topics are all crucial for RNs practicing in ambulatory care. The monthly peer group meetings offer education on health system-specific ambulatory care workflows such as organizational improvement, electronic medical record use optimization, comprehensive behavioral health patient care, and more. They also provide networking and social support among RNs experiencing the role transition simultaneously allowing RNs to share their experiences, support, and learn from each other.
Outcome: As of June 2024, 30 RNs have completed the program. 97% of these RNs remain in their roles as ambulatory care RNs. This retention rate serves as a reminder that even the most experienced RNs can benefit from targeted support and education when transitioning into a new specialty. Multi-site expansion, NCPD, and virtual attendance options are planned for program enhancement. The program’s success highlights the value of targeted support during role transitions, and plans for multi-hospital expansion, NCPD, and virtual attendance options further enhance its impact.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Sheryl Bartlett, BSN, RN, Nurse Manager, After-Hours Triage, UT Southwestern Medical Center | Alicia Bosse, MBA, BSN, CMSRN, AMB-BC, Clinical Nurse Educator, UT Southwestern Medical Center | Linda Jackson, MSN, RN, Senior RN Director, Children's Health Dallas | Murray Raymond, BSN, RN, DC | Calli Wood, MSN Ed, RN, NPD-BC, Director of Ambulatory Nursing Education and Training, UT Southwestern Medical Center
Updated: 05/18/25
Updated: 05/18/25
At a national conference, leaders from two healthcare organizations identified a critical gap in professional development for telephone triage nurses. Specifically, there was a lack of affordable, standardized learning opportunities that addressed the distinct needs of triage nursing across different settings. Both leadership teams recognized the need to provide cost-effective, structured training to improve triage skills, clinical decision-making, and adherence to regulatory standards.
This initiative’s primary goal was to develop and implement a standardized telephone triage education symposium tailored for nurses at both institutions. The program aimed to equip nurses with essential skills to enhance patient safety, improve clinical practice, and ensure compliance with regulatory requirements, particularly in managing triage calls. A key component was offering the training at no cost to participants to encourage wide accessibility and participation.
To develop the curriculum, leadership teams from both organizations held monthly collaborative Zoom meetings. These sessions included additional stakeholders from leadership and education departments who helped outline content, assign responsibilities, and create the necessary educational materials. The final program included two four-hour sessions, with content delivered by staff from both organizations through a shared presentation.
The symposium content covered regulatory requirements, including licensing standards and an overview of relevant nurse practice acts; triage fundamentals, such as conducting a focused assessment, obtaining a patient’s health history, and following established protocols; practical learning through an “escape room” activity where participants solved triage case scenarios; customer service skills to manage difficult calls and handle abusive callers; and going beyond the triage call with items including care coordination and the addressing of social determinants of health.
A total of 41 nurses attended the two-day educational event, which awarded participants with three nursing continuing professional development (NCPD) credits. Feedback was overwhelmingly positive: 73.3% of participants rated the training as “outstanding,” while 26.7% rated it as “good.” Nurses reported significant improvements in understanding regulatory standards and their application in telephone triage, particularly in following protocols and state nurse practice acts.
Furthermore, 80% of attendees rated the customer service training and strategies for managing difficult calls as “outstanding,” with the remaining 20% giving a “good” rating. The program not only enhanced participants’ clinical decision-making and patient interactions but also laid a foundation for continued improvements in telephone triage education. Plans are underway to record the sessions, expanding access to nurses unable to attend and offering the potential to provide continuing education credits to a broader audience.
Learning outcome: The project successfully increased nurses’ understanding of regulatory standards and enhanced their clinical decision-making and ability to manage challenging triage calls, supporting improved patient safety and care.
This initiative’s primary goal was to develop and implement a standardized telephone triage education symposium tailored for nurses at both institutions. The program aimed to equip nurses with essential skills to enhance patient safety, improve clinical practice, and ensure compliance with regulatory requirements, particularly in managing triage calls. A key component was offering the training at no cost to participants to encourage wide accessibility and participation.
To develop the curriculum, leadership teams from both organizations held monthly collaborative Zoom meetings. These sessions included additional stakeholders from leadership and education departments who helped outline content, assign responsibilities, and create the necessary educational materials. The final program included two four-hour sessions, with content delivered by staff from both organizations through a shared presentation.
The symposium content covered regulatory requirements, including licensing standards and an overview of relevant nurse practice acts; triage fundamentals, such as conducting a focused assessment, obtaining a patient’s health history, and following established protocols; practical learning through an “escape room” activity where participants solved triage case scenarios; customer service skills to manage difficult calls and handle abusive callers; and going beyond the triage call with items including care coordination and the addressing of social determinants of health.
A total of 41 nurses attended the two-day educational event, which awarded participants with three nursing continuing professional development (NCPD) credits. Feedback was overwhelmingly positive: 73.3% of participants rated the training as “outstanding,” while 26.7% rated it as “good.” Nurses reported significant improvements in understanding regulatory standards and their application in telephone triage, particularly in following protocols and state nurse practice acts.
Furthermore, 80% of attendees rated the customer service training and strategies for managing difficult calls as “outstanding,” with the remaining 20% giving a “good” rating. The program not only enhanced participants’ clinical decision-making and patient interactions but also laid a foundation for continued improvements in telephone triage education. Plans are underway to record the sessions, expanding access to nurses unable to attend and offering the potential to provide continuing education credits to a broader audience.
Learning outcome: The project successfully increased nurses’ understanding of regulatory standards and enhanced their clinical decision-making and ability to manage challenging triage calls, supporting improved patient safety and care.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Alicia Bosse, MBA, BSN, CMSRN, AMB-BC, Clinical Nurse Educator, UT Southwestern Medical Center | Amy Brewer, MSN, RN, Director of Ambulatory Nursing, UT Southwestern Medical Center | Calli Wood, MSN Ed, RN, NPD-BC, Director of Ambulatory Nursing Education and Training, UT Southwestern Medical Center
Updated: 04/22/25
Updated: 04/22/25
According to the National Academy of Medicine’s latest Future of Nursing report (2021), ambulatory care nurses are uniquely positioned to assess and address healthcare inequities and the social determinants of health (SDOH) for our communities. At a large urban academic medical center encompassing over 90 clinics across a multi-city metroplex that hosted over 2.5 million patient encounters in 2023, addressing SDOH was identified as a significant opportunity to impact community health outcomes.
In the summer of 2024, a multidisciplinary workgroup was formed, including nurse executives, nursing professional development practitioners (NPDs), information resource (IR) analysts, and clinical workflow informaticists (CWI). This workgroup aimed to evaluate current SDOH workflows and assess the potential for new workflows, such as automated SDOH screening and resource referrals. Initial analysis revealed limited SDOH documentation, lack of available resources in the electronic health record (EHR), and deficient access to social workers (SW), pointing to a limited addressal of SDOH needs. Concurrently, additional workgroups were tasked with establishing a pool of available SWs to support primary care clinics and improve SW workflows to help address patient care needs. Collaboration with IR analysts and CWI led to an innovative EHR-integrated workflow that included automated patient questionnaires and automated referrals to the social work (SW) team that triggers after high-risk areas are identified.
Three primary care clinics were identified to pilot the automated workflows, which began in November 2024. To prepare staff before the pilot implementation, socialization of the project took place with clinic leadership, followed by live virtual training with nurses, medical office assistants (MOAs), and SWs. This training included the background and purpose of assessing SDOH needs along with visual demonstrations of the workflow. Upon completion of the training, tipsheets with workflows were provided for clinical staff and leadership to ensure all employees were prepared and the workgroup was available for feedback.
Before implementation, only 23 referrals were placed to the newly available SW team over three weeks. Assessment of SDOH was scarce amongst health system clinics before implementation, and the resources available were insufficient for the nurse to adequately provide to patients if a need was identified. By the time of implementation, there were over 3,000 resources identified and created within the EHR for nurses to share with patients. Pilot data will capture anticipated increases in SW team referrals and provide baseline insights for SDOH reassessment post-intervention.
Initial outcomes after one week of pilot implementation include a 42% completion rate of assessments, with 14 of those identifying high-risk needs and producing automated referrals to SW. Additional outcomes to be measured will also include updated completion rates, referral counts, and the secondary impact on reassessed high-risk SDOH needs. Upon completion of the pilot, implementation will be expanded to all primary care clinics in the health system, and outcomes will be tracked through our EHR dashboard. Future implications include expansion to these clinics and the potential that this project could dramatically influence SDOH initiatives and workflows throughout the numerous remaining clinics within the organization.
In the summer of 2024, a multidisciplinary workgroup was formed, including nurse executives, nursing professional development practitioners (NPDs), information resource (IR) analysts, and clinical workflow informaticists (CWI). This workgroup aimed to evaluate current SDOH workflows and assess the potential for new workflows, such as automated SDOH screening and resource referrals. Initial analysis revealed limited SDOH documentation, lack of available resources in the electronic health record (EHR), and deficient access to social workers (SW), pointing to a limited addressal of SDOH needs. Concurrently, additional workgroups were tasked with establishing a pool of available SWs to support primary care clinics and improve SW workflows to help address patient care needs. Collaboration with IR analysts and CWI led to an innovative EHR-integrated workflow that included automated patient questionnaires and automated referrals to the social work (SW) team that triggers after high-risk areas are identified.
Three primary care clinics were identified to pilot the automated workflows, which began in November 2024. To prepare staff before the pilot implementation, socialization of the project took place with clinic leadership, followed by live virtual training with nurses, medical office assistants (MOAs), and SWs. This training included the background and purpose of assessing SDOH needs along with visual demonstrations of the workflow. Upon completion of the training, tipsheets with workflows were provided for clinical staff and leadership to ensure all employees were prepared and the workgroup was available for feedback.
Before implementation, only 23 referrals were placed to the newly available SW team over three weeks. Assessment of SDOH was scarce amongst health system clinics before implementation, and the resources available were insufficient for the nurse to adequately provide to patients if a need was identified. By the time of implementation, there were over 3,000 resources identified and created within the EHR for nurses to share with patients. Pilot data will capture anticipated increases in SW team referrals and provide baseline insights for SDOH reassessment post-intervention.
Initial outcomes after one week of pilot implementation include a 42% completion rate of assessments, with 14 of those identifying high-risk needs and producing automated referrals to SW. Additional outcomes to be measured will also include updated completion rates, referral counts, and the secondary impact on reassessed high-risk SDOH needs. Upon completion of the pilot, implementation will be expanded to all primary care clinics in the health system, and outcomes will be tracked through our EHR dashboard. Future implications include expansion to these clinics and the potential that this project could dramatically influence SDOH initiatives and workflows throughout the numerous remaining clinics within the organization.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Sheryl Bartlett, BSN, RN, Nurse Manager, After-Hours Triage, UT Southwestern Medical Center
Updated: 05/19/25
Updated: 04/22/25
Financial stewardship is a priority in healthcare today. Return on investment (ROI), productivity, and quality are key indicators for every organization. A telephone triage program relies on efficiency in productivity and staffing to ensure that quality patient care is being provided.
In reviewing the literature, there was limited information about telephone triage nursing productivity. Comparisons are made with non-nursing call centers looking at the number of calls managed hourly. Surveys have been completed by Schmitt Thompson Clinical Content (STCC, 2023) to try to establish a consensus on the average number of calls triage nurses can manage per hour. This does not consider the type of phone calls, the setting in which phone calls are taking place, or the complexity of the encounter. When determining staffing, we must account for all of these factors to ensure safe staffing.
Evaluating the length of the triage phone call is one way call centers establish their staffing ratios; however, with telephone triage, this does not always equate because of the intricacies of the practice and varied work settings. “In a healthcare call center, the patient experience takes priority which renders many standard call center metrics meaningless” (Envera Health, 2023). The nursing process required to care for a patient includes an assessment, diagnosis, planning, implementation, and evaluation. Critical thinking and nursing judgment are crucial in the delivery of safe care. Assigning a time limit or parameter on this may lead to poor outcomes for our patients. When we examined our program’s length of phone calls, our values fit into the standard survey results of an average of 4 patient calls/hour. Our length of calls average for FY2024 was 9 minutes and 31 seconds. When we evaluated the length of the entire encounter, our time for FY2024 team time was 29 minutes and 50 seconds. Length of encounters included documentation, contacting on-call providers to discuss care, and contacting pharmacies about prescriptions. This information is not calculated with a single length of call value.
After tracking this data over 12 months, we determined that comparing encounter times gave us better feedback for evaluating nursing practice and productivity. We now set benchmarks for our program and monitor individual nursing practices with this data. Plans include evaluating encounter lengths based on protocols used, the reason for the call, and determining if changes in our practice are necessary for patient safety and the efficiency of our program. Establishing a staffing model based on this information compared to the call center's limited length of call data may be best practice. It is not just talking time with nursing telephone triage. It’s coordination and management of the patient's current symptom or situation, ensuring the triage nurses are giving the most appropriate disposition and the patient can carry out that plan of care.
In reviewing the literature, there was limited information about telephone triage nursing productivity. Comparisons are made with non-nursing call centers looking at the number of calls managed hourly. Surveys have been completed by Schmitt Thompson Clinical Content (STCC, 2023) to try to establish a consensus on the average number of calls triage nurses can manage per hour. This does not consider the type of phone calls, the setting in which phone calls are taking place, or the complexity of the encounter. When determining staffing, we must account for all of these factors to ensure safe staffing.
Evaluating the length of the triage phone call is one way call centers establish their staffing ratios; however, with telephone triage, this does not always equate because of the intricacies of the practice and varied work settings. “In a healthcare call center, the patient experience takes priority which renders many standard call center metrics meaningless” (Envera Health, 2023). The nursing process required to care for a patient includes an assessment, diagnosis, planning, implementation, and evaluation. Critical thinking and nursing judgment are crucial in the delivery of safe care. Assigning a time limit or parameter on this may lead to poor outcomes for our patients. When we examined our program’s length of phone calls, our values fit into the standard survey results of an average of 4 patient calls/hour. Our length of calls average for FY2024 was 9 minutes and 31 seconds. When we evaluated the length of the entire encounter, our time for FY2024 team time was 29 minutes and 50 seconds. Length of encounters included documentation, contacting on-call providers to discuss care, and contacting pharmacies about prescriptions. This information is not calculated with a single length of call value.
After tracking this data over 12 months, we determined that comparing encounter times gave us better feedback for evaluating nursing practice and productivity. We now set benchmarks for our program and monitor individual nursing practices with this data. Plans include evaluating encounter lengths based on protocols used, the reason for the call, and determining if changes in our practice are necessary for patient safety and the efficiency of our program. Establishing a staffing model based on this information compared to the call center's limited length of call data may be best practice. It is not just talking time with nursing telephone triage. It’s coordination and management of the patient's current symptom or situation, ensuring the triage nurses are giving the most appropriate disposition and the patient can carry out that plan of care.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Heidi Pecott-Grimm, BSN, RN | Leilani Schnoor, MSN, RN, NPD-BC | Susan Tschorn, MSN, RN, CNM-LNPD-BC
Updated: 04/22/25
Updated: 04/22/25
Purpose: There are growing amounts of stress, mental health issues, and lack of empowerment in ambulatory care clinic staff as well as a sense of not belonging and disconnectedness between ambulatory care clinics.
Background/significance: The purpose of this pilot study was to assess the efficacy of a strengths-based resilience program for ambulatory care clinic staff to improve levels of stress, resilience, sense of belonging, and connectedness. A literature review showed different methods of promoting coping and stress management of nurses through journaling and mindfulness programs, but there was no evidence of a strengths-based resiliency program in the literature that was reviewed.
Method: The program was offered to ambulatory care nurses and support staff over a 10-week period. The strengths-based resilience program was facilitated by trained ambulatory care nurse professional development practitioners who work for the same organization. An adaptive resilience curriculum consisted of weekly sessions meeting virtually and discussed topics such as neurobiology of stress, resiliency, leadership, adaptive coping, and connections.
Results: Program results were evaluated using a mixed methods research design. Preliminary quantitative pre and post-surveys show an improvement in all measures. Qualitative data was analyzed from participants writings submitted during the program for evidence of positive change and is currently under analysis.
Conclusion: The ambulatory care nursing professional development practitioners created a positive environment where staff were able to come together and focus on their strengths. The virtual platform and in-person end celebration connected staff to be able to share vulnerable stories, which broke down isolation and created meaningful relationships. The program has helped to increase resilience, reduce stress, and create a sense of belonging for ambulatory care clinic staff. Staff experienced an increase in their ability to identify and utilize their unique strengths. The small sample size and self-selection are limitations of the study. Future research in the organization is limited by program costs and training time associated for participants to attend within their work week. Based on positive feedback from participants, there is interest and demand for continued expansion of the program. The outcomes of this program align with the organization's mission of employee engagement, belonging, and building a sense of community. Future directions include offering a cohort for leaders in January 2025 to provide a similar experience and help advocate for more cohorts across the organizational network.
Background/significance: The purpose of this pilot study was to assess the efficacy of a strengths-based resilience program for ambulatory care clinic staff to improve levels of stress, resilience, sense of belonging, and connectedness. A literature review showed different methods of promoting coping and stress management of nurses through journaling and mindfulness programs, but there was no evidence of a strengths-based resiliency program in the literature that was reviewed.
Method: The program was offered to ambulatory care nurses and support staff over a 10-week period. The strengths-based resilience program was facilitated by trained ambulatory care nurse professional development practitioners who work for the same organization. An adaptive resilience curriculum consisted of weekly sessions meeting virtually and discussed topics such as neurobiology of stress, resiliency, leadership, adaptive coping, and connections.
Results: Program results were evaluated using a mixed methods research design. Preliminary quantitative pre and post-surveys show an improvement in all measures. Qualitative data was analyzed from participants writings submitted during the program for evidence of positive change and is currently under analysis.
Conclusion: The ambulatory care nursing professional development practitioners created a positive environment where staff were able to come together and focus on their strengths. The virtual platform and in-person end celebration connected staff to be able to share vulnerable stories, which broke down isolation and created meaningful relationships. The program has helped to increase resilience, reduce stress, and create a sense of belonging for ambulatory care clinic staff. Staff experienced an increase in their ability to identify and utilize their unique strengths. The small sample size and self-selection are limitations of the study. Future research in the organization is limited by program costs and training time associated for participants to attend within their work week. Based on positive feedback from participants, there is interest and demand for continued expansion of the program. The outcomes of this program align with the organization's mission of employee engagement, belonging, and building a sense of community. Future directions include offering a cohort for leaders in January 2025 to provide a similar experience and help advocate for more cohorts across the organizational network.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 04/22/25
Updated: 04/22/25
Purpose: Outpatient nurses may perceive they have adequate diabetes knowledge, but their perceptions may not align with actual knowledge, potentially resulting in the sharing of inaccurate information. Prior to this study, little was known about basic diabetes knowledge among outpatient nurses. The purpose of this study was to determine relationships between perceived and actual basic diabetes knowledge.
Background: In the outpatient setting, patients with type 1 and 2 diabetes encounter many nurses, most of whom are not diabetes care and education specialists or certified diabetes care and education specialists (DCES/CDCES). During outpatient encounters, nurses may provide planned patient education on diabetes, but other interactions may be impromptu. As a result, it is vital that nurses have a basic understanding of diabetes-related information. Problems may occur if nurses rely on diabetes knowledge that comes from having diabetes (personal experience) or that of friends and family members who have diabetes (vicarious experience). If nurses perceive that they have adequate diabetes knowledge, but do not present accurate information, the quality of patient care may be compromised. The research team identified two studies on nurse perceived and actual knowledge. In one study, only a moderate relationship was found between perceived and actual knowledge among nurses in the inpatient setting. In the other study, school nurse perceived knowledge was much higher than actual; there was a low correlation between them. No studies addressing perceived and actual knowledge among nurses in the adult outpatient care setting were found.
Methods: The study team developed the diabetes basic assessment of knowledge (DiaBAK) tool. Survey links were emailed to nurses in outpatient settings and included the DiaBAK tool, a survey of nurse characteristics, and one question about perceived diabetes knowledge. Data were analyzed using Kruskal-Wallis and Spearman as appropriate.
Results: The sample consisted of 492 participants. Correlations of higher actual knowledge included being a DCES/CDCES, personal experience, caring for many patients with diabetes, and recent diabetes continuing education but did not include vicarious experience. Additionally, negative correlations were found for age and years in a nursing role, indicating that as age or years in nursing role increased, DiaBAK scores decreased. Perceived knowledge was higher for nurses who received continuing education compared to those who never received it. Apart from vicarious experience, all other associated factors of high perceived knowledge were also associated with high actual knowledge scores. The results demonstrate the value of regular continuing education and annual competencies for outpatient nurses and highlights the need for initial and ongoing education.
Conclusions: There are important implications when nurse actual knowledge is lower than they perceive. Concerns are raised that vicarious experience may be an underrecognized reason for the spread of misinformation. When nurses provide incorrect diabetes information, people with diabetes may be impacted in several ways. For example, misinformation about insulin storage, low blood glucose management, or target glucose levels may result in detrimental outcomes. A single nurse providing misinformation can influence other nurses and most importantly patients and patient support systems.
Background: In the outpatient setting, patients with type 1 and 2 diabetes encounter many nurses, most of whom are not diabetes care and education specialists or certified diabetes care and education specialists (DCES/CDCES). During outpatient encounters, nurses may provide planned patient education on diabetes, but other interactions may be impromptu. As a result, it is vital that nurses have a basic understanding of diabetes-related information. Problems may occur if nurses rely on diabetes knowledge that comes from having diabetes (personal experience) or that of friends and family members who have diabetes (vicarious experience). If nurses perceive that they have adequate diabetes knowledge, but do not present accurate information, the quality of patient care may be compromised. The research team identified two studies on nurse perceived and actual knowledge. In one study, only a moderate relationship was found between perceived and actual knowledge among nurses in the inpatient setting. In the other study, school nurse perceived knowledge was much higher than actual; there was a low correlation between them. No studies addressing perceived and actual knowledge among nurses in the adult outpatient care setting were found.
Methods: The study team developed the diabetes basic assessment of knowledge (DiaBAK) tool. Survey links were emailed to nurses in outpatient settings and included the DiaBAK tool, a survey of nurse characteristics, and one question about perceived diabetes knowledge. Data were analyzed using Kruskal-Wallis and Spearman as appropriate.
Results: The sample consisted of 492 participants. Correlations of higher actual knowledge included being a DCES/CDCES, personal experience, caring for many patients with diabetes, and recent diabetes continuing education but did not include vicarious experience. Additionally, negative correlations were found for age and years in a nursing role, indicating that as age or years in nursing role increased, DiaBAK scores decreased. Perceived knowledge was higher for nurses who received continuing education compared to those who never received it. Apart from vicarious experience, all other associated factors of high perceived knowledge were also associated with high actual knowledge scores. The results demonstrate the value of regular continuing education and annual competencies for outpatient nurses and highlights the need for initial and ongoing education.
Conclusions: There are important implications when nurse actual knowledge is lower than they perceive. Concerns are raised that vicarious experience may be an underrecognized reason for the spread of misinformation. When nurses provide incorrect diabetes information, people with diabetes may be impacted in several ways. For example, misinformation about insulin storage, low blood glucose management, or target glucose levels may result in detrimental outcomes. A single nurse providing misinformation can influence other nurses and most importantly patients and patient support systems.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 04/22/25
Updated: 04/22/25
Our growing centralized telephone triage program provides care to over 250,000 patients across an extensive care network of 30+ primary care offices located in Pennsylvania and New Jersey. We are associated with a large teaching institution which provides training to both resident and fellow physicians. We aim to achieve consistent disposition and care advice across all roles involved in the telephone triage program. During the expansion of our office hours program, the need for a standardized interdisciplinary approach for the training of pediatric resident physicians in the art of telephone triage was identified. Consistency and standardized educational materials were nonexistent, and the training experience outcomes differed significantly. Resident medical doctors were shadowing telephone triage nurses with little to no background information or context into the differing scopes of practice, protocol use, and assessment techniques which can be used over the phone during a triage call.
This author collaborated with a chief resident, as well as the medical director for the resident training program, to develop a standardized resident training program for telephone triage. Analysis of the challenges of the previous training method for residents resulted in the development of clear, concise learning objectives for the new resident training program. Scope specific educational tools and workflows were developed as a combination of self-learning modules, open discussion with an experienced triage nurse, demonstration of a nurse-led triage call, and skills observation by the MD preceptor. A variety of chief complaints as well as possible patient dispositions were considered by the triage nurse, and appropriate calls were forwarded to the residents to complete.
The outcomes of this project were measured using pre- and post-survey data. Pre-surveys collected residents’ baseline level of knowledge and comfortability, and post-survey data revealed the new training program’s efficacy. Data analysis revealed that using an interdisciplinary approach to training resident physicians in telephone triage led to increased understanding of the triage nurse’s scope of practice, assessment capabilities, and common challenges experienced during a telephone triage call. We believe that this standardized interdisciplinary approach will influence the future generation of physicians and empower their practice of telemedicine to include a mutual understanding and respect for their nursing counterparts.
After attending this poster presentation, the audience will be able to identify differences in physician vs. nurse telephone triage scope of practice, appreciate the value of the interdisciplinary approach to resident physician training, and model similar training and educational guides for use in their own institution.
This author collaborated with a chief resident, as well as the medical director for the resident training program, to develop a standardized resident training program for telephone triage. Analysis of the challenges of the previous training method for residents resulted in the development of clear, concise learning objectives for the new resident training program. Scope specific educational tools and workflows were developed as a combination of self-learning modules, open discussion with an experienced triage nurse, demonstration of a nurse-led triage call, and skills observation by the MD preceptor. A variety of chief complaints as well as possible patient dispositions were considered by the triage nurse, and appropriate calls were forwarded to the residents to complete.
The outcomes of this project were measured using pre- and post-survey data. Pre-surveys collected residents’ baseline level of knowledge and comfortability, and post-survey data revealed the new training program’s efficacy. Data analysis revealed that using an interdisciplinary approach to training resident physicians in telephone triage led to increased understanding of the triage nurse’s scope of practice, assessment capabilities, and common challenges experienced during a telephone triage call. We believe that this standardized interdisciplinary approach will influence the future generation of physicians and empower their practice of telemedicine to include a mutual understanding and respect for their nursing counterparts.
After attending this poster presentation, the audience will be able to identify differences in physician vs. nurse telephone triage scope of practice, appreciate the value of the interdisciplinary approach to resident physician training, and model similar training and educational guides for use in their own institution.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 04/22/25
Updated: 04/22/25
Patients at high risk for colorectal cancer (CRC) commonly fall behind in their CRC screening due to a lack of processes/systems that help close the loop on follow-up. Colorectal cancer is the third leading cause of cancer-related deaths in the United States. During the COVID-19 pandemic, colonoscopy procedures were canceled, and high-risk patients were bridged with stool-based tests or no screening at all. As a result, high-risk patients became overdue for their recommended CRC screening.
Our organization, a university-affiliated ambulatory care practice, does not have a gastroenterology department; our patients have the option to schedule their colonoscopy at several external facilities. As a result, no streamline process existed to ensure patients scheduled/completed their colonoscopy. If the colonoscopy was completed, reports that relay colonoscopy findings and follow-up recommendations were not consistently received nor acted upon. PCPs are often inundated with other medical care tasks, and this can result in limited time to address healthcare maintenance items. In order to address these issues, we designed a nurse-led ambulatory safety net (ASN) program to help close the loop on overdue high-risk CRC screening and follow-up.
This ASN is managed by the population health manager (PHM). The PHM is a registered nurse that is able to perform extensive chart reviews of patients who are high risk for colon cancer. Once the chart reviews are complete and patients are confirmed to be overdue for colonoscopy, these patients are managed by a patient navigator (PN) team to help perform outreach and assess/eliminate barriers that contribute to their overdue status. The PNs utilize a registry to track all outreach attempts and colonoscopy status as patients move through the program. The PHM is an integral part to this program, as the nurse can provide a higher level of education tailored to a patient’s learning/cultural needs. In addition, the PHM can queue up colonoscopy orders for PCPs, review colonoscopy report findings, and independently set the colonoscopy interval date in the EMR for future tracking. As a result, this work is removed from the PCP so they can focus on other aspects of the patients’ health care. In addition, the PHM is responsible for monitoring program metrics and analyzing data to make program improvements.
Since the implementation of the CRC ASN, high-risk patients who were overdue for surveillance colonoscopy and converted to a “scheduled” or “completed” status increased from 33% to 89%. In addition, documentation of the next colonoscopy due date field has increased from 30% to >95%.
Learning objective: Learn strategies to help overdue high-risk patients complete their CRC screening.
Our organization, a university-affiliated ambulatory care practice, does not have a gastroenterology department; our patients have the option to schedule their colonoscopy at several external facilities. As a result, no streamline process existed to ensure patients scheduled/completed their colonoscopy. If the colonoscopy was completed, reports that relay colonoscopy findings and follow-up recommendations were not consistently received nor acted upon. PCPs are often inundated with other medical care tasks, and this can result in limited time to address healthcare maintenance items. In order to address these issues, we designed a nurse-led ambulatory safety net (ASN) program to help close the loop on overdue high-risk CRC screening and follow-up.
This ASN is managed by the population health manager (PHM). The PHM is a registered nurse that is able to perform extensive chart reviews of patients who are high risk for colon cancer. Once the chart reviews are complete and patients are confirmed to be overdue for colonoscopy, these patients are managed by a patient navigator (PN) team to help perform outreach and assess/eliminate barriers that contribute to their overdue status. The PNs utilize a registry to track all outreach attempts and colonoscopy status as patients move through the program. The PHM is an integral part to this program, as the nurse can provide a higher level of education tailored to a patient’s learning/cultural needs. In addition, the PHM can queue up colonoscopy orders for PCPs, review colonoscopy report findings, and independently set the colonoscopy interval date in the EMR for future tracking. As a result, this work is removed from the PCP so they can focus on other aspects of the patients’ health care. In addition, the PHM is responsible for monitoring program metrics and analyzing data to make program improvements.
Since the implementation of the CRC ASN, high-risk patients who were overdue for surveillance colonoscopy and converted to a “scheduled” or “completed” status increased from 33% to 89%. In addition, documentation of the next colonoscopy due date field has increased from 30% to >95%.
Learning objective: Learn strategies to help overdue high-risk patients complete their CRC screening.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
