Implementation of a Triage Nurse Role in a Surgical Oncology Clinic to Improve Patient Access to Care

Background: Access in health care has been an identified topic of interest to companies, as well as patients. A person’s ability to access health care has a direct effect on their health and well-being. Access to health care can include available services, timeliness of services, and availability of qualified providers. In a surgical oncology clinic, Press-Ganey scores have been below targeted level of achievement in the category of access to care. Items affecting this score include their ability to access their nurses and/or provider team for problems and questions. Survey items, such as ease of getting clinic on phone, the clinic’s promptness in returning phone calls, and phone calls answered during same day have all been consistently needed improvement over the past year in a surgical oncology clinic.

Aim: The aim of this project was to implement a nurse triage role to increase the patient satisfaction mean scores by 10% in the Press-Ganey domain of access to care 3 months, specifically for the access to staff by telephone during and after-clinic hours, for surgical oncology patients in the League City Houston Area Location (HAL) within 9 months of implementation.

Process of implementation: The intervention consisted of developing and implementing a triage nurse role for the clinic setting at the League City HAL. This triage nurse’s role was to answer telephone calls during clinic hours and to follow up with telephone messages during the same day. Collaboration with providers was necessary to develop processes for issues that warranted inquiry beyond the clinical nurse. Additionally, the triage nurse provided follow-up phone calls to all new patients, procedures, and consults to address any needs. The number of phone calls received, number of phone calls made, and patient reasons for concerns were all tracked by the triage nurse. These results were reviewed monthly to identify any trends in care and use of the triage nurse line.

Results: Data were analyzed by comparing the Press-Ganey pre- and post-implementation mean scores in the domain: access to care 3 months. Results reflected a 5% increase in scores for the question “clinic’s promptness in returning calls,” comparing the 9 months pre- and post-implementation. Results also reflected a 28% increase in scores for the question “phone during office hours answered same day,” comparing the 9 months pre and post implementation.

Relevance in clinical practice: The implementation of a nurse triage role in a surgical oncology clinic facilitated patient communication and improved patient access to health care. While there was a slight increase in scores for returning telephone calls, the dedicated triage role significantly improved same day answering of the telephone calls, thus mitigating risks post-surgery by addressing any issues real time with the patients before they become more severe.