Improving Patient Safety and Satisfaction with Triage Nursing Resource Reallocation

Patient safety, caller experience, nursing engagement, and staff satisfaction are all essential components of a telehealth nursing department which require constant attention and quality improvement work. Additionally, fiscal management of resources is necessary. In early 2018, Gillette Children’s Specialty Healthcare’s telehealth triage department was struggling with long patient waits, high volume of patient concerns and complaints regarding delayed service, high staff stress and burnout, and decreased nurse engagement. Our challenge was to increase patient safety, improve quality of patient experiences, and strengthen nurse engagement and satisfaction, while simultaneously remaining budget neutral.

Our telehealth department consists of two sub-departments: triage for established patients and one-call access for new patient referrals. For this project, a close look at the volume of work and current patient safety levels in each sub-department was needed to identify where we should allocate our resources, while remaining budget neutral. After data analysis, we identified the ability to shift 0.5 FTE from one-call access to triage work.

Our number one concern was patient safety, and we knew our current queue wait times and abandon rates needed to be improved. On average nurses were assessing the patient’s needs within 7 minutes of initial call. These statistics also directly negatively affected our caller’s experience with our services. We were reviewing, on average, one to two patient feedback and/or occurrence reports each week. Nurses were reporting an increase in stress and burnout. This was evidenced by discussions with leadership and a turnover in staff.

In March 2018, we designed a PDSA (plan, do, study, act) which included a new nursing role for the one-call access nurses. Monday through Friday, 8am to 12pm, is a peak time for patient calls. After a hyphenated training, the one-call nurses were able to take every established patient phone call coming into the triage queue during this high-volume time frame. The nurses answer the calls within 50 seconds, complete an acuity triage in less than 1 minute, and then get the caller to the correct department at Gillette or to the triage nurses. This PDSA also included building the triage queues to prioritize our highest volume and acuity calls. The triage nurses are able to select calls from the queues in order of acuity. In order, these are neurology, urgent, orthopedic, and non-urgent.

The PDSA showed significant improvement in patient care, underwent some small adaptations, and then was adopted. Our improved telephone queue statistics, significant decrease in patient feedback and occurrence reports, and a reported increase in nurse satisfaction and engagement are proof of our successful redesign of the telehealth department at Gillette Children’s Specialty Healthcare. In addition, one-call access nurses have continued to deliver safe quality patient care for the new patient referrals.