Telephone Triage Playing Front-Line Role in COVID-19 Outbreak

Purpose: The quality improvement (QI) project aimed to evaluate the impact of conducting telephone triages (tele-triage) during the COVID-19 pandemic and reflect on the outcomes of these interventions on the COVID-19 pandemic to improve the care of patients during a potential future crisis.

Background/significance: The novel coronavirus, known as COVID-19, was declared a public health emergency by the World Health Organization (WHO, 2020) in March of 2020. According to the Center for Disease Control and Prevention (CDC, 2020), the COVID-19 virus has a higher transmission rate when compared to the influenza virus. COVID-19 affects the geriatric population, young adults, and pediatrics with and without any past medical history. In New York City, many hospitals faced challenges maintaining continuity of care during the "shut down" caused by the pandemic. As a result, the role of registered nurses (RNs) and advanced practice registered nurses (APRNs) assumed even greater importance in the continuity of care. In response to the call for a multidimensional approach to ensuring the community served continues to receive seamless and holistic primary and episodic care, the centralized clinical telephone center (CCTC) evolved, for many, into the first contact point for those patients served by the hospital organization. The CCTC comprises RNs and APRNs who deliver primary and episodic triage services using a 100% technological platform. The goal of CCTC is to reduce health disparities, provide timely access to care, and link those patients with the world's best healthcare services. CCTC continues to be on the front lines battling the effects of the COVID-19 pandemic within the community.

Method: This QI project adopted the plan, do, check, and act cycle.

Conclusion: A total of 8112 patients received tele-triage interventions by the RNs of the CCTC, 7,745 patients received tele-triage interventions and episodic telemedicine interventions by the APRNs of the CCTC within the first month of the pandemic. Patients received timely care due to the CCTC's commitment to providing high-quality intervention while allowing for the hospital to focus on critical care and urgent need patients. The providing of these services also proved significant in the deterrence of community spread of the COVID-19 virus.

Implications: CCTC’s APRNs and RNs play a vital role throughout the COVID-19 pandemic. CCTC's tele-triage interventions maintained and, in some cases, increased patient's access to healthcare. CCTC's APRNs managed many patients’ chronic conditions and chronic and episodic medications, thus reducing emergency department visits within an already stressed hospital system. CCTC RN/APRN tele-triage services allowed for focusing internal hospital resources on patients with critical needs. Managing patients at home proved significant in preventing community spread. Telemedicine is challenging, particularly with patients who lack access to technology. Thus, the need for outreach and educational programs to enhance telemedicine availability is necessary, particularly to a vulnerable population.