The Impact of Telephone Triage on Emergency Use

Purpose: This quality improvement (QI) project aimed to assess whether a standardized process for telephone triage, reinforcing caregiver use of the AAP, and documentation impacted ED visits and nursing practice.

Description: National asthma education guidelines and current evidence promote asthma self-management education at all contacts and using an asthma action plan (AAP) to improve life quality and reduce healthcare costs and emergent care needs. Emergency department (ED) visits are preventable, with a local report citing that most pediatric patients who sought ED evaluation in the prior two years did not require hospitalization. We identified that nurses working in a single primary care pediatric setting with high asthma prevalence (14%) did not have an evidence-based process to provide education or document patient/caregiver concerns during telephone triage.

Evaluations: The knowledge-to-action methodology guided the process' development, which included aspects of staff education, assessments, implementation of the patient's AAP during telephone triage, and smart-phrase documentation. To inform differences, ED visits, call volume, and intervention fidelity were observed over eight weeks pre-and post-intervention.

Outcome: Positive changes were observed pre- to post-process intervention. Improvements were noted in nursing recommendations adhering to practice standards: triage assessment documentation (p = 0.014), AAP education (p < 0.001), and follow-up advice (p < 0.001). No statistical difference in ED visits was identified between time periods (p = .40). A significant finding was that ED visits following a nurse triage encounter were much lower than visits without a preceding nurse encounter, 22.2% vs. 77.8%, respectively. Improvement was observed in Press Ganey score answering phones (+37.5%) in the first quarter post-intervention.

Conclusions/implications for practice: Assessment helped to inform a reliable telephone triage process to improve call documentation and nurse use of asthma education guidelines at all contacts. Efforts to encourage contact with the clinic, deployed from check-in to checkout, may explain improved scores for call satisfaction, but it did not lead to higher call volume. A significant takeaway from this project was an assessment of ED patterns. We learned that most caregivers did not call for advice; more education is needed to support caregivers calling the clinic for advice. The project's importance was that it highlighted the patients that can be supported by the healthcare team with evidence-based education when asthma symptoms develop. Next steps include interventions aimed at caregiver contact, expanding triage support, and continued tracking of ED visits and call volume until a downward shift is sustained.