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Essential communication: Physicians and triage nurses collaborating to reduce response time for triage messages
Description of the project or subject matter: The purpose of the initiative was to reduce patient wait time from initially speaking with a triage nurse to resolution by the primary care physician. The triage nurses are in a centralized location and not in individual physician practices. Current workflow for triage messages that require physician advice is the messages are routed to a “flow manager” who then sends the message to the physician. The flow managers had up to 4 hours to send the message to the physician. In the Initiative, the process changed eliminating the flow manager. Triage notes were sent directly to the physician. Once the physician has made a recommendation, the message is sent back to the triage nurse who contacts the patient and gives any instructions thus closing the loop. The percentage of triage calls requiring advice was approximately 30% of the total call volume. This initiative took place in 6 internal medicine practices with a total of 28 physicians.
Methodology: This was a quantitative study in which 5 work days of data were compared pre- and post-initiative. Each call was recorded and a turnaround time from sending the message to the physician to notifying the patient of the outcome was determined. The times for each day were averaged. Each day of the week in the pre-initiative was compared to the corresponding day of the week in the post-initiative and a percentage was determined for the days showing the decrease in time. An average of the 5-day comparison was determined to obtain the decrease in turnaround time.
Data analysis/results: The comparison of the pre- and post-initiative turnaround time of a triage message showed a 64% reduction in the amount of time it took a patient to receive a response from the physician by the nurse and close the call.
Implications for research and or practice: This initiative showed a 64% decrease in turnaround time in 6 internal medicine practices with 28 providers. Given this significant decrease, this initiative could be disseminated to other physician practices in a large healthcare system to produce a similar reduction in response time.