Real-Time Virtual Triage

Background: During a global pandemic, the need for a rapid switch to telemedicine was indicated. Having important clinical information documented and technical support prior to the appointment is essential to facilitate a more comprehensive and efficient virtual visit. To help meet these objectives, we implemented a phone call to the patient the day prior to obtain important clinical information and ensure they were prepared for the scheduled virtual visit. However, only 40% of virtual visits were successfully completed as originally scheduled. Both patients and providers were frustrated with the inefficiency and inaccuracy of scheduled virtual visits.

Significance of the problem/literature to support the project: Large health systems face challenges with how to enroll a large population of patients into the required telehealth program, how to engage staff in the expansion of telemedicine, and how to create measurable outcomes (Ellimottil et al., 2018). Only 33% of our patients had the proper access needed for a successful telemedicine visit prior to their appointment time. This barrier forces providers to spend time troubleshooting technical challenges during their appointment instead of focusing on the clinical needs of the patient. Kruse et al. (2018) also noted that technology specific barriers are the biggest challenge in the adoption of telemedicine.

Intervention: To combat these challenges, a pilot model for real time virtual triage with one pediatric specialty division was developed. Health information management team partnered to coordinate direct access in enrolling patients into the preferred telehealth program at the point of scheduling. Instead of obtaining the clinical information the day prior via phone call, a nurse joins the virtual visit on the telemedicine platform 5 minutes prior to the scheduled appointment time. The nurse works through any technical difficulties and obtains the clinical information necessary for visit. This process gives a better patient and provider experience by offering assistance with technical difficulties in real time. This also creates an experience similar to that of an in person visit where important clinical information is obtained and documented prior to provider visit.

Outcome measures: A successful telemedicine visit is defined as a patient enrolled in preferred telemedicine platform prior to visit, clinical information obtained and documented prior to appointment time, and technology working properly in order to complete visit at the scheduled time. Prior to implementation of pilot program only 60% telemedicine visits were successful. After implementation successful telemedicine visits were improved to >90%.

Implications for nursing practice: This real-time patient interaction provides an experience closer to that of an in person visit. This model allows the team to support the patient and obtain the vital information prior to seeing the provider. The partnership to enroll patients in the preferred platform, a consistent team working through the technical difficulties, and improved patient/provider experience makes this virtual triage experience a success.