Using Modern Applications for Clinical Advice in Primary Care Pediatrics

Purpose/background: Our purpose is to provide our pediatric primary care patients and their parents access to a modern HIPAA compliant secure triage text platform as an alternative method to reach triage RNs for clinical advice. Pediatric patients and their parents contact our healthcare system through phone, website, electronic health record (EHR) portal, and now, text. Annually, 700,000 calls are received by our centralized pediatric call center. Historically, parents accessed triage RNs through phone encounters. Increased call volume increases wait times for parents to speak with a triage RN, which leads parents to using electronic health record portal communication tools. Offering a triage text chat will provide patients with a convenient access method. Requests for clinical advice are in the top five reasons patients and families call into the pediatric primary care call center and nurses are ranked highly as trusted professionals. Leadership hypothesized that if we found another other avenue for our patients to reach us during heavy call volume times, that would help decrease call volume, improve patient care, and meet our patients “where they are.” Millennials have grown up in the information age and are used to communicating via cell phones. Currently, they are the generation with young children utilizing pediatric care. A 2019 Pew research center report stated, “96% of Americans have a cell phone, with 99% of people with cells phones from ages 18 to 49.” Adding a text option to communicate with pediatric triage RNs promotes access and efficiency when addressing acute symptoms and concerns.
Description: We partnered with a company which designed a HIPAA compliant text platform. The centralized virtual ambulatory care pediatric nurses initialized the operations of this platform using evidence-based triage protocols. Training is provided to pediatric triage nurses working in the clinic, which allows for more personalized patient concerns to be addressed. The program workflow allows virtual triage RN team to warm text transfer the patient’s messages to a triage RN working in the patient’s primary care practice if needed. This eliminates the delayed back and forth communication seen in EHR portal platforms where accepted response timeframes are up to 48 hours.
Evaluation/outcomes: Pilot program started August 31, 2022. 74 text messages received for patients 0-21 years. 107 messages received for patients 22+ that were re-directed to appropriate resources. Data is collected on each text encounter to allow us to learn how to improve functionality and patient care. Robust pediatric triage RN training is in development to allow a larger number of trained nurses eligible to respond to the text messages. Triage RNs are learning how to handle different types of patient requests, including the need to schedule an appointment for evaluation, progress from text to phone call triage encounter and workflows to involve patient’s pediatrician for advice. Triage RNs have developed smart phrase shortcuts to quickly type commonly used questions/phrases, which allows them to quickly obtain relevant symptoms for triage. Anecdotal evidence from parents shows a positive experience with the triage text encounter.