As part of an ongoing health system-wide initiative to pursue care delivery innovations, advancements in quality and safety and operational efficiencies, in August the Duke Cancer Institute led the way by launching a new telephone triage service at the cancer center. The service, a response to Transforming Our Future, now centralizes incoming calls, connecting patients to individuals who can address their specific needs.
“Our goal is to provide a consistent level of triage services for all patients receiving care at the Duke Cancer Center,” said Mary Ann Plambeck, M.S.N., R.N., a clinical operations director for the Duke Cancer Center and lead to the new initiative. “This new triage service will increase efficiency, improve access to care and enable us to deliver dependable provider support”
Previously, triage was supported by primary nurses in the clinic, administrative staff and various other individuals. Oftentimes nurses, after a jam-packed day in the clinic, attended to voice mails left on office phones earlier in the day by patients seeking assistance
Calls are now routed based on need. For instance, when a patient calls in, he or she can select from one of six options for needs, such as scheduling an appointment, refilling a prescription, nurse advice and more.
A patient seeking health advice is routed to a line answered by a registered nurse. Instead of having to leave a message, patients will speak to a nurse each and every time they call during triage hours.
“Triage phone messages are now delivered to the provider’s in-basket as a telephone encounter,” said Plambeck. “We no longer use email for relaying triage messages”
Provider messages are labeled “Open” or “Closed.” Open messages require action or input. Closed messages are for information only. Providers are paged in cases where the message is urgent and requires immediate attention.
“The centralized service was designed to take our current model to the next level,” said Tracy Gosselin, Ph.D., R.N., A.O.C.N., associate chief nursing officer for Ambulatory Care and associate chief nursing officer & assistant vice president for the Duke Cancer Institute. “As we work through Transforming Our Future, one of the key elements is to mitigate gaps in care or services for our patients. The team recognized early on that not all patients had access to triage and some who did, often may have experienced an extended lapse in time before receiving a return call.“
After two weeks, on average the triage team is receiving 250 to 300 calls, many related to care coordination, per day.
“Our peak volume seems take place from 9:30 a.m. and 3:30 p.m.,” said Gosselin. “All calls are cleared from the line by day’s end, and those calls deemed as urgent are followed up on appropriately the same day.”
Triage phone lines are open Monday through Friday, from 8 a.m. to 5 p.m. Triage calls between 5 and 6 p.m. are routed so that the clinician, doctor or APP, receives a page if the patient requires immediate attention, but not an ED visit. Patient calls whose needs can be addressed the following day are flagged as such. Calls received on weekends or holidays will be referred to the Duke paging system which will then notify the provider on call.
“The triage staff is excited and eager to learn,” said Plambeck. “Since this is a new service, I invite constructive criticism and helpful feedback. Together, we can make this successful.”
The Duke Cancer Center is one of the first at Duke to launch a centralized triage service to address patient concerns outside the clinic encounter. Planning for similar services is underway throughout DUHS ambulatory clinics.
“As we move forward we will be conducting follow up with a subset of our patients to better understand their experience and opportunities to build upon this work,” Gosselin said. “Additionally, in 2015 we will have further discussions with Epic to create a dashboard of call metrics.”
The triage team will soon relocate to a single location. Future plans also include the development of protocols and the filling of positions still open. For more information, inquiries or to provide helpful feedback, please email Mary Ann Plambeck or call Plambeck at 919.681.4951. For more information on the health system’s proactive pursuit of care delivery innovations, advancements in quality and safety and operational efficiencies, visit Transforming Our Future. Duke Cancer Center patients can reach the oncology telephone triage service by calling 919.668.6608.
Circle photo (top): Mary Ann Plambeck, clinical operations director, and Kathy von St. Paul, nurse manager, have led the charge in the establishment of the DCI's new triage phone service.