Improving Effectiveness of Ambulatory Nurse Triage Calls in Adult Primary Care
Joan Pohutsky, DNP, RN, Susan Hossli, MSN, RN, NEA-BC, Colleen McDevitt, BSN, RN, ACN, Molly Moran, MSN, RN, CCRN
In December 2017, Rush Ambulatory Nursing launched the use of evidence-based triage protocols housed in the electronic medical record. A review of the use of the evidence-based triage protocols between Dec. 6, 2017 and Jan. 5, 2018 found only 4% of completed nurse triage encounters were created utilizing the evidence-based protocols.
The Ambulatory Nursing Professional Development Committee identified a goal to increase utilization and adherence to the telephone triage protocol by ambulatory care nurses in adult primary care clinics.
In October 2018, all ambulatory care nurses working in an adult primary care position attended a 4-hour telephone triage education program which included didactic content and simulation lab content developed by Joan Pohutsky and ambulatory nursing leadership in conjunction with the Professional Development committee.
The didactic content included information on the telephone triage policy and review of the evidence-based protocol format. During the simulation lab portion of the program, RNs worked a scenario on the phone with actors participating as patients and responding to the RNs. A member of ambulatory nursing leadership led a debrief of the call after it was completed.
In December 2018, an evaluation of the telephone triage program was completed including participant pre and post knowledge, program evaluations, and use of telephone triage protocols. Continuing educational gaps of the participants were identified. Based on the educational gaps, the “Back to Basics of Telephone Triage” program was developed and conducted in February 2019 which included didactic and case study content.
In comparing the use of the evidence-based telephone protocols pre and post-delivery of the education program, there was a 27.3% increase in protocol utilization. These findings suggest that utilizing a continuous quality improvement framework to implement practice change significantly increased utilization and adherence statistics in primary care nurses employing evidence-based telephone triage protocols. Supportive leadership was crucial throughout the project to facilitate the practice change.