To better respond to workplace injuries and ensure the best possible care for injured workers, pre-claim nurse triage is on the rise. What truths should employers know about nurse triage?
By Paul Binsfeld, president of Company Nurse, LLC, and Gina Tabone MSN, RNC-TNP, director of clinical solutions at TeamHealth Medical Call Center
According to OSHA, before its founding 43 years ago, an estimated 14,000 workers were killed on the job every year. Today, workplaces are much safer and healthier, going from 38 fatal injuries per day to 12, but there is still much work to be done. Following the establishment of a safe work environment, employers’ first line of defense in treating an injured worker is early intervention.
As such, one benefit to employees that was once only attributed to health care insurance companies is becoming a more commonplace practice with employers – nurse triage.
Work injury call centers provide a major innovation for workers’ compensation. Specially trained triage nurses are involved at the front end of the process, making immediate, critical medical decisions that positively impact the employee’s medical care, as well as overall claims costs and outcomes. With this benefit, many commercial and public entities have decreased overall workers’ compensation costs by as much as 30 percent.
Whether outsourcing pre-claim nurse triage or thinking about establishing one in-house, employers need to know key facts about nurse triage. Gina Tabone MSN, RNC-TNP, Vice President of Strategic Clinical Solutions at TeamHealth Medical Call Center, shares with us these “Five Truths About Nurse Triage”:
1) Telephone nurse triage is safe.
It is grounded in Standards of Care that have been developed by the American Association of Ambulatory Care Nursing (AAACN). Telephone nurse triage is performed by specially trained registered nurses with an average of 5 to 10 years of experience in Emergency and Primary Care, Medical Surgical Nursing and Pediatrics. Practice is guided by evidence-based clinical guidelines that are physician approved and updated annually. There are several options when selecting the best decision support tools for your patients, but the common denominator is the fact that these are guidelines and not algorithms. Qualified registered nurses understand the need to apply critical thinking skills developed in prior roles when taking care of patients remotely. The ability to observe, palpate and smell are not an option available with remote care, so expertise in astute active listening and therapeutic communication is critical. Quality Assurance monitoring of nurse triage calls indicates that in 97 percent of the encounters, telephonic triage recommends patients to the safest level of care.
2) Nurse triage contributes to optimal outcomes.
Triple Aim sets the bar for all health care providers. The Institute for Healthcare Reform (IHI) identifies the dimensions of Triple AIM: 1) improving the patient experience of care (including quality and satisfaction); 2) improving the health of populations; and 3) reducing the per capita cost of health care. Triage Nurses are caregivers who can significantly contribute to the fulfillment of these goals. After-hours triage care for each patient is done on a 1:1 basis. It is foundational to most primary care practices, is extremely cost effective, and generally assimilates services and information across enterprises. Improved outcomes require your patients have access to telephone nurses, so make sure this information is shared with your administration.
3) Exceptional patient experience is an integral part of optimal outcome goals.
A sign of an organization that is committed to providing exceptional patient experiences is one that provides their patients with access to 24/7 nurse triage services. Today’s health care marketplace holds patients in the same regard as consumers. Market studies indicate today’s consumer wants what they want when they want – including clinical care. In the recent past, the only option to receive acute medical care was to go to the emergency room. That is no longer the case for organizations that provide their patients with the option to speak directly to a triage nurse at any time. Telephone triage nurses conduct assessments of patients’ current health issues and tell the patients what they need to do and provide a timeline for care.
4) Executive leadership needs to give ample consideration to either maximizing or investing in a medical call center that is committed to continuous clinical care.
ROI valuations are impressive and varied–depending on whom you ask. There is no denying the fact that a triage model that pays an RN an average of $30 per hour with an expectation of handling four triage calls during that time is a bargain when compared to other options available. The initial investment can be perceived as costly, mainly due to the fact that purchasing call center technology is necessary. One way to dilute initial expenses is to consider partnering with an outsourcing medical call center company that can seamlessly provide telephone nurse triage to your patients. Many health care organizations have made permanent outsourcing arrangements, reaping all of the benefits of a nurse triage model with no capital expenditures. Telephone nurse triage is an investment, not an expense.
5) Nurse triage provides a worthwhile solution to the challenges The Affordable Care Act has bestowed on caregivers.
We’ve already discussed the role nurse triage plays in achieving success as measured by the Triple Aim. Offering 24/7 nursing triage care can augment the role of newly created care coordination teams. Additionally, 24/7 service can be provided to ensure patients are not at risk of escalating to a higher level of acuity simply because their provider’s office was closed. Nurse triage provides access to clinicians, facilities and comprehensive triage care. It ensures an integrated care approach and often leads to internal referrals. Nurse triage helps organizations better utilize scarce resources at overcrowded emergency departments, and increased demands for primary care providers. Many trendy readmission prevention programs currently being managed by telephone triage nurses are proving to be successful. Continuous care contributes to the bottom line in the current fee-for-value reimbursement system. There are numerous other examples that demonstrate the positive impacts an optimized Nurse Triage service can make on your organization. To best serve the needs of your patients and ensure your organization maintains its competitive edge, your leadership must view nurse triage as a necessity and not a luxury.
Paul Binsfeld is the founder and president of Company Nurse, LLC, a firm that specializes in medical triage and injury management for workers’ compensation. His career began as a workers’ compensation consultant with mid-size employers helping to streamline claims processes and improve outcomes for injured workers. By working with many different types of employers, he identified a common need for early intervention in the workers’ compensation claims and injury management process, and thus, Company Nurse was born in 1997. Binsfeld – one of the pioneers of the pre-claim nurse triage industry – has over 25 years of experience in workers’ compensation and is one of the most influential leaders in the market.
Gina Tabone MSN, RNC-TNP is the Vice President of Strategic Clinical Solutions at TeamHealth Medical Call Center. Prior to that she served as the Administrator of Cleveland Clinic’s NURSE on CALL 24/7 nurse triage program. Under her direction, ED utilization declined, continuous care coordination improved, performance metric targets dropped from 33% ABD to > 5%, URAC accreditation was achieved, and the department grew from covering 350 physicians to the integration of more than 1500 employed and affiliated providers. Year after year she was able to operate Nurse on Call at or below the forecasted budget.