The Four Essentials of Telephone Nurse Triage You Need to Know


I love what I do for a living. My job title is VP of Strategic Clinical Solutions for AccessNurse. In this role, I have the privilege of partnering with hospitals, physician groups, FQHCs, pharmaceutical software corporations, law firms, pain clinics, case management groups and with a company that manages employee injury claims. There are times when I am surprised by the rewarding opportunities I have had and how some of the difficult experiences I have lived through turned out to be gifts. Never in my wildest imagination did I think I would be included in the strategic plans of several healthcare organizations to either develop or contemplate solutions to clinical and operational challenges. Let me share some of my key take-away from my consulting experiences in Nurse Triage/Medical Call Centers industry.

This is a dynamic industry.

Change is the norm and all you can plan on, is that whatever you planned on, you can’t plan on!!! Serving as a leader in a medical call center environment is not a behind closed doors type of role; rather, it requires approachability, meaningful communications, and consideration of others. Circuiting among staff, hearing the types of conversations that are happening in real time is a practice that is imperative. Many managers have strategically forfeited their offices in favor of a cubical in the call center. “Being in the trenches “fosters improved performance, in addition to enhanced employee engagement and job satisfaction because when nurses and support staff see you out and about on a regular basis and hopefully greeting them by name.

Let the experts be the experts.

Synchronized technology, processes and people are the building blocks of every successful access center. Nurse Triage offers specialty patient care by skilled clinicians in a remote environment. Let the nurse do what they do best – provide healthcare to those in need. IT and telephony should own their respective areas and take responsibility for smooth functioning, ease of use, training and responsive escalation procedures for when things go wrong. An awareness of each other’s roles is expected, but please stay in your lane and do what you do best.

There are 168 hours in a week.

Operating a triage service or a call center 24/7 is quite an undertaking. Many organizations find it difficult to justify remaining open overnight, when call volumes historically drop. Id was recently working with an academic medical center in Oregon that had been struggling with their decision to offer nurse triage and appointment scheduling around the clock. Productivity was very low with night shift RNs handing 1.5 calls per hour vs their daytime peers taking 4.7 calls per hour. After factoring in labor costs, overhead, security guards and an average utilization of less than 30%, we assembled a team to discuss options. Reducing hours of coverage for access to clinical care was not desirable to stakeholders since it was not in the best interest of patients and providers.

I introduced the possibility of a hybrid model of nurse triage. Highest call volume hours would have the organization managing all incoming calls and during less busy times (9pm-6am) they partnered with an outsourced nurse triage medical call center. Reducing the hours of operation from 168 hours to 105 hours a week, resulted in a cost savings that more than paid for the cost of outsourcing. It was not long before they increased the outside coverage to include overflow coverage during unplanned high volume periods.

Patients first.

If an organization does not put the patient’s needs first, there will be a bad outcomes! With the  recognition by the C-Suite of the relevance and value of medical call services also has come expectations. Productivity, utilization, average handle time, calls per hour, abandonment rate are key performance indicators which are measures of success. No doubt metrics are essential. Under no circumstances does achieving an established target supersede the health altering impact of a skilled nurse allaying the anxiety of a new parent, or offering support and reassurance to a patient contemplating suicide, or realization that the gentleman on the line may be experiencing subtle symptoms of a stroke and he is resisting your advice to call 911. When patient care is at stake, the clinicians lead the team!

As I said before, I love what I do for a living. I was able to make the most of my 20+ years at Cleveland Clinic’s Nurse on Call as a Telephone Triage Nurse, and move forward into a role in the healthcare marketplace that awards me an opportunity to help others help patients.

The patient is the motivation!

Gina Tabone, MSN, RNC serves as the Vice President of Strategic Clinical Solutions for AccessNurse.

Prior to joining AccessNurse, 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 less than 5%, URAC accreditation was achieved, and the call center grew from covering 350 physicians to the integration of more than 1,500 employed and affiliated providers.