HHQI National Campaign Best Practice Intervention Package

1. HHQI National CampaignBest Practice Intervention Package Simply Summer Series Home Telehealth TELETRIAGE July 11, 2007

2. New York State Local Area Network of Excellence (LANE)

3. Objectives • Define teletriage • Describe how to use decision support tools • Identify several tools/resources available in the Best Practice Intervention Package

4. Teletriage • Teletriage is the unscheduled, appropriate disposition of health-related problems by skilled clinicians via telephone or electronic information processing technologies that have been initiated by the patient/caregiver

5. Teletriage • Simply put…. • Teletriage is what occurs when a patient calls the agency for health-related advice. This is usually initiated by the patient/caregiver, but can occur in response to phone monitoring or telemonitoring encounters

6. Unscheduled Initiated by the patient.caregiver Not optional Is part of the agency’s normal daily activities Includes off hour telephone calls Requires problem-solving or action Scheduled Initiated by the agency Optional Purposeful May require problem-solving or action, but usually involves reinforcement of teaching Triage vs Telephone Monitoring

7. Teletriage • Increases the value/effectiveness of home care services • Increases access to skilled, empathetic and effective clinical service providers • Promotes appropriate use of services • Supports reducing “avoidable” hospitalizations

8. Teletriage • Effectiveness of a Teletriage Encounter • Interviewing & communication skills • Availability of patient related data • Patient/caregiver involved in decision-making • Pre-established emergency plan • Patient satisfaction

9. Leadership Operational Considerations • Who? triages – agency nurses • What? Patient’s clinical problem • When? Occurs daily-as soon as the nurse picks up the telephone or telemonitoring data is received • Where? During normal office hours or after hours (on-call) • How? Via telephone or telemonitoring equipment

10. Leadership Operational Considerations • Agencies can plan for teletriage by: • Identifying potential interventions that may be approved by a physician in advance • Obtain clinical parameters • Establish home care goals with patient/caregiver • Become proactive to decrease risk for an urgent teletriage encounter • Ensure patient’s past medical history, medications, and allergy information is available to the nurse(s) accepting triage calls

11. Leadership –Operational Considerations • Who is performing teletriage? Skills to consider: • Excellent assessment skills • Dynamic communication skills • Systematic documentation capability • Knowledgeable of home health regulations and community resources • Appreciation of the role other disciplines • Ability to collaborate • Ability to work under pressure • Ability to prioritize

12. Leadership Organizational Assessment • Investigate current agency teletriage processes • Perform agency self-assessment • Highway versus Path • Protocol • Orientation and evaluation • Risk management/HIPAA compliance • Specific teletriage guidelines • Develop action plan

13. Teletriage Practice Follow Adequately Review Medications Properly Assess the Patient Provide for patient safety Agency Policies & Procedures Document condition, treatment and response Communicate changes in patient condition Question Orders Intervene Timely Any Rule That Applies to Nursing Applies to Teletriage

14. Leadership • Effectiveness of Teletriage Process • Expectation that patient’s issue can be handled appropriately • Included in staff education program • Training for administrative support in routing calls • Process to evaluate impact on patient outcomes • Hospice Connection • Communication with the Physician

15. Teletriage Support Tools • Teletriage At a Glance • Routing of calls • Teletriage reference tools (18) • Decision support tools (3) • Teletriage documentation tools (21)

16. Teletriage at a Glance • Assessment • Risk level • Interventions • Evaluation and follow-up

17. Teletriage at a Glance

18. Routing of Calls • Automated versus Live Response • Average wait time • Voicemail option • Use of decision support tools by nurse • Patient understands when a returned call will occur OR patient understand direction provided by nurse

19. Routing of Calls

20. Adverse Drug reaction Anxiety Bleeding Breathing difficulty Confusion Constipation Depression Falls & injuries Feeding tube problems Fever Gastro-intestinal difficulty/nausea and vomiting Hyperglycemia Hypoglycemia Lightheadedness/dizziness Pain Urinary catheter problems Urination difficulty Wound drainage/infection Teletriage Reference Tools

21. Decision Support Tools • Heart Failure • COPD • Diabetes

22. Adverse Drug reaction Anxiety Bleeding Breathing difficulty Confusion Constipation COPD Depression Diabetes Falls & injuries Feeding tube problems Fever Gastro-intestinal difficulty/nausea and vomiting Heart failure Hyperglycemia Hypoglycemia Lightheadedness/dizziness Pain Urinary catheter problems Urination difficulty Wound drainage/infection Teletriage Documentation Tools

30. Clinical Education Tracks • Nurse • Therapy – PT/OT/ST/(RT/RD) • Medical Social Worker • Home Health Aide • Success Story

31. Summary • Not an optional service and occurs daily • Effective teletriage increases the value of home care services • Decision support tools are developed to use as a guide and help standardize the teletriage process • An essential component of an agency’s efforts to reduce “avoidable” hospitalizations

32. Resources • Home Telehealth Reference 2005 • Home Telehealth Reference 2006/2007 • Home Telehealth Disease Management Series • (All of these resources are on www.medqic.org) • Impact of Technology & Organizational Culture on Patient Care Management - 02/21/07 • (available for access athttp://providers.ipro.org/index/homehealth)

33. Resources (cont.) • Rutenberg, C. D. (2000).Telephone Triage. AJN, 100 (3), p. 77-81 • Leff, E., Walsh, D. E. (2005). Critical success factors for the on-call home care nurse. Home Healthcare Nurse, 23(7), p. 435-440

34. Sara ButterfieldProject Leader IPRO20 Corporate Woods BoulevardAlbany, New York 12211Phone: 518-426-3300 ext. 104Fax: 518-426-3418sbutterfield@nyqio.sdps.org Victoria AgramontePerformance Improvement CoordinatorIPRO20 Corporate Woods BoulevardAlbany, New York 12211Phone: 518-426-3300 ext. 115Fax: 518-426-3418vagramonte@nyqio.sdps.org Christine StegelPerformance Improvement CoordinatorIPRO20 Corporate Woods BoulevardAlbany, New York 12211Phone: 518-426-3300 ext. 113Fax: 518-426-3418cstegel@nyqio.sdps.org IPRO Home Health Project Team Contact Information

35. State Association Contact Information • Kelly Donohue Coordinator of CommunicationsContinuing Care Leadership Coalition555 West 57th - Suite1500 New York, New York 10019 Phone: 212-506-5424Fax: 212-258-5331donohue@cclcny.org • Alexis SilverDirector of Development and Special ProjectsHome Care Association of New York State, Inc.194 Washington Avenue, Suite 400Albany, NY 12210Phone: 518-810-0658Fax: 518-426-8788asilver@hcanys.org • Margaret ClarkAssistant Director of Public PolicyNew York State Association of Healthcare Providers, Inc. 99 Troy Road, Suite 200East Greenbush, New York 12061Phone: 518-463-1118 ext. 811Fax: 518-463-1606clark@nyshcp.org • Rose DuhanSenior AnalystHome and Community Based ServicesHealthcare Association of New York StateOne Empire DriveEastRensselaer, NY 12144Phone:  518-431-7620Fax: 518-431-7915rduhan@hanys.org