Telephone Triage in the Emergency Department: A Collaborative Outcome

1. Telephone Triage in the Emergency Department: A Collaborative Outcome Lincoln Medical & Mental Health Center • member of NYC Health & Hospitals Corporation(HHC) • member of Generations+/Northern Manhattan Health Network

2. Purpose • Meet the challenges of Managed Care by providing the South Bronx community an effective alternative to access healthcare. • Decrease overcrowding in the ER

3. Goals Provide an alternative to the ER for low acuity problems Improve the quality and reliability of the service Provide the community with reliable access to heath care information Facilitate appointment for managed care patient to primary care services

4. PI Methodology P - lan D - esign M – easure A - ssess I - mprove

5. PDMAI Approach Design Procedures/Protocols Patient Pediatric Protocols Awareness/ understanding of the service Adult Protocols Patient Acuity Assessment Protocol Quality Telephone Triage Language barrier Computers Management and follow-up of panic values Cyracom Phones Follow-up on “no answer” TTY Machine Staffing effectiveness Community outreach /education materials Phone rings a long time before being answered Quality of Care Provider Environment/ Equipment

6. Design Triage RN may consult with provider/PCP at anytime during the process Patient initiates phone contact Call comes into Telephone Triage unit Call comes into ER Call comes from laboratory Panic Values Call comes into appointment unit Clerk answers phone RN answers phone Yes Urgent? No RN assesses situation Clinic appointment scheduled Advice only Emergent call Urgent call Appointment only LMMHC/Belvis/Morrisania RN gives patient appointment (24 hour window) RN documents case Appointment unit notified of time frame for appointment Patient referred to nearest ER or 911 contacted Follow-up of all pediatric and some adult cases Follow-up on ER Referrals LMMHC/Belvis/Morrisania Call transferred to appointment unit

7. Patient Disposition • Emergency Referral • Urgent (Same day) • Urgent clinic appointment (within 24- 48 hrs) • Clinic appointment (48-72hrs) - sick visit but not urgent • Clinic appointment (visit within four days or more) - not a sick visit

8. Telephone Triage History 7/29/96 - Lincoln Pediatric calls 9/06/96 - Lincoln Adult calls 5/98 - Belvis Pediatrics and Adult calls 10/98 - Other clinic Pediatric and Adult 4/24/00 - Morrisania Pediatric and Adult calls

9. Total Number of Calls