Ambulatory Care Nurse Triage Documentation Optimization

Telephone triage provides patients with an evaluation of symptom acuity along with care advice to support their health status. A functional, effective triage system can contribute to the organization’s goals of increasing patient safety, improving quality outcomes, decreasing adverse events, improving patient satisfaction, and decreasing hospital visits.

The current state of the nursing triage workflow in our ambulatory care clinics was observed by the triage nurse educator and findings were reviewed with the clinical workflow informaticist team and the nurse triage council (NTC). These findings showed that there is a lack of understanding of the nurse triage tool, an underutilization of the triage function, a lack of standard triage documentation, and confusion when reviewing nurse triage notes. To improve documentation of triage telephone encounters a pilot ambulatory care clinic was selected with a goal to reduce symptom-based telephone encounters by 10% and improve reason for call documentation.

Several interventions were implemented to reach our goal. These include revamping triage education classes and increasing class offering frequency, bringing back onboarding triage classes to in-person to increase participation and engagement, manual chart auditing on documentation and reviewing findings with staff, providing triage data and reason for call resources to clinic leadership, updating triage workflow and documentation process, and sharing changes and updates with staff at department level and council meetings. The baseline average for symptom-based telephone encounters was 42. The average for post-implementation was 86 encounters. The percent change is 107%. The average percent of “blank” reason for call for telephone encounters reduced by 2% from June 2023 – January 2024. The 10% target was not met due to more accurate labeling of reason for call for telephone encounters. Our post-implementation data shows an increase in nurse triage encounters and a decrease in "blank" telephone encounters. This can be attributed to a better understanding and use of the nurse triage documentation tools and improvement from non-clinical staff labeling symptom-related calls by adding "assessment" as the reason for call.

Utilizing nurse triage tools can be correlated to preventing unnecessary emergency room (ER) visits, preventing delay in care, preventing duplicate diagnostics, and improving patient experience. Improving nursing documentation can help prevent liability risk and potential implication to the institution. For next steps, resources and tools the clinic can utilize to increase the correct labeling of nurse triage encounters include development of standard operating procedures (SOP) on clinic-specific expectations for nurse triage utilization. Additional measures to increase nurse triage tool usability include continuing documentation audits to ensure accuracy, adding training and e-modules for telephone triage utilization with the triage nurse educator, and increasing provider inclusion in the nurse triage education.