How and why practices can mimic the critical communication service.
Before the novel coronavirus was declared a pandemic in March, Deanna Tith spent her days as a medical secretary and team leader at Newton, MA-based health system Atrius Health. Most of her time was devoted to scheduling surgeries, coordinating with the surgeons on her team, and taking patients’ vital signs.
But now Tith’s days are spent at home staffing Atrius Health’s Covid-19 triage line, where she answers calls from patients about the infectious disease caused by the coronavirus. She’s part of a home-based workforce that includes 65 registered nurses, 17 medical secretaries, and one licensed practical nurse who triage calls from symptomatic patients with Covid-19 and what Jane Connor, RN, associate chief nursing officer, calls the “worried well,” or people who are anxious and uncertain about the highly infectious disease.
Approximately 85 percent of the calls are from patients with symptoms of Covid-19, while 15 percent of the calls come from patients who are worried about navigating life safely during the pandemic, says Connor. Tith and the other staff answering patient calls are only working from home, which means they’re not at Atrius Health practices seeing patients in person.
The triage team, which received its first call March 9, fielded 11,000 calls from patients during a busy three weeks from the end of March to mid-April. During that time, fewer than 100 patients were directed to the emergency department. The number of staff answering patient calls has flexed up and down, in response to patient need, says Connor.
In mid-April, Massachusetts was “right in the middle of a surge [of Covid-19 cases],” said Governor Charlie Baker, as reported by WBUR, Boston’s NPR news station. At 528 cases per 100,000 people, at that time, the state had the third most cases per capita in any state. During the surge in cases, Connor saw an increase in talk time while the number of calls went down. That’s likely because it was a sicker population of patients who were calling the triage line, she explains.
Keeping patients out of the ED; responding to questions
Keeping patients out of the emergency department was the initial goal, according to Connor. Triage team members can connect patients with resources such as drive-through testing, care in their homes, telehealth consults, urgent care, or a hospital visit, if necessary. Connor also wanted to keep staff members and other patients safe from the highly contagious disease. That meant phone-based triage was the right approach, she says.
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The nurses and medical secretaries on the triage team also answer many questions from patients who are anxious and uncertain about living safely during the pandemic. For example, Deborah Helen, RN, clinical patient safety and risk management specialist, who works on the team, explains that it’s easier for a mother to tell an 11-year old child than a toddler why she can’t hug them if she has Covid-19.
Patients also ask about breastfeeding and pet safety, among other concerns. To respond to these questions, Helen and her team access the latest information from the CDC and the Massachusetts Department of Public Health. As of May 6, most people two years of age and older who can’t safely practice physical distancing in public are required to wear a face mask or face covering in Massachusetts. But convincing young children to wear a mask can be a challenge. Her advice? Color the masks and make it fun.
Continue reading on page 2...Patients who have Covid-19 are concerned about keeping their children and other family members safe, says Helen. She recommends that they use a separate bathroom from other family members, if that’s possible.
Speaking in a clear and concise manner and providing examples to patients is important, explains Helen. Connor says that patients who are really anxious can be referred to a nurse practitioner, physician assistant, or doctor for a consult by video or phone.
How the Covid-19 triage call team works
Patients who call one of the Atrius Health practices because they’re symptomatic or have questions about Covid-19 are immediately patched through to a member of the home-based triage team. Each member of the triage team has access to a list of scenarios that help them provide the most up-to-date, accurate information about Covid-19. For example, if a patient thinks they have the disease, the nurse or medical secretary will ask about their symptoms to determine if access to a Covid-19 test or a telehealth visit with a physician is appropriate.
Every weekday morning before their shifts start at 8 a.m., triage team members participate in a 30-minute “virtual huddle” meeting where they learn about new symptoms, testing criteria, and guidance from state and federal agencies about Covid-19, says Connor. When patients call outside those hours, their calls are picked up by a different team of medical secretaries and nurses who have gone through the same training protocols as the weekday team. Connor adds that patients who call during the weekend and after-hours can also have access to a nurse practitioner or a physician assistant by video.
Smaller practices that want to set up a phone-based triage team should ensure they have coverage between the hours of 7 a.m. and 7 p.m. at a minimum, advises Connor. That’s because the majority of calls arrive before people leave for work and after work in the evening, she explains.
Take-aways about the Covid-19 triage call team
Helen says the ability to alleviate patients’ fear is the most rewarding part of taking calls on the Covid-19 triage line. “This is new to everyone. We’re all nervous about this virus and how it can impact our lives and our families’ lives,” she explains.
The team huddle, where team members can ask questions at the start of the day, helps ensure everyone’s communicating a consistent message with patients, says Helen. Patients have found the telephone-based care and telehealth visits to be so convenient that they don’t want them to end, she adds.
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What’s next for the Covid-19 triage call team? Connor says Atrius Health continues to evaluate patient call volume on a daily basis. One variable she uses to adjust staffing levels is the length of the calls from patients. She expects call volume to go down over the summer, but Atrius Health is planning for a potential Covid-19 symptom surge in the fall. “[We] will be prepared to bring our team back together at any time to restart our call center when needed,” says Connor.
The Boston Globe reported that the state’s three-day average of Covid-19 deaths is 67 as of May 22, signaling the eighth day of decline. Hospitalizations of patients with Covid-19 are also trending downward.