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PROFILE
The Nurse Partners Pediatric Telephone
Triage Program provides after hours nursing triage for newborns,
infants, children, adolescents and their parents. Nurses respond
to over 60,000 calls per year covering 165 pediatricians from 45
practices. The program is located on Ellison 18 at the MassGeneral
Hospital for Children. UNIT FOCUS
Calls are managed according to the Barton
Schmitt After Hours Pediatric Telephone Triage Protocols and the professional
judgement of the nursing staff. The nature of calls can vary from
a parent struggling with a fussy newborn to a distress call from an
adolescent contemplating suicide. Most common calls
involve children with fevers, vomiting, earaches, sore throats,
coughs, abdominal pain, and trauma. Approximately 11% of the callers
are directed to the ED, several require ambulance transportation.
The majority of callers require a systematic assessment to determine
where, when and if the child should be seen, reassurance that their
child will be fine, a plan for follow up with the pediatrician and
clear instructions on how to observe and care for the child through
the next few days. Nurses take this opportunity to educate families
in normal child development and reinforce information on how to
care for the child should this problem arise again. Follow up phone
calls are made to families later in the day if the nurse determines
the family needs a follow up assessment and/or additional education
and support.
The program is accompanied by a full scale quality
improvement program. Each call is entered into a data base which
enables us to track call volume, patient problems, ED referral rates
and call back response time. An ACD phone system also tracks the
amount of time patients spend waiting on the phone. Physician satisfaction
surveys are completed annually and a patient satisfaction survey
is being developed. Patients and practices are encouraged to communicate
all their ideas and concerns to the program as opportunities for
improvement.
PATIENT CARE DELIVERY
MODEL
The patient care delivery model is a patient-focused model, supported
by primary nursing. Patient-focused care is high quality, comprehensive,
accessible, supportive and personalized care.
TEAM MEMBERS
The RN staff is supported by administrative
personnel who initially greet the callers, coordinate communication
with answering services and physicians offices and assist in the
smooth operation of all aspects of the program. Physicians are on
call should the nurse need to contact a covering physician with
a concern or problem. The AT&T Language Line is utilized as
needed.
SCHEDULING PRACTICES
Staff schedules are driven by patient need.
The program operates weekday evenings from 5PM to 9AM and 24 hours
per day on weekends and holidays. Staffing is determined by historical
call volume. The scheduling process is staff driven and flexible
to accommodate personal and educational needs. Call volume tends
to peak in the evening creating some opportunities for scheduling
a few hours at a time. The winter months also bring a dramatic increase
in call volume. Once the schedule is posted, the staff manages changes.
STAFF ORIENTATION
All staff attends a one- week nursing orientation
program. Unit orientation is preceptor based, individualized and
determined by the Nursing Director, clinical nurse specialist and the
new employee. The length of orientation is also individually determined.
New nursing graduates participate in the New
Graduate Mentorship Program.
EDUCATIONAL AND DEVELOPMENT OPPORTUNITIES
Staff education and development is supported
by The Norman Knight Nursing Center for Clinical & Professional Development. Full and partial day programs
are offered. Staff may also access outside educational opportunities.
The teaching environment provides staff with a daily opportunity
to discuss patient care related educational issues with members
of the graduate medical education program and with other members
of the care-delivery team.
Clinical Nurse Specialists provide educational
support to staff on the nursing units. Staff has time allocated
and the necessary support to offer educational programs to other
staff members. Nursing Grand Rounds programs are offered on a regular
basis.
Staff RNs have the opportunity to participate
as a nurse preceptor or a team leader. RNs may advance in their
clinical practice and demonstrate proficiency through the Clinical
Recognition Program. Several formal educational programs relating
to Nurse Triage are planned each year and are based upon the expressed
needs of staff. |
