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Director of Education, Michelle Holztrager’s Article Featured in Connections Magazine

Recently, TeamHealth’s Director of Education, Michelle Holztrager RN, wrote an article that was featured on the cover of Connections magazine. With more than 25 years’ experience in the healthcare industry, her knowledge in areas of clinical experience prove vital in providing the right information to continue to make TeamHealth a success.  We are excited to share her article below or you can read the original article on Connections Magazine’s website here.

What Makes an Excellent Telephone Triage Nurse?

By Michelle Holztrager
Telephone triage nursing has become a highly skilled and specialized field of nursing. At TeamHealth Medical Call Center, we believe telephone triage is an art. We have found that the most successful telephone triage nurses excel in four areas: process skills, clinical knowledge, critical thinking, and listening skills.

Process Skills: Process skills consist of typing and computer navigation skills. We utilize a number of tests to evaluate software comprehension, keyboard dexterity, typing speed, and multitasking. Our nurses must access a number of different programs and client EMRs to meet client specifications and drive patient-centered care. It is important that nurses not lose focus on patient interactions by difficulties managing technology.

Clinical Knowledge: The need for clinical knowledge is obvious, and excellent phone assessment skills are paramount. Generally, nurses with broad experience – in particular ER nurses – are a good fit for telephone triage. Ambulatory care nurses usually have the benefit of previous in-patient experience coupled with phone assessments from their practice experience. For call center specialties and sub-specialties, we seek nurses with specific experience. TeamHealth Medical Call Center also provides intensive training on phone assessments, guideline selection, and the clinical phone triage process.

Clinical Thinking: Adept critical thinking is another crucial attribute of a telephone triage nurse. A telephone nurse must be able to follow the triage process to do well. Deviating from the process or the guidelines often results in poor decisions or the nurse going down the wrong path. A nurse with strong critical thinking skills can take in extra information and sort out important nuggets without allowing the extraneous communication to influence the call. Callers are usually subjective in their words, and the telephone triage nurse must be able to separate the objective from the subjective and apply the triage process to the presenting facts.

Listening Skills: Lastly, successful telephone triage requires excellent listening skills. There are no physical cues as to the patient’s disposition, and thus the nurse is dependent on truly hearing and clarifying what the caller says. Listening skills and the ability to hear the important details are vital to the process. At TeamHealth Medical Call Center, we focus on listening skills and verbal indicators throughout our training program.

I like to say that the art of telephone triage is the science of nursing with the addition of specially trained listening skills. Nurses are used to physically multitasking, but telephone triage requires very focused mental multitasking. Nurses who are proficient in these four areas will usually shine in the field of telephone triage.

Michelle Holtztrager, TeamHealth Medical Call Center Leadership, Director of Education and Staff Development

Michelle Holztrager, RN, is the director of education and staff development at TeamHealth Medical Call Center. With more than 25 years’ experience in the healthcare industry that ranges from provider relations to patient services management, her areas of clinical experience include pediatrics, labor and delivery, and neonatal intensive care. The last several years Michelle has been with TeamHealth in Occupational Health, health coaching, wellness, and diabetes management. She received certifications in neonatal intensive care nursing and health coaching. Her desire to teach and educate has been evident through one-on-one education as well as group settings. Michelle received her associate’s degree in nursing from Jefferson State Community College in Birmingham, Alabama, and a Bachelor of Science in Health Care Administration from the University of Cincinnati.

By |April 2, 2015|Blog, Telephone Triage|Comments Off on Director of Education, Michelle Holztrager’s Article Featured in Connections Magazine

The Startling Impact of Appropriate Utilization

red_barchartBy Gina Tabone – MSN, RNC-TNP

Today’s healthcare environment mandates the optimal utilization of all available resources. Every organization is scrambling to figure out how high quality care can be provided at a lower cost. Many organizations have hiring freezes, are suffering from decreased 2014 reimbursements and are relying on innovative administrative teams to work with budgets that are lower than previous years. Emergency Medicine Departments can be one of the most expensive venues for the provision of care and must come up with immediate solutions to the dilemma of unnecessary visits. Initiatives need to focus on offering patients the most appropriate level of care available that does not involve showing up at the ED. The safest, most cost effective, and easily implemented option is to provide nurse triage to potential patients, prior to them showing up.

The primary beneficiary of having a triage nurse available for advice is definitely the patient. Patient who leave their home and seek care in the ED, are often seeking a level of care that is not necessary for the degree of severity they are experiencing. Having an option to speak with a nurse trained in the specialty of telephone triage represents an access to care that most callers appreciate and end up complying with. They may be able to remain home, and either be referred to a provider in an office setting, or receive home care that will alleviate the current problem. Diverting Patients from the ED is not the goal. The goal is to direct patients to the most appropriate level of care for the symptoms they are experiencing, so that their treatment is continuous and aligned with their primary care providers. In addition to the health benefits of nurse triage there is also a copay savings that would occurs if care was provided in any setting other than the ED. Other stakeholders that would benefit from a pre-ED triage call include health plans, managed care plans, self-insured employers and organizations currently offering ACO’s. The National Hospital Ambulatory Medical Care Survey cites the additional cost of an ED visit vs a PCP office visit to be $580. There is significant opportunity for payer savings as well.

EDs are busy. They are over-crowded, understaffed, 24/7/365, and required by law to treat any patient who shows up. The Emergency Medical Treatment and Active Labor Act (EMTALA) is an act of Congress passed in 1986. It requires hospitals that accept payments from Medicare to provide emergency health care treatment to anyone who believes they need to be seen. There are no reimbursement provisions in the Act. The consequence of ED overuse is threatening the existence of hospital Emergency Departments across the country. The study of Avoidable Emergency Department Usage Analysis estimates that 76% of ED visits made by commercially insured patients are not medical emergencies and can be better treated with skilled and opportune outpatient care. In some states, Medicaid payments for certain ED diagnosis are no longer being reimbursed. Decreased payments, compounded with the fact that from 1991-2010 there was an 8% decline in the number of hospital ED’s in the United States poses a considerable threat to those that remain open. Integrating Telephone Triage is the solution to keeping those 76% of patients who don’t need to be there out of your ED waiting rooms. The specialty of Telephone Triage is practiced by registered nurses using years of experience, critical thinking skills, and evidence based decision support tools. Safe outcomes result from an adherence to the nursing process, a detailed assessment, analysis of symptom specific medical criteria and finally by providing the patient a recommendation to the most appropriate level of care. Offering patients this service provides high quality care at the lowest cost possible. Hospitals need to consider having telephone triage nurses as a component of their Emergency interdisciplinary teams.

TeamHealth Medical Call Center is a nationally recognized, premier provider of remote patient care with enhanced outcomes for a variety of specialty departments including the ED. If you are interested in strategies that best utilize the resources of your organization please contact Karen Brown at to discover how the Triage Nurses at TeamHealth can be your immediate solution.

gina_taboneGina Tabone, MSN, RNC-TNP, is Director of Clinical Solutions at TeamHealth Medical Call Center.   Prior to joining TeamHealth, she served as the Administrator of Cleveland Clinic’s NURSE on CALL 24/7 nurse triage program. Under her direction, ED utilization declined, continuous care coordination improved, performance metric targets dropped from 33% ABD to less than 5%, URAC accreditation was achieved, and the call center grew from covering 350 physicians to the integration of more than 1,500 employed and affiliated providers.

By |March 19, 2015|Blog, Quality Improvement|Comments Off on The Startling Impact of Appropriate Utilization

Could This Easy-to-Implement Service/Benefit Help to Prevent Physician Burnout and Improve Your Physician Recruiting Success?

78715046_smallBy Jeanne Griffin – Director of Business Development

Evidence supports that physician dissatisfaction and burnout is a serious and growing problem. According to the Medscape Physician Lifestyle Report 20151, US physicians suffer more burnout than other American workers. At the top of the list are our front-line physicians—Critical Care, Emergency Medicine, Family Medicine, and Internal Medicine, ranging from 50 to 53 percent of responding physicians in each of those specialties. Medscape Psychiatry2 reports that “45% of primary care physicians would quit medicine immediately if they had the financial means.” These statistics may be alarming to some, but it is the reality for those front-line physicians and healthcare administrators tasked with recruiting and retaining physicians. Physician burnout will not only impact individual practices and healthcare systems, but it also is likely to have dire consequences on our entire healthcare infrastructure.

The good news is that physician burnout is not going unnoticed. It’s top of mind among healthcare professionals who are publishing numerous articles, focusing on identifying root causes and proposing potential solutions. I recently attended a national healthcare conference and found issues related to physician burnout to be hot topics. Physicians and healthcare administrators, visiting our TeamHealth Medical Call Center exhibit, were searching for options and discussing potential solutions that would provide some relief to what they referred to as their overwhelmed and overworked providers.

What benefits and programs are offered to address physician burnout and to help physicians reduce stress and improve work-life balance? To find answers, I searched the Internet to see what perks are offered, either in the recruiting process to attract top talent or used to retain physicians. My findings included the important, but standard benefits, such as different types of insurances, continuing education reimbursement, relocation allowances, signing bonuses, etc. I did not find any benefits or offerings that would positively impact work-life balance and address stress, which is a major cause of burnout among physicians.

During one of the informal huddles at our conference exhibit, someone mentioned the idea of using afterhours telephone triage as a recruiting benefit. Once this idea was presented to the group, consisting of providers and administrators, it was as if a light bulb turned on for several participating in the discussion. Some said they already planned to implement after hours telephone nurse triage to bring relief to their physicians, but they never thought to mention it during the recruiting process or list it as a benefit.   A health system CEO in the group told us that he’s been courting a physician for some time, but he hasn’t been able to get a commitment, and he believed that freeing her from afterhours call duty could make the difference. Several administrators said that their younger physicians have been asking for this afterhours support and were not expecting for afterhours on call to be part of the job.

Being able to offer the provider flexibility to attend family events, get an uninterrupted night’s sleep, and know that they can confidently make leisure time plans is a powerful benefit. For the facility, it can improve provider performance when they have had adequate rest and leisure time. The performance of a rested provider will be reflected in patient satisfaction and quality of care delivered. Carving the 24/7 access out of the provider’s core responsibilities is a powerful physician recruitment and retention game changer.

1Carol Peckham, Medscape Physican Lifestyle Report 2015, January 26, 2015.
2Herdley O. Paolini, PhD; Burt Bertram, EdD, LMFT, LMCH; Ted Hamilton, MD, MBA, “Antidotes to Burnout: Fostering Physician Resiliency, Well-Being, and Holistic Development,” Medscape Psychiatry, April 19, 2013.


Jeanne GriffinJeanne Griffin, Director of Business Development at TeamHealth Medical Call Center, holds a marketing degree from the University of Tennessee and 20-plus years of sales and business development experience. Throughout her career, Jeanne’s mission has been to work with each prospective client as a potential partner and ensuring that each client receives high-quality services that are customized for each client’s specific needs, thereby improving client satisfaction as well as the client’s customer/patient experience. 


By |March 9, 2015|Blog, Miscellaneous|Comments Off on Could This Easy-to-Implement Service/Benefit Help to Prevent Physician Burnout and Improve Your Physician Recruiting Success?

Return on Respite, A Physician’s Story of After- Hours Nurse Triage

By Jack Seidel M.D.

Tired DrFor many years I took my own calls at night. I would try to take notes, but realized the next morning that I not only did not take very good notes when I was just awakened from REM sleep, but I had very poor memory of the call. Not only could I not document the call well, but I often had the nagging feeling that maybe I did not get the whole story and maybe I did not give the most prudent advice. I would frequently call the parent back in the morning to try to sleuth out what had transpired a few hours before in the middle of the night. This would take a lot of extra time, and when I couldn’t reach the parent, I would keep trying. I wanted to make sure that the child was OK and that my advice had been prudent.

I later kept a tape recorder by my bed so I could listen to what I said the next morning. That was helpful but extremely time consuming. I would sometimes hang up the phone and worry about a kid and then couldn’t fall back asleep for a long time. Sometimes I would just get up. My wife would sometimes be awakened with these calls as well. When one is putting in a long day at the clinic and then is frequently awakened at night, it is rough on the body and the mind. It can impair concentration, memory, cognition, efficiency, and judgment. It is also hard to be cheerful when one is sleep deprived.

There’s no question that a nurse who is wide awake and following a protocol is going to be more thorough and attentive than someone who is sleep deprived and suddenly awakened. Certainly the advice will be more detailed and will be better documented.

When the nurse triage call information is faxed or sent into the practice EHR on a timely basis, a nurse can review the call first thing in the morning and follow up with the patient. Parents love this demonstration of care.

By |February 10, 2015|Blog, Telephone Triage|Comments Off on Return on Respite, A Physician’s Story of After- Hours Nurse Triage

On Target with Triple Aim

By Gina Tabone – MSN, RNC-TNP

triple aimThe Affordable Care Act objectives can be summarized very simply by what is known as “TRIPLE AIM.” The emphasis is on providing better care for the patient and improving the health of the population all while lowering the per capita cost of healthcare. For almost two decades, the TeamHealth Medical Call Center has been and remains focused on these three priorities. Our AIM is great, and we’ve hit the bull’s eye!

Providing the “best” care for patients means that access to care is essential and should be available when the patient deems it necessary. TeamHealth is on target with this. Our nationally recognized team of call center experts has built a dependable infrastructure, designed “plan-of-care” processes, and assembled the clinician staff needed to respond when your patients reach out.

Dedicated registered nurses who are available 24/7 triage any acute symptom that a primary care patient may have or coordinate ongoing care of patients who are most at risk. We work with your organization to make certain that your patients never experience a gap in their healthcare—whether it’s nighttime, a weekend, or a holiday. We deliver an exceptional patient experience for every patient.

TeamHealth pioneered the delivery of care that improves the overall health and well-being of large groups of patients. Our organization doesn’t take patient care lightly, and we consistently achieve high quality outcomes for adult, pediatric and specialty populations. TRIPLE AIM validates the need for robust readmission prevention programs, so we have implemented disease-specific, post-discharge patient call back programs to ensure recently released patients are progressing as planned and making smooth transitions to their home settings. And we don’t settle for just one call. Multiple calls are made to the patient to verify that they have a clear understanding of their discharge instructions, whether follow-up appointments have been scheduled, and whether they’re taking their medication according to instructions.

Our proactive contact with patients helps them avoid the inconvenience and expense of unnecessary ED visits, and successful post-discharge call back programs ensure clinical intervention early on and greatly reduce preventable readmissions.

In 2014, readmission fines were imposed on 2,610 healthcare organizations, and Medicare estimates those fines resulted in a reimbursement reduction of $428 million. TeamHealth can work with your organization to ensure lower readmissions that will in turn improve your bottom line, and Nurse Triage is a large part of the solution because remote telephone triage is the most cost-effective means of providing high-quality healthcare.

All practices are challenged when it comes to efficiently utilizing their resources. By authorizing dedicated triage nurses to care for your patients, you empower your clinical staff to do what they do best—take care of the patients who present to the clinic. When your nurses are returning dozens of phone calls every day, they’re not able to coordinate care for your highest risk patients, assist with procedures, or guide the practice of your unlicensed staff.

Integrating telephone triage in the continuum of care is a key solution for any Accountable Care Organization to succeed TeamHealth provides seamless care to more than 500 practices, hospitals, third-party payers, and university health centers, and the cost savings and benefits to patients, providers, hospitals, and insurance plans are more than impressive.

TeamHealth Medical Call Center is the premier provider of solutions for achieving goals of the TRIPLE AIM.

gina_taboneGina Tabone, MSN, RNC-TNP, is the Director of Clinical Solutions at TeamHealth Medical Call Center. Prior to her current role, she served as the Administrator of Cleveland Clinic’s NURSE on CALL 24/7 nurse triage program. Under her direction, ED utilization declined, continuous care coordination improved, performance metric targets dropped from 33% ABD to less than 5%, URAC accreditation was achieved, and the department grew from covering 350 physicians to the integration of more than 1,500 employed and affiliated providers. Year after year she was able to operate Nurse on Call at or below the forecasted budget.


By |February 3, 2015|Blog, Quality Improvement, Telephone Triage|Comments Off on On Target with Triple Aim