By John Gabriel

This is part one of a two part blog entry.ques mark 2

Vision
 The motivation for outsourcing an after-hours nurse triage service may vary. It might be to meet the 2011 NCQA Medical Home certification requirements or the Meaningful Use Phase I requirements or perhaps it is simply to reduce non-urgent after-hours calls to the on-call physician. You’re doing some sort of “after-hours” now, whether it’s alternating nurses for lunch coverage or rotating physicians at night. So the question is what is your big vision for the future and how are you going to accomplish it?

In the summer of 2003, my wife and I purchased and renovated a 40 + year old home. We embarked on one of the largest projects we could ever imagine. Ralph our general contractor jokingly commented that if our marriage survived this project, it could survive anything. His pearls of wisdom and more importantly his keen ability to “begin with the end in mind” proved more invaluable than we could ever have imagined. Ralph understood that we had a “wish” list of things we eventually wanted, but couldn’t swing at that moment. He remodeled with our list in the forefront, laying the groundwork for items we wanted in the future, but couldn’t have right now.
Somewhere along the way, it occurred to me that while home remodeling and nurse triage may seem miles apart, from a life impact and life cycle standpoint, they are quite similar. It’s a remodeling of your services. Whether you are a medical group, healthcare plan ACO, or single physician practice, implementing a nurse triage service requires having a vision of the end result, knowing what you need and building it. It’s an added value extension of your business and your services and as such it needs to compliment and augment your existing system. In other words, healthcare companies seeking to expand their nurse triage service would benefit from the “begin with the end in mind” approach that Ralph took with our remodel.

Weighing Effort and Effectiveness
I started my career as a tradesman and still have an active general contractor’s license, thus I considered doing the remodeling project myself. I mapped out everything that needed to be done and quickly realized I could not focus on this remodel and still effectively perform my primary 9-to-5 job. Simply put, taking on the remodel would take me away from my core competencies. My efforts were better spent on breadwinning and outsourcing the remodeling by hiring a general contractor.

When looking at whether to outsource a nurse triage or run one in-house, the same logic applies. What’s the big picture, what does it take to get there and does the effort of running an in-house nurse triage enhance or reduce the effectiveness of the primary practice? For many practices, nurse triage is an option at lunch that can be achieved by staggering nurse lunches or maybe staff absenteeism or office patient queuing makes this an unreliable option. Nights and weekends present a separate issue since the volume of calls may not justify hiring a full-time nurse and you may have to over hire to support absenteeism, vacation and turn-over. And perhaps the physicians don’t want to be on call every other weekend. There is also the consideration of how to document the triage interaction and what system will be used to ensure the triage experience is thorough and consistent for your patients. Some practice management systems offer basic triage functionality. However, they may not provide care advice and rely on the triage nurse’s experience and training for providing care and documentation. Dedicated nurse triage software is available, and it can be costly. And there’s the question of where the in-house nurse triage will reside. There is a cost associated with providing after-hours nurse triage support – facility operations cost, computers and equipment, a call distribution or multi-line phone system. Nurse supervision may also be a concern if your state prohibits non-management employees to work unsupervised.

What is your wish list vision for after hours nurse triage coverage? Keep your end vision in mind as you sort through the needs, options and costs. Don’t be afraid to dream big and scale back. It’s your practice that you’re remodeling.