Saint Elizabeth Telephone Line to Care After-Hours Nurse Triage Program
It’s all about relationships.
We at Saint Elizabeth know your patients have a trusting relationship with you. And you have personal, caring connections to them and their families. But we also know you want to spend more quality time with your own family or need more down-time for yourself. We can help.
Start a working relationship with us.
We are the Telephone Line to Care (TLC) Call Center, based at Saint Elizabeth Regional Medical Center, Lincoln, NE. We have a team of RNs who currently help more than 70 physicians not so different from you, to improve their own quality of life with the comfort of knowing their patients are in caring, professional hands should medical questions or emergencies arise. We provide after-business-hours symptom management and health information for patients like yours. Saint Elizabeth Telephone Line to Care has provided after-hours nurse triage services since 1996. Our team of RNs currently serve 25 practices in Nebraska. Six are Pediatric while the remaining 19 are Family Practice and other specialty practices.
Symptom Management / Clinical Guidelines
Calls are processed utilizing computer guidelines provided by McKesson Corporation with the objective of providing the right level of care at the right time. The guidelines were developed for use by registered nurses who comply with the respective Nursing Practice Act with the Rules and Regulations issued by each state. The guidelines recognize that a registered nurse will utilize knowledge and skill to make clinical decisions to manage each patient’s unique needs. Specific caller variables such as risk factors and distance from care can influence the recommended disposition and care advice.
- The pediatric guidelines are developed by Dr. Barton Schmidt, MD. In 1994 he wrote the first computerized pediatric triage protocols. His pediatric protocols have become the standard of care for telephone triage in the United States.
- The adult guidelines are managed by the Clinical Services department within McKesson.
Not a diagnosis
These guidelines do not diagnose disease or conditions. They help define actual or potential health problems that need further evaluation and facilitate initiation of an appropriate plan of care from a continuum of disposition options ranging from emergent care to home care. Triage guidelines should not be confused with practice standards and/or critical pathways intended to standardize medical diagnoses and clinical management.
Guidelines are updated annually by a team of physicians contracting with McKesson with the intent to provide clinical content that is evidenced-based.
Guidelines are reviewed by our TLC nurses and the Medical Directors prior to implementation to ensure compliance with regional and local community standards. Any specific requests or changes noted by a physician are considered Provider Factors and become the standard for all of physicians within a practice. There are approximately 200 pediatric guidelines and 150 adult guidelines. Guidelines for pregnancy-related symptoms are not available in the system making them unavailable to nurses. Callers for these symptoms are referred to their obstetric provider.
How they work
Each guideline begins with an overview description and summary of key clinical points.
Assessment questions asked by the nurse provide structure to the assessment process sequenced in to distinguish acuity of the presenting problem.
Clinical alerts are incorporated in the text of the guidelines. An alert is a clinically-pertinent fact providing more information such as significant risk factors to support disposition and care recommendations. An alert is also used to define or clarify clinical signs or symptoms to improve the reliability of how a question is asked. A clinical alert may also be helpful in convincing a reluctant caller to follow advice, expanding patient education, or providing rationale for upgrading a disposition.
Care advice is associated with individual assessment questions directed to the caller’s described symptom(s) versus possible undiagnosed conditions. Specific care advice is given after a recommended disposition is determined through the nurse’s assessment. NOTE: These care advice instructions are as succinct as possible to improve caller retention of the most important information. The advice gives the caller or caregiver a care plan to follow in lieu of or until the provider is seen. At the end of each call, the nurse asks if the caller understands the information given and if they will be able to carry out the instructions and this understanding is documented in the patient’s record. Records are automatically faxed to the provider’s office and may also be automatically faxed to a secondary location if the patient is referred to the emergency department for continuum of care.
TLC Triage Program
- Triage patient symptom calls using only approved McKesson HBOC Guidelines and/or Physician Provider Factors.
- Call or page physicians for further instructions as appropriate.
- Notify the patient’s preferred pharmacy for prescriptions per physician orders.
- Return follow-up calls to patients regarding physician’s orders or education.
- Fax report of symptom calls to physician’s office with 24 hours of the call.
- Automatically refer callers accessing TLC three times within a 24-hour period to the physician on call for second level triage.
- Facilitate callers with telephone access of their physician upon request.
Determine by office, how patients will access TLC service.
Inform patients about TLC service; hours of availability.
Respond to TLC pages within 10-20 minutes.
Fax physician call schedules monthly to TLC.
Communicate changes to physician phone numbers, pagers, hours and/or new physicians joining the practice.
Assure that all physicians in the practice are in agreement with and jointly sign requested guideline changes know as Provider Factors.
Assure adequate paper and toner supply in the office fax machine for receipt of caller reports.
You will be pleased to know our fees are competitively priced with similar services in the region The service fee includes outbound calls to the physician for further instructions or emergency care authorization; calls to the patient’s pharmacy for prescription orders; follow-up calls to patients with physician’s orders and education; and calls to urgent and emergent care facilities with notification of physician authorization. Provider calls include calls from a healthcare provider such as a physician, Emergency Department, or Nursing Home.
Activity Reports and monthly invoices for services received during the prior calendar month will be sent to physician practices by the 15th of each month. Payments will be considered delinquent by the 15th of the following month.
Accessing Telephone Line to Care
We provide toll-free phone access for communities located outside the "402" area code.