2025 FY DCC Competency Phone Triage

2025 FY Vanderbilt Adult Ambulatory Operations

DCC Communication

• Review customer service
• Discuss quality assessment via phone and the model of care delivery

• Identify patient status (urgent, emergent, etc.) and when to escalate care
• Discuss HIPAA

• Review best practices and key components of documentation
• Review follow up actions and teach back

Objectives

• Caller name, relationship to patient, phone number
• Chief complaint
• Patient assessment
• Meds discussed
• Advice given
• Caller's agreement with plan of care
• Route to right pool
• Interventions
• Tasks

• End call efficiently
• Review recommendations, request teach back
• Instruct pt to call or seek medical care if needed
• Thank the patient
• Remind pt of DCC services
• Any other needs?

• Identify pt s/s
• Gather relevant pt hx
• Recommendations/care referral
• Medication recommendations
• Use health literacy

• Identify yourself
• Provide DCC info
• Verify pt name & DOB
• Confirm who caller is

Documentation

Closing

Protocol Utilization

Introduction

For DCC

The Model of Care Delivery

• Interview
• Begin with demographics
• Questions need to be clear and concise
• Listen for audible clues: Heavy breathing, moaning, background noises, crying
• Data collection
• Who, what, when, where, and why
• Prioritize
• High Priority: Airway, Breathing, Circulation comes first!

Phone Triage

Follow-up of Patient Phone Calls, MyHealthatVanderbilt (MHAV) Messages policy

Prioritization

• Onset
• Location
• Duration
• Character/Timing
• Aggravating Factors
• Relieving Factors
• Treatment
• Severity

OLD CARTS

Review of Systems Your review of sytems will depend on the patient's Chief Complaint. As a resource, you can use the mnemonic “OLD CARTS”.

• The caller name, relationship to the patient, and the phone number
• Chief complaint
• Your assessment of the patient
• Document any medications discussed
• Advice given to patient
• Caller's agreement with the plan of care
• Route the note to the appropriate pool
• Interventions with the correct discharge CSN
• Document the call in a timely manner

Documentation Requirements

Real Documentation Example

"According to the Notice of Privacy Practices, you may release personal information to anyone that the patient has identified as the recipient of such information (see Communication with Family and Others about Your Care and Permission to See Your Medical Record). Refer all others to the contact person the patient designates. In all other cases, telephone communication about patient information is challenging since you can't physically confirm the identity of the caller. Reasonable precautions need to be taken to safeguard the privacy of the patient. Suggested precautionary steps: Check the record to make sure the patient is listed as a no information; check Alerts; Ask the caller to identify two pieces of personal information about the patient that a typical acquaintance would not know; such as birth year, maiden name, mother's maiden name. Always follow the Minimum Necessary Rule and only disclose specifically what is needed by the family member to support the patient's care."

Telephone Triage: HIPAA

Ensure to complete all tasks ensured to the patient(called the nurse, sent message, paged provider, etc.)

Teach Back

Further Provider Follow Up

However over each topic to learn more!

Follow Up Actions

How?

Why?

What?

This is why teachback is so important!

• Confirm patient's plan using teachback
• Click on the buttons below to learn more

Teach Back

1/10

What does the GREAT Acronym stand for?

Great, Realize, Explain, Acknowledge, Thank

Good, Reply, Extra, Acknowledge, Talk

Greet, Relate, Explain, Ask, Thank

Introduction, Production, Communication, Documentation

Internalize, Produce, Utilization, Communicate, Documentation

Introduction, Protocol Utilization, Closing, Documentation

2/10

What is the model of care delivery in the DCC?

Patient who is complaining of severe shortness of breath.

Patient who complains of burning when urinating.

Patient who reports rash around post operative dressing.

Using the priorization guidelines, which patient would need follow up first?

3/10

Click to view larger text

Spoke with patient's son, Bob. Best callback phone number: 555-555-5555. Reason for call - outreach, response to patient text. Details of call: Spoke with man who states he is patient's son. Reports pt is doing okay but he is out of oxycodone and pain is out of control, 8/10 on average. Informed patient's son that I would send communication to Ortho team to review but they may request to see patient in office. Verified pharmacy information. Provided teach back education on how to take oxycodone. Son is agreeable with plan. Routed communication to trauma team for review and gave return phone number for patient.

What piece of documentation is missing?

The nurse has documented the following:

Verification of patient identifiers

Follow up

Teach back education

4/10

5/10

Regarding follow up, it is important to use what resource to know who to for which particular issue, routing to the appropriate pool/team, and paging the correct on-call provider if needed?

VUMC Quick Links

PolicyTech

The DCC Protocols in the Info Guide

American Academy of Ambulatory Care Nursing. (2018). Scope and standards of practice for professional telehealth nursing. American Academy of Ambulatory Care Nursing (AAACN). (2011). Scope and standards of practice for professional telehealth nursing (5th ed.). Pitman, NJ: AJ Jannetti, Inc. Brennan, K., Huff, T., Koss, K., Moss, K., Stefansic, C. (2021). Telephone triage - outpatient clinics. Vanderbilt University Medical Center. https://vanderbilt.policytech.com/dotNet/documents/?docid=20971 Burke, S., & Belongia, M. (2013). Telephone triage guidelines: a professional resource for pediatric hematology/oncology and stem cell transplant nurses. Chicago: APHON, Association of Pediatric Hematology/Oncology Nurses. Clawson JJ & Democoeur KB. (2003). Principles of emergency medical dispatch (2nd ed.). Salt Lake City: Priority Press. Espensen, M., & American Academy of Ambulatory Care Nursing. (2009). Telehealth Nursing Practice Essentials. Jannetti Publications Incorporated. Lephrohon J & Patel V. (1995). Decision strategies in emergency telephone triage. Medical Decision- Making, 15(3), 240–53. Listen to Understand.(2019). Retrieved from: https://d1vy0qa05cdjr5.cloudfront.net/8fb651dc-6f50-4f63-8ea3-82468310aae4/Listen%20to%20Understand%20-%20Leader%20Guide%20-%20GOLD.pdf Montague, B. & Novack, R. (2013). Kid President's 20 Things We Should Say More Often. Retrieved from https://www.youtube.com/watch?v=m5yCOSHeYn4 Rutenberg, C. & Greenberg, M.E. (2012). The Art and Science of Telephone Triage: How to Practice Nursing Over the Phone. Hot Springs, AR: Telephone Triage Consulting, INC Schmitt, B. D. (2018). Pediatric telephone protocols: 16th Edition . Elk Grove Village, IL: American Academy of Pediatrics Smits, M., Keizer, E., Ram, P., & Giesen, P. (2017). Development and testing of the KERNset: an instrument to assess the quality of telephone triage in out-of-hours primary care services. BMC health services research, 17(1), 798. UNM School of Medicine. (n.d.). Template for clinical soap note format. UNM School of Medicine. Retrieved on May 11, 2021 from https://fcm.unm.edu/education/images/docs/template_clin_soap_note.pdf Wheeler SQ. (2005). Risk management in telephone triage (continuing education course). Retrieved from http://www.teletriage.com.

References

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