Phone Triage

Brainstorm

Phone Triage

Re-grouping after collecting thoughts and ideas

Purpose

Goals

• No double work or accidentally doing the same task as someone else
• Still being present in clinic when it's not your triage day
• Teamwork!
• Clear basket
• NO BURN OUT

TOPIC 1

Prior authorizations

TOPIC 1 // Prior Authorizations

"Would we feel it to be helpful to start a list that says which insurance likes which inhaler to decrease the time tryping to submit a PA if we know 'x' insurance likes 'x' inhaler?"

"Dickinson, Alex K: I like this but I know Sarah said they change A LOT. I'm not sure if that means monthly or yearly. If it's just every year, having a list would be good"

TOPIC 1 // Prior Authorizations

"PA Specialist/dedicated team member or PAs - does not have to be an RN - handles all PA requests and submits, follows-up on them, and ocmmuicates with provider/RNs if there are futher steps needed (appeal or letter)"

"Dickinson, Alex K: I feel like it takes a lot of nursing knowledge to fill out PAs 0- the only other option would have it be someone's job like AIT/challenges/etc." "Rucker, Maggie W: at my old clinic, we had a PA specialist and it greatly took the burden off the nruses and allowed for continuity of care with one person knowing what was going on"

TOPIC 2

Fax to file

TOPIC 2 // Fax to File

"Can Allergy get our own F2F? Separate fax # from Adolescent? Pipe dream? (not having to sepearate faxes)"

"Speer, Leslie M: We do have our own fax number – however the faxes were forwarded to one number since there was only one fax machine (way back when) – I don't know if that is something that is able to be undone or not."

TOPIC 2 // Fax to File

"Can referrals get their own fax number? Would decrease how much we have to look through/sort through"

"Speer, Leslie M: This is also NOT possible. This would be a massive overhaul to the system requiring several changes: addition of a fax number which is a cost, changing all of our referral information with new numbers, and much more. Likely practices will still have our old fax number and will fax referrals to the number, and we will still be sorting them. We used to change the name of the file to "ADMIN1", "ADMIN2", etc. for all referrals so I know what has been sorted and what hasn't.

TOPIC 3

General Ideas

TOPIC 3 // General Ideas

"Triage buddy system - similar to how we had admin days for sarah. Each person has a buddy that can help monitor the basket but is NOT out of staffing. Could delegate specific tasks like F2F, result notes, refill requests, etc."

TOPIC 3 // General Ideas

"Triage system: there are certain tasks that are EASY to complete that don't tkae much time at all. Easiest meaning- peaople can help when they are in clinic. Harder tasks take significant time, and require more in detail digging."

"Dickinson, Alex K: I think the most helpful thing when in triage is going through Adolescent fax and deciding which ones belond to us. It's just tedious and is an easy "inclinic" help"

TOPIC 3 // General

Some MHAV and Communications are very easy to handle, but it is hard to tell who has claimed what with everyone "opening them and marking as new" What if we had a number system that let everyone know the depth that is needed for the task at hand? We could write it in the follow up comment? It could help let the team know which task needs to be saved for the triage person vs. Can be handled by clinic help? 1. In depth, must be handled by triage person 2. Will take a lengthy amount of time 3. A more in depth response is needed, but it’s an easy question. 4. Message/ communication not urgent could be allowed the 48 hour turn around if it HAD to be given/ this could be handled by the people in clinic

"Dickinson, Alex K: I think this would be more time consuming than it's worth"

TOPIC 3 // General IDEAS

"can we look at the possibility of taking us out of the "middle man" situation with scheduling wiht Heme/Onc? It increases the risk of something being scheduled incorrectly and quite frankly doesn't seem very logical"

Speer, Leslie M: We have talked about this before, and I have brought it to the infusion clinic leadership, and it is NOT an option. The infusion clinic schedules infusion for all of children's meaning Hem/Onc, GI, Pulm, Rheum, etc. so there is no way for the scheduler to have all the insider knowledge of scheduling these infusions. The schedulers do not have access to all the clinical information needed (i.e. authorizations, therapy plans, etc) that are needed to ensure the patient's infusion is scheduled correctly and authorized. otherwise, the patient is stuck with a large out of pocket bill or VCH eats the cost. They used to schedule infusions this way and had A LOT of issues with infusions not being authorized or not scheduled on time, so this is the best solution we have.

TOPIC 3 // General

"Is there a way for us to quantify our work in triage? So, we can show need/proof that it is too much for 1 person to do (i.e. Keep a tally of how many PAs you start/send in a day, how many calls you make, time spent on calls total during the day? Time spent writing letters, doing school forms?? Just an idea"

Speer, Leslie M: I did ask this question in our CHOC nurse leader meeting. Candy and Caroline were going to reach out to me about work done on this, I have attempted to follow up with them but have not heard back. Other ideas is keeping a log like mentioned above - something like a sign out of what you worked on, what's still in the air for the next person, etc.?

TOPIC 4

TIPs

Topic 4 // Tips

General Tips/Suggestions

PA determinations should be faxed eventually - can always enter Key to check status. we do not all see the same things automatically on our Dashboard in CMM. You must enter the KEY for it to show up on your "Sent to Plan" tab.

Call pharmacy to cancel Rx if changed to another med

Saving letters we are creating to build a library that can be tweaked to each patient

Where do we want to save them???

CMM PA follow up

cancels PA trigger

PA/Drug Change Requests - double check the chart to make sure it hasn't already been submtted!

Level of emotional and mental involvement of the user with the content. High engagement improves information retention and overall course experience.

Fax PA Approvals to the pharmacy to notify them

If you don't the pharmacy doesn't know to re-run the Rx

Topic 4 // Tips

General Tips/Suggestions

It can be really helpful to check the "dispense report" to determine which version of which inhaler has previously been provided to the patient. (barring insurance hasn't changed, etc.)

If you didn't know, you can press control + spacebar in the chart to search for keywords for anything you are looking for :)

you can press "ctrl" + "spacebar" in the chart to search for keywords

Pro Tip

Pro Tip

Pro Tip

PA determinations should be faxed eventually - can always enter Key to check status. we do not all see the same things automatically on our Dashboard in CMM. You must enter the KEY for it to show up on your "Sent to Plan" tab.

Be mindful to re-bold things in the message basket if not handling

Be mindful to re-bold things in the message basket if not handling

Feedback received by the user right after an activity. Helps correct errors quickly and improves understanding.

Claim the faxes with your name after REFRESHING the page

Refreshing helps make sure you have the most up to date info

CMM PA follow up

Did we miss anything?