We are considering giving our front office personnel a list of “buzz words” that would signify patients who need to speak to a nurse immediately. Can you give us some help in this regard?
Many organizations give front office personnel lists of problems to watch for which should be transferred promptly to a nurse (“buzz words”, “red flag lists”, “cheat sheets”). While there’s nothing wrong with sending a patient with “chest pain” directly to a nurse, the problem with these lists is that they have the potential to lull the office staff (including the RN) to sleep on those calls that don’t meet criteria for immediate transfer. For example, those who have attended my seminar have heard me talk about the patient who called complaining of a sinus headache, which turned out to be an intracranial bleed. Another patient called complaining of a “cold” but was actually having an MI. I think a better way to identify high risk patients is to ask the caller!. If, for example, you have a policy that states calls will be returned within 2 hours, it would be appropriate to have the secretary say, “The nurse will call you back within 2 hours… Can it wait that long?” It is probable that if patients are concerned, they will ask to speak to a nurse immediately. While the secretary will certainly know a little more about the inner workings of your practice (or your call center), the patient will know more about her own situation and generally (admittedly not always) knows whether their call is of an urgent nature or not. It’s a matter of choosing the lesser of two evils and considering which option will best assure patient safety. Of course, any time that the front office personnel are concerned about the patient, they, like the nurse, should err on the side of caution and transfer the patient to a nurse immediately.
I do have a DVD presentation that addresses the topic of “The Role of Front Office Personnel in Patient Intake”. Rather than giving them a formal role, the DVD stresses the value of front office personnel in non-telephone triage activities surrounding patient intake. It addresses the complexity of telephone triage, stressing the importance of having professional nurses manage those calls and illustrating the many obscure and often misleading ways patients present by telephone. The purpose of the presentation is to a) establish their value to the organization and b) stress the importance of having these calls managed by RNs. It also speaks a little to recognition of patients in trouble when they walk in the front door. If you’d like more information about this taped presentation on DVD, you may check it out on the Products page of this website.