A NURSE LED INTERVENTION TO IMPROVE ACCESS TO CARE USING A TELEPHONE TRIAGE ALGORITHM

Abstract

Abstract BACKGROUND Inflammatory bowel disease is a chronic inflammatory condition for which patients may require care on a more urgent basis. Response times can be delayed when clinics are inundated with calls or when providers are not available for immediate patient care. We developed and tested an algorithm to empower nurses to effectively triage phone calls and improve access. METHODS We created an algorithm for nurses handling phone calls and electronic messages to a tertiary care IBD clinic. Calls were divided into four categories: Needs Immediate Response, Disease Flare, Routine and Other. IBD nurses triaged calls to facilitate urgent visits with a nurse practitioner (NP) when deemed appropriate, bypassing physician review or response. We compared the time from call-to-visit during the 3 months before and 3 months after implementation of the algorithm. We also assessed clinical outcomes of these urgently scheduled visits including visit type (in-person or virtual), and whether there was a change in dose or type of therapy, new prescription of steroids, or emergency room referral. We used the Mann Whitney U Test to assess for pre-post changes. RESULTS We randomly assessed 60 visits per month in the 3 months before and 3 months after the algorithm was implemented (June 1, 2022), for a total of 360 visits. The median time from call-to-visit improved from 5 days during the 3 months prior to the algorithm implementation to 3.5 days during the 3 months after algorithm implementation (p=0.016). There was no significant change in visit type pre- and post-intervention. Overall clinical interventions during these visits included therapy change (36%), a new prescription of corticosteroids (9%), new diagnostic testing ordered (67%) and ER referral (1%); these did not significantly differ in the pre- and post-intervention periods. CONCLUSION Utilization of a phone call triage algorithm by nurses can help improve the time from call-to-visit without involvement of a physician. Urgently scheduled NP visits result in important clinical interventions including changes to therapy and diagnostic testing. Implementation of nurse-led triage algorithms can improve access to care in a tertiary IBD clinic.