Empowering the Role of Nurse Triage in Radiation Oncology - A Single Center Analysis.

Abstract

Hours spent on the increasing volume of electronic medical record (EMR) messages and phone calls is a significant contributor to clinician burnout1. Within radiation oncology, nurses often serve a critical team role in patient education and EMR and phone call response. With the goal of maintaining high quality care and rapid EMR and phone response, our clinic utilizes a rotating triage nurse position; patterns of practice and team member perspectives are investigated. A retrospective chart review was conducted analyzing EMR messages and phone calls to the RO department between Sept-Dec 2021. Messages were identified for theme, author of message recorded (patient, family, provider), number of message iterations, and message pathway. Separately, an online survey was administered via REDCap to physicians (50% response rate), nurses (57% response rate), and radiation therapist (60% response rate) to assess nurse triage efficacy and efficiency. Four of the most common message themes were scheduling (26%), medications (21%), side effects/symptoms (15%), and treatment decision making (13%). Only 12% of messages were resolved by the RO triage nurse without further message forwarding. The average number of message iterations by healthcare personnel was 2.93 with mode of 2 (i.e., RN -> patient -> MD is a 2 message iteration). Across all themes physicians concluded 67% of the routed messages and nursing concluded 29%. By theme, physicians concluded 95% of treatment questions, 77% of medication questions, 69% of side effect/symptom questions, and 57% of scheduling questions. Survey results indicated average satisfaction with 'effectiveness of triage' was 3 (max 5), perceived triage nurse preparedness to resolve encounters was 3 (max 5), and perception of the overall EMR triage program by physicians was 2.2 (max 5). Staff survey established clear opportunity to improve effectiveness of RN triage through better alignment of nurse and physician expectations and improving nurse preparedness. Two-thirds of patient messages were ultimately concluded by physician response whereas 12% were resolved by nurse triage alone. Preparing nursing staff about common patient messages should increase autonomy to resolve patient queries and may improve work satisfaction for all providers through enhanced multidisciplinary collaboration and empowering individuals to practice at top of his/her license.