Appropriate Level of Patient Care

Instructions, Cautions, and the Call Record
During a call, the triage RN may record notes in an area of the screen on the nurse note template. The template is a user-defined form used for the capture of symptom descriptions, related complaints, patient status, allergies, medications, etc. The nurse can also enter any text comments and observations directly on the protocol itself (actually type notes on the face of the protocol). This documentation is automatically recorded and transferred into the nurse note area.

Follow-up Reminders
During or upon completion of a call, the triage nurse can set a follow-up reminder or "tickler" (by date and time). A critical feature, the "tickler" reminds the nurse to call and check on a patient's status, follow-up on a physician page and call the patient back, assist with a prescription refill request, transfer calls among operators, and similar action reminders. The operator designates who should make the call -- a specific operator or any individual in a work group (a work group such as triage nurses). The "tickler" is displayed in a work list format, prioritized by scheduled follow-up date and time. The user can view patient/population demographics and "tickler" notes from the work list and the system will automatically initiate the Sharp Focus call session at the operator's command.

Sending the Caller Information
The ClinicalAdvisor Health Information Reference Library module of Sharp Focus provides call center staff with online access to health information and medication topics. The health information serves to support provider communication and education initiatives; resulting in improved patient outcomes and member wellness. The topics may be printed or faxed upon completion of the call session.

The CareAdvisor's Audio Health Information System is a turn-key system that includes both hardware and software. CareAdvisor operates in concert with Sharp Focus, or as a stand-alone system and may function on a 24-hour basis without staff intervention. The CareAdvisor library includes prerecorded health topics with adequate space for custom topics. Each prerecorded topic includes a general description, population at risk, signs and symptoms, causes, diagnosis, and treatment and prevention sections.

Consumers access the CareAdvisor Audio Health Information System in either of two ways. First, they can access the system using a touch-tone phone and self-selecting topics for listening. The consumer can enter a fax number and the text of the topic will be faxed to them. The second method is via the Internet (this feature requires the Sharp Focus for the Net module). The consumer accesses the institution's web page and, via hyperlinks to health information topics, browses the list, reads topics, prints topics, and can listen to the topics (if the PC has a sound card).

Monitoring Quality Improvement Aspects
Detailed outcomes measurement is typically accomplished by retrospective call encounter follow-up. Clients typically follow-up on all priority, emergent call outcomes, and a sample of all other symptom based calls. Using Sharp Focus call encounter electronic record and the Survey module, the retrospective review provides documentation of the patient called, nurse chosen, subsequent action taken by the caller, what action the caller would have done if the service wasn't available, and the health outcome from the action taken.

Both HealthLine Systems and the Cleveland Clinic Foundation recommend recording of all symptom calls.

The Source and Development of the Protocols
The Cleveland Clinic Foundation Senior Editorial Board reviews, updates and incorporates new protocols annually.  The cost associated with the medical/legal review and protocol updates is included in the annual software license and support fee.