Telephone triage nurses and triage process
confusion
ONCOLOGY, EVENT
Telephone triage nurses are the main vector of communication between the patient and the clinical oncology team in the IePRO model. This role was developed and reviewed with oncology physicians, nurses, and CNS. For some oncology subspecialties, the CNS provide sporadic telephone consultations for the most vulnerable patients; therefore, clarifying the role of triage nurses was essential to avoid confusion among providers and patients. While triage nurses work as gatekeepers, helping patients access and appropriate level of care, CNS are a resource to ensure evidence-based symptom management and provide highly specialized care.Triage nurses were trained to use the United Kingdom Oncology Nursing Society (UKONS) 24-hour triage tool [The tool standardizes remote symptom assessment and provides clear guidance on remote symptom management. Triage procedures are triggered when triage nurses detect a new or worsening symptom in the ePRO application. The triage algorithm outputs three types of alerts according to symptom severity: (1) green alerts are issued for mild and stable symptoms where self-management support is recommended, (2) amber alerts represent symptoms that may increase or decrease in severity and thus require a new assessment within 24 hours, and (3) red alerts are issued when symptoms are moderate-to-severe, and in-person assessment is recommended. Nurses log triage procedures in the EHR using an electronic version of the tool’s triage log form. Since CIS integration was not possible, triage nurses alert physicians, CNS, and nurse practitioners of triaged symptoms and of their recommendations by sending a daily summary of all calls.In the event of a green alert, triage nurses provide self-care guidance, and the oncology team is notified via the e-mail summary. When an amber alert is issued, the oncology team is immediately contacted via e-mail to validate the triage nurses’ assessment and determine if any additional care should be provided. More than one amber alert or at least one red alert triggers triage nurses to call the patient’s oncology physician to seek their specific recommendations and call the patient back to convey the latter. As this model of care is complementary to the standard of care, outside of the triage nurses’ operating schedule, standard procedures apply.As part of the eHealth education (eHE) component in the IePRO model, triage nurses were trained extensively with the ePROM application between April and November 2021. It presents nurses with a visual and numerical representation of the reported symptoms (Fig. ePRO app—triage nurse’s view