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Fam Pract Manag. 2000 Oct;7(9):68.

Phone triage system

Q

How should I set up a system for a triage nurse?

Before you set up a system, make sure a triage nurse is right for your practice. In a family practice, hiring any licensed nurse is rarely cost-effective unless there are more than five physicians. Often, a well-trained — and less expensive — medical assistant acting under physician direction is adequate. That said, if you determine your practice would benefit from the services of a triage nurse, you should begin by developing and putting in writing clinical triage protocols that are agreed upon by all providers in the practice.

To set up a system, create a workstation for the nurse that’s located near the inbound phone receptionists, and equip it with a telephone headset and computer terminal. The receptionists can either route calls to the nurse or lean over and ask questions. Also, program your telephone auto-attendant to give patients a choice of either speaking directly to the triage nurse or leaving a message.

You must also ensure that all phone contacts are entered into the patient charts. If you have practice management software that includes clinical notation capabilities, the triage nurse should use it. If you don't have that, you can develop your own documentation protocol and implement it using stand-alone software (commonly called personal information manager, PIM, software) or a paper system.

Finally, keep in mind that a physician is usually required to sign off on all significant nurse decisions. Find out exactly what your state regulations and your managed care contracts require.

For more information about triage, here is a list of recommended books:

  • Telephone Triage for Pediatric and Adult Populations. Wheeler SQ. Gaithersburg, Md: Aspen Publishers; 1997.

  • Telephone Triage Protocols for Nurses. Briggs JK. Philadelphia: Lippincott; 1997.

  • The Medical Practice Preemployment Tests Book. Borglum KC, Cate DM. Los Angeles, Calif: Practice Management Information Corp; 1996.

  • Medical Practice Forms: Every Form You Need to Succeed. Borglum KC, Cate DM. New York: McGraw-Hill; 1995.

  • Telephone Triage: Theory, Practice and Protocol Development. Wheeler SQ. Albany, NY: Delmar Publishers; 1993.

Part-time practice advice

Q

I'm considering setting up a part-time practice situation in which three physicians would share two positions. Do you have any advice?

I shared a practice with another physician in which each of us worked half time. We had a successful five-year partnership that ended when she moved out of the area. For anyone contemplating a similar arrangement, I would offer the following advice:

  • Try to have everyone involved be equally passionate about the endeavor. This will ensure that they work hard to succeed in patient care and as a small business.

  • Spend plenty of time up front getting to know your partners. My partner and I took a weekend retreat to the mountains to talk about our vision and plans for the practice.

  • Take time to discuss controversial issues such as productivity expectations or the prescribing of opiates and benzodiazepines. Since physicians in these arrangements often share patients, it's best if you have similar practice styles and philosophies. Everyone needn't be alike, but understanding each other's beliefs can make differences more tolerable.

  • Keep the lines of communication open, and ask for help when necessary. My partner and I used a therapist for “couples therapy” when we disagreed on some important issues.

  • Delegate parts of running the practice according to the interests and talents of each physician, but ensure that everyone has an important role.

  • Divide everything else equally — call schedule, work hours, salary, vacation time, expenses, etc.

Corporate ownership

Q

I'm forming a corporation ownership structure for a walk-in, acute-care clinic. I want the physician assistant (PA) who's helping me create the business and who will share the provider duties to be part owner of the corporation. How can I make this happen without violating the laws?

Ask your state board and the board that regulates PAs for their written opinions. If you would rather remain anonymous, make the request through your attorney.

Some states allow professionals rendering similar services to be co-owners of a professional corporation. However, other states — or the boards regulating each of the professions involved — do not permit this.

If you find that this kind of joint ownership is not permitted, you may be able to structure a “ghost stock” arrangement that gives the PA extra compensation (now or in the future) based on the success of the practice. This can be complicated, though, so consult with your health care attorney and financial advisors.


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Copyright © 2000 by the American Academy of Family Physicians.
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