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Original Investigation
June 2018

Interventions to Improve Response Time to Nurse Triage Phone Calls in a Tertiary Care Pediatric Otolaryngology Practice

Author Affiliations
  • 1Department of Pediatric Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio
  • 2Quality Improvement Services, Nationwide Children’s Hospital, Columbus, Ohio
  • 3Wexner Medical Center, The Ohio State University, Columbus
JAMA Otolaryngol Head Neck Surg. 2018;144(6):507-512. doi:10.1001/jamaoto.2018.0308
Key Points

Question  How can the clinic nurse triage response time for caregivers and patients be improved in a high-volume tertiary care pediatric otolaryngology practice?

Findings  In this quality-improvement study, following the implementation of a collaborative team intervention, a 2-hour phone call response time for resolution of patient care concerns was achieved 76.7% of the time and sustained for 3 years.

Meaning  Utilization of advanced practice nurses, development of standardized education, and communication pathways have been successful in improving ambulatory patient care services.


Importance  Delay in response for telephone triage calls that need clinician input for resolution can result in delay of care and unintended frustration for patients and families. It can be a challenge to manage calls in a high-volume pediatric otolaryngology practice.

Objective  To improve the percentage of nurse triage clinically relevant phone calls returned within 2 hours to parents or caregivers.

Design, Setting, and Participants  This was a quality-improvement study of a tertiary care pediatric otolaryngology practice with more than 32 000 clinic visits and more than 9000 surgical patients per year.

Interventions  In 2014, a collaborative team was created at our center to determine the optimal time for triage callback to families and to define an optimal process that would allow more rapid response time for calls that the triage nurses needed to escalate to the patient’s managing surgeon. Several plan-do-study-act cycles were performed to optimize the process. The utilization of advanced practice nurses as an intermediary step was crucial in allowing a more efficient flow of communication.

Main Outcomes and Measures  Percentage of triage phone calls returned within 2-hour time frame.

Results  Over 40 months, 4839 clinically relevant phone calls occurred, averaging 128 calls per month. The baseline mean was 101 calls per month, and the postintervention mean was 130 calls per month. Prior to this project, only 42% of calls were being addressed within 2 hours. After our interventions, the average time for caregiver callback within 2 hours decreased from 15.3 hours preintervention to 3.9 hours postintervention. In addition, caregivers received clinician callback within 2.0 hours 76.7% of the time postintervention compared with 42.0% with a baseline shift (difference probability between preintervention and postintervention, 0.21; 95% CI, 0.15-0.27). Outcomes were sustained for 3 years and continue to be monitored.

Conclusions and Relevance  The most effective intervention was using advanced practice nurses to efficiently resolve patient triage concerns that were outside the scope of practice of the registered nurse. By establishing clear pathways of communication and standardized education among our team, we successfully improved our processes, which resulted in more optimal care for our patients.