Tele health

Telehealth may appear to be a recent concept, yet it has been there since the time of Alexander Graham Bell. Recent technological advancements have made this century-old medical technique more widely known. Telehealth is no longer a medical trend, but rather the standard. Individuals and health care facilities are rapidly incorporating telehealth into their medical operations, particularly nurse call centers. A nurse call center is a telephone answering service that connects physicians, medical practitioners, and nurses with patients (Martich, 2016).

In this system, nurses play a crucial role. Nurses in most facilities deal with patients online at the nurse call center. They attend to patients virtually through listening carefully to their symptoms, assessing them for diagnosis and recommending action to be taken. For those making inquiries, they offer them the best available options to deal with their questions. Nurses too help in keeping patients records from the calls.

The advantages of nursing call centers are immense; they are cost-effective, very flexible, they promote patients’ privacy as well as enhanced and prompt service delivery. It is more of preventive than curative. The disadvantages which are fast fading include the risk of wrong diagnosis and unmanageable traffic.

Set up is easy as there are plenitude of communication companies that can be contracted to procure and install functional equipment. Best practice recommends the use of latest technology to secure data and customer privacy. There is still however insufficient literature on trends and best practice of nurse call centres. Such scholarly undertakings need to be carried out to maximize the potential nursing call centres present in healthcare. This study will focus on the pros and cons of nurse call systems, the role of nurses, a system setup and the future of the practice. It will explore the tenability of nurse call systems including the security of the system and the legal and ethical standards befitted within the system.

Nursing Call Centers

Population and Use Demographics

By 2015, over 50 million people were annually using nurse call system, and in 2017, the numbers have quadrupled as the system is picking up more users globally. America and Europe are the largest users of this system with most of their health facilities incorporating nursing call centres. Future projections estimate that by 2020 over 800 million people globally will be using the system.

The Role of Nurse within the Modality

Listening

Nurses play a very vital role in the nursing call centre. They are responsible for talking to patients, assessing their problems through the phone and recommending appropriate action or solutions (Arnold & Boggs, 2015). The nurses on call are expected to be highly trained and skilled in order to carefully listen and correctly interpret the verbal cues from the patient into visual clues to aid in diagnosis. Nurses have the role of adequately probing the patient to dig out necessary information pertaining the patient’s ailment or enquiry.

Assessment

Within this modality, nurses have the role of assessing condition based on the telephone conversation which means that nurses should be vastly knowledgeable since patients will make enquiries on a wide spectrum dealing with a multiplicity of ailments. The nurses’ clinical judgment on the given healthcare advice must, therefore, be well informed. The nurse is supposed to diagnose the patient through assessment.

Decision-making

The ultimate goal of a nurse call is to establish whether the patient needs care and the nature of care the patient should seek. The nurse has a role of making judgments from the details given by the patient and make appropriate referrals and recommendations. In some instances, the nurse may be tasked with the duty of advising the patient on call. He or she should be able to determine the urgency of the matter at hand. In the case of emergencies, the nurse has the prerogative of making prompt and appropriate decisions on how the caller should act (Urvashi & Clarke 2014). Nurses, therefore, have a crucial role in decision-making on what the patient should do.

Record keeping

After making a diagnosis and administering the appropriate remedies, the nurse is supposed to document the patients’ records in the medical database (Beach & Oates, 2014). This information may later be reviewed by the patient’s physician and may be used in making future medical judgments concerning the patient. Such records are also vital in case the patient files a legal malpractice concerning the nurse or the physician.

Advantages of Nursing Call Centers

Prompt service delivery

A nursing call center gives patients instantaneous and direct access to healthcare information. With a dial, a patient can make enquiries on the different issues they are seeking. This process which would normally entail consultation after booking an appointment is now done promptly at the press of a button. The respondents at the call centre are always efficient and effective in service delivery. Furthermore, the service in most facilities is available on a 24-hour basis meaning a patient can make an enquiry or consultation at any time of the day. Call centres have been empirically proven to be invaluable in the dissemination of healthcare information because of its easiness of the entire process. Through this, increased patient satisfaction has been noted since early ailment intervention, and admittance to appropriate medical care has been made possible. Patients have benefitted from medical follow-ups and the plethora of education on healthcare available on the system.

Privacy Protection

Since the service is offered over phone calls, the physical identity of patients is usually undisclosed, anonymity for this reason is capitalized by patients. However much patients appreciate the idea of being open with their physicians, most of them at times feel ashamed depending on the nature of their ailments. Patients fear their records finding a way to the public. Medics too can sometimes be judgmental and stereotypic, and their decisions may at times be informed by bias (Ellway, 2013). Nursing calls, therefore, comes as an antidote to privacy violation. Identities are concealed unless otherwise, patients are thus able to express themselves more incognito. Through this, the potential occurrence of stereotypic and biased judgments are drastically reduced.

Flexibility

Nursing call centres provide a lot of flexibility in terms of working hours and place of work. This resource provides favourable working conditions for physicians as they can work from home and other remote places yet still provide equally effective and efficient service to geographically distant patients. During weekends and evening, patients’ calls are routed to nurses who will respond to questions and keep the information for the physician to review. This resource has helped retain physicians and nurses leaving the profession citing long working hours with limited vacation. Call centres are therefore ideal as they can work from the comfort of their homes offering services without being physically present at the workstation. Call centres reduce Physicians’ workload as trained RNs can be left to handle patients’ questions leaving the physician to handle patients only during office hours (Traci, 2014). Through this, the physicians’ quality of life is improved.

Cost-effectiveness

Call centres have proven to be an ideal way of delivering quality healthcare services in a relatively cheap manner. The resource which is subversive of the traditional outsourcing of healthcare providers takes advantage of cutting cost by reducing full-time employees who are accustomed to salaries and other monetary benefits. Hiring part-time employees with flexible working timelines are economical. With a little motivation, these employees can be greatly devoted to improving the present healthcare service with less cost. Outsourcing is pragmatically known to increase competitive advantage leading to better service delivery. With decreased unnecessary visits to emergency rooms, a lot of money and time is saved.

Disadvantages

Unmanageable Traffic

At times, the call room is jammed with patients who cannot then be fully served by the infrastructure existing and workforce. Because of the ease of using the system, nurse call centres are often prioritized in seeking medical attention; call lines are likely to be crammed by patients especially during peak hours. In an attempt to quickly serve the patients, quality service may be compromised. The compromise on quality may be further compounded by an inexperienced outsourced part-time workforce who may not be fully conversant with the dictates, ethos and profession practices.

Improper Diagnostics

Nursing call centres present the challenge of wrong medical diagnosis because the verbal information given by the caller without visual cues may present communication discrepancies. The patient might not be able to share the most pertinent and critical symptoms fully or may not be cognizant with the ailment and thus provide inaccurate information to nurse on call. The inability to visually see and physically examine the patient presents the challenge of incorrect and inaccurate diagnosis and thus a wrong medical advice may be given to the patient. The nurse, physician and the employer can be used for medical malpractice.

Infrastructure

Equipment

Real-time locating systems (RTLS). This equipment is used by nursing call centres to locate the caller location. Knowing the caller location is significant especially in the case of emergencies where patients need to be referred to the nearest health facility. Medical teams can also be deployed to the area of emergency especially when the situation is critical.

Management monitoring and reporting system. This equipment is used to display calls from all connected systems and providing a comprehensive report on the system activity. This system provides advanced features such as a master system station with LCD colour display showing nurse and aide location, call statistics, master-master intercommunication and a display of calls their origins and time. It manages the running programs to ensure a round the clock operability of the entire system in providing services to patients.

Nurse call/bell. This equipment is mostly used in hospital wards and nursing homes to link patients with caregivers/nurses. Bells are mounted at the bedside in wards or maybe in wearable devices for the case of nursing homes and linked to the receiving centres at the nursing call facility.

Computers and internet connectivity. Within the nursing call centre, having a working computer is essential especially in making diagnosis and record keeping. Fittings such headphone and microphone are fitted to the computer. Internet connectivity should be optimum to allow for the nurse on call make enquiries from the rest of the medical fraternity. Almost all equipment in the nursing call centre relies on the internet for efficiency and general running. The computers are used to record and store the nurse-patient conversation for future reference enabling nurses to respond to emails and live chats from patients (Raheja, 2015). With more patients having a preference to communicate via texts through smartphones and tablets, having a computer and good internet connectivity is imperative.

Servers. Any nurse call centre should have its own servers. The server provides functionality for other software used within the nurse call centre. It is the backbone of the entire communication as it keeps and provides data to all the software in use. The online clinic database is kept within the call centre server. The server acts as the host of the call centre website. Giving the call centre online presence where patients can make enquiries and seek deemed information and get empowered in self-care.

Facilities

Nurse call centre can be a simple open office, but in centres which serve a huge population, an ideal room should be set up to host both equipment and the human resource who are predominately nurses. The room can be customized to allow nurses communicate with their clients without distracting each other.

Technical Assistance

To effectively run the nurse call centre, technical assistance from information technology experts should always be sought. The technicians are in charge of providing and managing software and other programs working in milieu to run the entire process. Technical assistance can be sourced to evaluate the efficiency and effectiveness of either process and give room for innovation and customization of systems to suit the needs of different patients. Technical assistance can be outsourced from equipment suppliers or can be sourced from the nurse call centre workforce.

Privacy

Nursing call centres have a standard policy for protecting the privacy of patients. They are ethically bounded to maintain patient autonomy and data discretion. Such information is only limited to medical practitioners and should not find way a to the public domain. Patients can communicate with nurses without revealing their physical identity; this disguised communication channel enables patients to seek medical attention for conditions they believe are disgraceful such as sexually transmitted diseases (Ellway, 2013). Knowing records are secure gives patients the confidence to open up.

Security of the system

Most triage systems have upgraded their security systems to meet the international standards which are impenetrable. Latest firewalls are used in the system to ensure a secure end to end communication channel between patients and nurses. (Gregory, 2015) The firewall protects the system from internet networks that thought not secure and trusted.

Future benefits on the society

The future of nursing call centres is promising, a lot of innovation and invention of secondary features to be combined with the telephone triage system is on course. All aimed at improving service delivery and providing excellent and quality services without neither straining the existing workforce nor the monetary coffers (Martich, 2016). With these advancements in place, the society stands to reap immensely from the prompt responses, better experiences and improved attention to patients’ needs among other benefits. With over 20 years since its re-inception, the rationale and systems behind nursing call centres are continuously being refined, this in the future will translate to standardized protocols and enhanced training for triage nurses.

The employment of latest technology in the system will create opportunities for perfected efficiency; this will see the addition of new features to benefit patients, nurses and service providers. Among the direct benefits will be an upgraded impenetrable secure communication channel between patients and nurses. This future trend will see patients’ records and calls protected from external intrusion and access. With technology lapse sealed patients will be able to communicate directly with nurses without having to use specific mobile apps.

Call centres are now gravitating towards incorporating the triage protocol into their Electronic Medical Records. Call data if embedded within the medical records system will see better management of patients’ health records (Gregory, 2015). This technological evolution will enable physicians and nurses to have their patient’s records instantaneously. The liaison of medical systems will enable patients to receive better medical attention as well as ease of access to the nurse triage. These improvements are in the process of implementation, but the full potential will be realized in due time.

Conclusion

Nurse call centres hold the future of medical practice in regards to consultation, inquiries, medical advice, and general healthcare informatics. With the present structures still in the implementation stage, the full potential of this system is yet to be actualized. Nurse call centres present limitless opportunities which can be tapped to enhance healthcare. Present infrastructural research is aimed at addressing the noted challenges to achieve a self-sufficient system for the future. This field presents a lot of opportunities for research especially on how the system can be further infused with technology to produce an iconoclastic model devoid of legal, ethical and operability undercuts. More scholarly work and research should be done to broaden the present study with the ultimate aim of bettering the system for enhanced patient experience and satisfaction.

References

Arnold, E. C., & Boggs, K. U. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.

Beach, J., & Oates, J. (2014). Maintaining best practice in record-keeping and documentation. Nursing Standard, 28(36), 45-50.

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http://hfmmagazine.com/articles/1664-nurse-call-system-upgrades

Martich D. (2016). Telehealth Nursing: Tools and Strategies for Optimal Patient Care.

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Raheja R. (2015). What is the Future of Telephone Triage Call Center Software?

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http://triagelogic.com/what-is-the-future-of-telephone-triage-call-center-software

Traci H. (2014). Telehealth Nursing Practice. Retrieved on 15th September, 2017 from

www.answerstst.com/article/telehealth-nursing-practice/

Urvashi S. & Clarke M. (2014) Nurses’ and community support workers’ experience of

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http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-164