FREQUENTLY ASKED QUESTIONS

On this page we’ve gathered answers to a variety of questions we have been asked about ClearTriage. If you can’t find what you need here or on our main SUPPORT PAGE, we’re available by phone or by email and happy to help out! Our regular phone hours are 8 am – 6 pm Mountain Time, Monday through Friday.

Call us at 800-755-3545 or

Email Us

Frequently asked questions  

Several of our customers have reported faster call times and a reduced need to involve physicians in telephone triage, both of which contribute to the ROI (Return On Investment) of ClearTriage. In fact, one large group of 9 clinics measured call times for their team of 16 triage nurses before and after implementing ClearTriage. They found that using ClearTriage dropped their average call time by more than two minutes per call! (From 12 minutes 22 seconds using paper protocols to 10 minutes 6 seconds using ClearTriage.)

The following two papers co-authored by Dr. Barton Schmitt and Dr. Andrew Hertz provide background information and cite studies about the financial benefits of nurse telephone triage using protocols:

Decreasing ER Utilization with Nurse Telephone Triage

The Case for Publicly-Funded Medical Call Centers

ClearTriage does not receive, store or transmit PHI (protected health information), so a BAA (business associate agreement) isn’t necessary and we don’t sign them with our customers.

ClearTriage works best on a desktop computer, either Windows or Macintosh. It can also run on an iPad (iOS version 10 or higher) but it will not run on a mobile phone.

ClearTriage runs in almost any web browser. Here is the minimum required version for common browsers:

  • Chrome: Version 42 or higher
  • Edge: Version 12 or higher
  • Firefox: Version 41 or higher
  • Internet Explorer: Version 11, requires Adobe Flash to be installed
  • Safari: Version 10 or higher

Normally you don’t have to worry about the following, but if you are in a highly-secured environment please make sure Cookies and JavaScript are enabled in your browser and that you allow access to https://*.cleartriage.com.

ClearTriage After Hours (AH) comes with hundreds of additional protocols from Dr. Schmitt and Dr. Thompson, dispositions suitable for 24/7 usage and targeted care advice to support faster calls. But because of the price difference, some organizations wonder if they can legally use the Office Hours version of ClearTriage instead.

Here is the pertinent legal language from our Terms of Use:

Unless you license an After Hours version of ClearTriage, your right to use ClearTriage to take telephone triage calls is limited to Office Hours. “Office Hours” means the hours during which the physical office with which you are affiliated is scheduled to be open and seeing patients, not to exceed 14 hours in any 24-hour period.

However, even if you do not license an After Hours version of ClearTriage, you are permitted to use ClearTriage outside of Office Hours for educational and training purposes or for use by one On Call Staff Member at a time. “On Call Staff Member” is defined as a member of your staff who regularly works at your practice during Office Hours and sometimes takes triage calls outside of Office Hours.

You specifically cannot use ClearTriage to regularly take telephone triage calls in an after hours call center unless you license an After Hours version of ClearTriage.

———

If you still have questions about your specific situation, please CONTACT US and we’ll help you figure it out.

Summary: Annual updates to the telephone triage protocols are included in your subscription. We’ll give you notice that the updates are coming so you can review the changes, then the new and updated protocols will be available in ClearTriage on the designated release date with no installation required.

Details: Dr. Schmitt’s and Dr. Thompson’s telephone triage protocols are updated once a year. Once we receive those updates from the doctors, we will give you notice as to the date they will be released in ClearTriage along with information from the authors about what has changed.

If the update information doesn’t provide enough detail, we’re happy to provide you with redline documents showing the complete changes in each of the protocols. Or we can give you access to the new protocols on a temporary server where you can see the changes in ClearTriage before you begin using them.

There’s nothing you need to do to “install” or “activate” the updated protocols. They will simply become available to you in ClearTriage on the date listed.

Here is an example of Dr. Schmitt’s Office Hours Update Letter.

From Drs. Schmitt and Thompson, authors of the clinical content used in ClearTriage:

The terms guideline and protocol are often used interchangeably.  For example, one online definition defines a clinical guideline as a “best practices protocol for managing a particular condition, which includes a treatment plan founded on evidence-based strategies and consensus statements by peers in the field”. Another definition that still stands the test of time, developed by the Institute of Medicine (1990), defines a clinical practice guideline as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. The Schmitt-Thompson clinical content conforms to these definitions of a clinical guideline. The Schmitt-Thompson clinical content is a decision-support tool that was developed systematically through a survey of the relevant medical literature, incorporation of evidenced-based information when available, and reviewed by an expert panel of nurses and physicians. The Schmitt-Thompson clinical content is updated annually based upon changes in the medical literature, feedback from triage nurses, physicians and call center medical directors, input from the Schmitt-Thompson expert reviewer panels, and results from ongoing analysis of outcome and quality assurance information.

One can define an algorithm as a logical sequence of steps for solving a problem that can be translated and loaded into a computer software program.  The Schmitt-Thompson clinical content meets this definition of an algorithm.  The Schmitt-Thompson clinical content is stored in a highly structured relational database and organized algorithmically. The central elements of each guideline are stored within a table named “Algorithm”. Other linking tables provide search words, triage questions, care advice, and references.

  • A table of specifically selected search words or chief complaints directs the triage nurse to the most appropriate guideline(s).
  • A definition is provided at the start of each guideline to help the nurse determine if this guideline is the best match for the patient’s symptom. If not, additional prompts re-direct the nurse to related (more appropriate) guideline(s).
  • Within each guideline, triage questions from the relevant table in the database are presented in descending order of acuity from symptoms of the highest acuity to those of lowest acuity. Nurse triagers find this question arrangement both logical and intuitive as it supports their natural clinical assessment and thought processes.
  • Each triage question is linked to targeted, explicit care advice.

Regardless of whether one describes the Schmitt-Thompson clinical content as telephone triage guideline or as an algorithm, its purpose is:

  • To facilitate a safe telephone triage process and sort patients to the most appropriate level of medical care (disposition) based upon the acuity and severity of their symptoms (triaging the right patient to the right place at the right time);
  • To provide decision-support to telephone triage nurses;
  • To deliver best practice care and advice based on expert consensus and evidence-based research;
  • To reduce variability in triage practice and provide a standardized basis for referral and patient education;
  • To promote efficient use of resources;
  • To serve as a framework for quality assurance audits and quality improvement.
  • To provide a reference for ongoing nurse education both during and after triage calls.

Footnotes

  1. http://medical-dictionary.thefreedictionary.com/Clinical+guideline
  2. Institute of Medicine. (1990). Clinical Practice Guidelines: Directions for a New Program, M.J. Field and K.N. Lohr (eds.) Washington, DC: National Academy Press. Page 38.
  3. http://www.merriam-webster.com/dictionary/algorithm

Some of the EHRs that are being used regularly with ClearTriage include Allscripts, athenahealth, CareEvolution, Cerner, e-MDs, eClinicalWorks, Epic, GE Centricity, Greenway, HealthFusion, Medent, MEDITECH, Office Practicum, PCC, Pulse Systems and STI ChartMaker. But that’s not the complete list – ClearTriage truly works with any EMR/EHR, CRM or CMS.

Here are two documents that can help answer that question. Please contact support if you need additional information.

Evidence Behind OH Protocols

Quality Measures – OH Protocols
 

Dr. Schmitt’s Pediatric Telephone Protocols, of course. In addition, there are two books we highly recommend for telephone triage nurses or anyone looking to better understand the role of the triage nurse:

ArtAndScience
The Art and Science of Telephone Triage by Carol Rutenberg and Liz Greenberg

Endorsed by the American Academy of Ambulatory Care Nursing (AAACN), this book is a detailed and thought-provoking resource for every front-line nurse practicing telephone triage; as well as the nursing managers, office managers and pediatricians who work with them. It explores the history of nurse triage, the application of the nursing process to telephone triage, the role of decision support tools such as ClearTriage, and numerous examples of challenging triage calls. This is a book you will share with all of your colleagues once you finish it.

The Checklist Manifesto
The Checklist Manifesto by Atul Gawande

This New York Times Bestseller makes a powerful case for why humans benefit from checklists when working with rich and complex sets of knowledge. Gawande shares his experience as a doctor developing the WHO Surgical Safety Checklist, as well as stories from checklists in the airline, building and other industries. A fast but insightful read that drives home the value of accessible protocols for telephone triage nurses. (CLICK HERE to read a 9-page New Yorker article by Dr. Gawande that preceded the full book.)

Sure! For now, after you hit copy you can paste your call note into a Word document and print it out to insert into the patient’s chart. And please let us know if you’re doing this! If enough practices are interested, we can provide an option that would let you have a “PRINT” button rather than a “COPY” button.

Note: This question pertains to practices using the option to display Y and N buttons in front of each triage question. Many practices instead use the option of just having a single checkbox in front of each question.

There are two schools of thought here. Dr. Schmitt’s recommendation for using his protocols is to mark just the first positive triage question. The triage nurse should directly or indirectly be ruling out all of the questions above the first positive question. But Dr. Schmitt feels that marking each of those as a negative response is unnecessary, wastes time and makes the chart difficult to read.

Other people feel that it is important to document what the triage nurse rules out. Documenting the negative triage questions makes the call note more descriptive and can convey to the provider more details about the patient.

Keep in mind that marking only some of the questions N could be seen as a liability risk. Weren’t the other questions ruled out? Why do some nurses in your practice record negative responses and some don’t? Dr. Schmitt argues a consistent office practice is critical.

Finally, note that ruling out all of the questions above the first positive question does not mean asking each of these questions. The triage nurse should use her clinical judgment and experience to determine which questions can be ruled out without directly asking the caller.

The fever protocol should only be used if the patient has no other related symptoms. Fever is covered in all protocols where fever could be an accompanying symptom.

Consider the Care Advice screen a “menu” from which the nurse delivers “a la carte”. Some callers may benefit from 3-6 pieces of information; others may only need 1 or 2. The triage nurse should select care advice as determined by the caller’s needs.

Try to limit your advice to 3 instructions and try to keep your comments brief (2 or 3 sentences per instruction). Reason: to improve caller’s memory of imparted information.

The most important care advice to give is the reasons to call back. These should be reviewed with the caller on every non-urgent call.

For more details, please review the Clinical User’s Guide.

If the patient has multiple symptoms, always select the most serious symptom. If none of the symptoms are serious, select the one with the highest likelihood of needing to be seen (e.g., earache instead of cough, cold or fever).

If uncertain where to start, ask the caller, “Which symptom are you most concerned about?” (Exception: If the caller’s answer is “fever” and is present with other symptoms, go to their second concern.) Fever is covered in all protocols where fever could be an accompanying symptom.

5-10% of calls may require using two protocols, but this should be for symptoms in unrelated body systems.

If you use Greenway PrimeSuite and record your triage call notes as a Comment in a Task, be aware that the comment will only hold a limited number of characters. You can paste more characters in than the limit, but then you will not be able to edit the text that has been pasted in.

For practices using this configuration, it is recommended to mark only the first positive triage question (not recording any negative questions) and one of the simpler care advice recording options.

Contact us and let us know you wish to cancel your subscriptions. Keep in mind that you pay for your subscriptions in advance and there are no refunds, so you are cancelling the next renewal of your subscriptions.

For an annual subscription, you will receive an invoice by email approximately 45 days in advance. Respond to that invoice to cancel your subscription. For a monthly subscription, just contact us in advance of your monthly billing date and we’ll take care of it.

The number of ClearTriage subscriptions you need may change as your practice grows or as you enter a busy season.

You can add subscriptions at any time. The new subscriptions can be pro-rated so they’ll be on the same billing cycle as your other subscriptions. Just contact us and we’ll take care of your needs.

You pay for your subscriptions in advance and there are no refunds, so you can only reduce the number of subscriptions you have at the end of your license period. For an annual subscription, respond to the invoice and we can adjust the number of subscriptions. For a monthly subscription, just contact us in advance of your monthly billing date and we’ll take care of it.

If you have more than 10 nurses using ClearTriage at the same time, contact us for volume pricing.