MHNI Phone Nurse/Phone Triage System

Who is the “phone nurse”?

Specially trained registered nurses who are considered senior nurses in the system and have a lot of experience in pain illnesses are assigned to address clinical phone calls from 8:00 a.m. to 12:00 p.m. and 1:30 p.m. to 4:00 p.m. each day MHNI is open for business. MHNI remains committed to providing patients with ongoing access to their MHNI physicians and the phone nurse system aids in this endeavor.

How is information communicated to the patient’s MHNI physician?

It is the phone nurse’s responsibility to document each call and relay pertinent information to the MHNI physician or designee. The physician then reviews this information and the patient’s record and has the phone nurse convey his/her recommendations to the patient as soon as possible, usually within 24 hours of the initial call. The doctors at MHNI make all decisions that should be made by a physician. In addition, direct contact with the patient’s physician will be arranged if necessary.

How many calls are answered by the telephone nurse each day?

MHNI receives more than 100 clinically-related telephone calls each day, and while some are for urgent matters, many others are of a routine nature. Monday tends to be our busiest day, followed by Friday. Except for urgent or emergent situations, MHNI physicians must attend to telephone calls as time allows during the day. Given the high volume of calls, patients may be required to wait “on hold” while other calls are being addressed or may need to be called back by the phone nurse or her associates. Because safety comes first, the chart review process and disposition by the physician may take some time to complete. In addition, except in true emergencies, the physician’s time must be prioritized to those patients who are attending the Institute on a particular day.

What types of calls does the phone nurse receive?

The most common question relates to medications. Other common topics include the return of a severe headache, a new symptom, or a call regarding medication refills.

Depending on the information provided by the patient, some calls are easier and some more difficult to answer. The easier calls are from patients who have very specific questions, know exactly what they want, and are able to communicate that to the telephone nurse. The most difficult calls are from patients who live a significant distance from MHNI and are not doing well. These calls are complicated by the fact that the patient cannot come in as easily for a visit with their physician.

What questions cannot be answered by the telephone nurse?

Appointment changes, requests for letters, or copies of records cannot be addressed by the telephone nurse. These requests are handled by the appointment specialists or the Medical Records Department at MHNI. In addition, introducing new medications over the phone is discouraged; patients usually must be seen by their physician before such a change can occur.

When calling the Institute, what information should a patient have ready?

The following information should be available when calling the Institute regarding a clinical matter:

• The date of a patient’s last and next appointment with MHNI
• The name of the patient’s MHNI physician(s)
• A list of the patient’s current medications, their dosages, and when they are taken
• Any new medical problem or treatment since the patient’s last visit to MHNI
• A list of any questions the patient wants to ask
• Midweek days are a good time to call. Monday mornings or Friday afternoons should be avoided if possible, as the clinical calls to MHNI are exceptionally heavy during those periods.

To assure safety and promote availability of the MHNI system to address urgent calls, the following guidelines are recommended:

1. Patients are encouraged to call MHNI to report a new symptom, side effect, or significant change in their headache or pain pattern. Severe pain which has not responded to treatment is also appropriate to report. Clinical staff will address these issues as efficiently and promptly as they are able by phone and in a manner that assures the patient’s safety and satisfaction as much as possible. Generally, a full evaluation at MHNI or by a patient’s local doctor will be recommended.
2. Treatment programs cannot be changed over the telephone. Although dose levels of medication may be adjusted, in general, medication changes will be managed only during appointments at MHNI.
3. Prescription refills will be provided at return visits and generally not by telephone. At each appointment, patients will be provided with prescriptions for enough medication to last until their next visit. It is essential to schedule follow-up appointments within the time recommended by the MHNI physician in order to ensure aequate prescription supplies. On the rare occasion when a refill must be done by phone, the requst must come during daytime business hours. Requests for a refill of controlled or scheduled medications cannot be honored by the on-call physician.
4. Patients using medicine with habituation potential or using the upper limits of abortive medication require close and frequent medical supervision. Extending these prescriptions by telephone between visits is not generally possible.
5. Beyond regular office hours, an assigned on-call physician can be reached through the Institute’s answering service by calling (734) 786-4366. For urgent matters, MHNI’s answering service will contact the on-call physician who will return a patient’s call as soon as possible. The on-call physician will not have medical records available after hours, and therefore treatment recommendations are limited. The on-call physician should be contacted for urgent calls only; non-urgent calls should be directed to MHNI during regular business hours.