Date of Completion

Spring 5-18-2025

Document Type

Open Access Project

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Eileen Stuart-Shor, PhD, ANP-BC, FAHA, FAAN

Practice Site Mentor

Debra Lajoie JD, PhD, MSN, RN

Committee Mentor

Christie Potter, DNP, APRN, CPNP-PC

Abstract

Background: Children with short bowel syndrome are medically complex, requiring specialized management and coordinated care to address acute triage issues between scheduled visits. Their risk for rapid decompensation and distance from specialty centers often necessitates telephone-based triage—a typically non-reimbursable method. At a leading Northeastern U.S. children’s hospital, the Intestinal Rehabilitation (IR) center manages high-risk telephone triage of these patients’ concerns using experienced nurse practitioners. The inability to directly visualize patients during telephone encounters, however, limits clinical assessment and decision-making, presenting challenges to efficient and safe care delivery. A systematic literature review indicated that telehealth can enhance parental confidence, improve clinician satisfaction, improve quality and safety of care, and reduce unplanned in-person visits.

Methods: Guided by the UCSF School of Nursing Symptom Management Model and using Plan-Do-Study-Act cycles, this project evaluated NP-led video telehealth to improve acute triage management. The project outcomes evaluated included: the use of the algorithm, points of contact, prevention of in-person visits, and staff perception of feasibility and value added.

Intervention: A clinical triage algorithm was developed to incorporate NP-led video telehealth visits to address clinical triage. This intervention ensured that patients and triage concerns were appropriately screened for NP-led video telehealth visits.

Results: Utilization of the triage algorithm increased from 32% in PDSA Cycle 1 to 44% in Cycle 3—a 38% overall improvement over 14 weeks. Although the average points of contact per triage rose by 1.44, NP-led video visits achieved an 85% conversion rate, preventing 55% of unplanned in-person visits either to the emergency room, primary care, or IR clinic. Feedback led to refinements such as integrating direct electronic medical record portal messaging and instituting an IR nurse “first pass” call to enhance accuracy. A post-implementation survey affirmed that the intervention was both feasible and added value.

Conclusion: Implementing a standardized triage algorithm for NP-led video telehealth reduced the need for in-person consultations for pediatric short bowel syndrome patients, converting 85% of appropriate triages into billable visits and reducing the burden of in-person care. These findings support the sustainability of the intervention and its potential for broader application in managing complex pediatric populations.

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