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Clinics and Hospitals Use Trained, Certified Community Members To Screen and Support Primary Care and Postdischarge Patients, Reducing Physician Visits and Costs

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1: Triaging
This sounds like nurse triage to me. In Washington only RN's can legally provide triage over the phone. I saw the example form and where it states to immediately notify the nurse supervisor for x symptoms and where it states advice was verbally read to nurse supervisor. It seems like a slippery slope of non RN's providing care that should only be provided by RN's. There is a lot more to telephone triage than asking closed ended yes or no questions.
I think it is great to have the Grand Aides do everything but the telephone part. The Grand aides could be cross trained as health coaches and use motivational interviewing to help people in their follow up visits in person or by phone.
Mary Whittington RN, MSM, Wednesday, October 17, 2012 10:46 pm| Hospital; Nurse
Thanks. Every single encounter of a patient with a Grand-Aide is supervised directly by a nurse -- no exceptions. If the nurse wants, she/he can get on the phone immediately with the patient.
A. Garson, Thursday, October 18, 2012 2:20 pm| Other; Physician
I have been a telephone triage nurse for 18 years. Initially I worked in an office setting. Now I am working an office that does telephone trige for about 500 physicians and providers, both primary and specialty care. We use protocols for each contact. However, because we are RNs, the protocols are guidelines only. Frequently the caller will answer our questions and protocols would dictate a plan of care that, with further probing outside of the scripted questions, proves to be the wrong choice. I believe this program has some benefits, but any triaging needs to remain in RN hands. Anything else can place the patient, G.A, nursing supervisor and provider in a bad situation.
Colleen Sigafoos RN, BSN, Friday, October 19, 2012 7:04 pm| Hospital; Nurse
I am working as a long term care nurse and wound care nurse for more than 5 years (combine). The concept is like in a nursing home or SNF where are CNAs are doing direct care to the patients, then, they will notify the charge nurses (RNs) immediately for any medical emergencies. In SNF/ LTCF, CNAs are trained and have basic knowledge and skills in health care. In SNF/ LTCFs, RNs or LVNs have 30-35 patients under their care, its too much for 1 nurse because there no exact patient-nurse ration in SNF. The CNAs are really helpful in notifying their supervisors for any emergency situations and CNAs knows how to respond in an emergency since they have certification to prove for their competencies. I believe this program can really benefit the patient.
Jean Guerrerero, BSN, RN, Sunday, February 23, 2014 5:33 pm| Other; Nurse
5: More to explore
I want to explore more about this program for the future of health care. Seem there is still more to research and I am skeptical about the fact that CNAs will be the front liner in the field of health care as they will be assessing the patient. Its also like in a home health setting and public health nurse who goes to patient homes for follow up. Its intriguing in a sense that CNAs will do comprehensive assessments.
Jean Guerrero, BSN, RN, Sunday, February 23, 2014 5:39 pm| Other; Nurse
6: To Ms. Guerrero
Thanks for the note. I am sorry this is not clear. The Nurse Practice Acts specifically prohibit "assessment" by a CNA. The Grand-Aide fills in a "yes/no" questionnaire and then send it electronically to the supervisor who then, in chronic care, gets on video with the patient every time the Grand-Aide is in the home. Therefore, the supervisor does all the "assessment."
Arthur Garson, Jr., MD, MPH, Monday, February 24, 2014 11:05 am| 0; 0
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Original publication: September 12, 2012.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: November 20, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: October 21, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.