PROFILES OF AFTER HOURS TELEPHONE TRIAGE PROGRAMS

1.What is the name of the program?
 
2.Who is the primary contact person?

a. Name
b. Title
c. Address
d. Phone
e. Fax
f. E-mail
 
3.Is this after hours call center affiliated with a hospital?   Yes   No
a. If yes, please list the name of the hospital:
 
4.Is this after hours call center affiliated with a managed care plan?   Yes   No
a. If yes, please list the name of the managed care plan:
 
5.What services does your call center provide?
Yes  No
a. Pediatric triage and advice for physician offices
b. Pediatric telephone triage and advice for the general public
    (eg, "ask a nurse," etc.)
c. Adult triage and advice for physician offices
d. Adult triage and advice for the general public
e. Physician referral services
f. Outbound calls for hospitals
g. Appointment reminder calls
h. Telephone case management
 
6.List all States in which after hours service operates:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
 
7.In what year was the service started?  
 
8.Which triage guidelines and/or vendor protocols are used by telephone triage staff?
 
9.What was the total number of clinical patient calls handled last year?  
 
10. What was the total number of pediatric clinical patient calls (age 0-17) handled last year?  
 
11. What was the number of physicians served last year?  
 
12. What was the number of medical practices served last year?  
 
13.Who answers clinical patient calls?
Yes  No
a. Medical Assistants
b. Licensed Practical Nurses
c. Registered Nurses
d. Physician Assistants
e. Resident Physicians
f. Other
(please describe)  
 
14.Describe training program for triage staff:
 
16.Who supervises telephone triage staff?
Yes  No
a. Nurses
b. Nurse Practitioners
c. Physician Assistants
d. Physicians
    What speciality?
e. None
 
17.Is the after hours service accredited by URAC*?   Yes   No
 
18.What is the name of your Medical Director?
 
19.Is the Medical Director board certified?   Yes   No
a. If yes, in what specialty?  
 
20.How do patients access triage and advice services at your call center?  (check one)
a. Call center accepts incoming calls directly from patients
b. Call center receives notification of patient request and makes outgoing call
c. Call center provides both incoming and outgoing calls
 
21.Describe your program quality assurance program:
 
* Originally, URAC was incorporated under the name "Utilization Review Accreditation Commission." However, that name was shortened to just the acronym "URAC" in 1996 when URAC began accrediting other types of organizations such as health plans and preferred provider organizations.