[The "Nephrology outpatient Triage": an organizational model for the ambulatory care of patients with advanced renal disease].

The clinical course of outpatients with advanced chronic kidney disease requires a close monitoring by the nephrology team, in order to identify emerging clinical problems promptly and prevent subsequent complications. With the aim of improving the outpatient management in our clinic dedicated to advanced renal failure, we implemented the "Nephrology Clinic Triage" (NCT). This organizational model is coordinated by the nephrologist and supported by nurses. In case the outpatients, or their caregivers, have clinical problems or need advice, they can easily get in touch with a nephrology nurse by a dedicated telephone line. The nurse, who had been specifically trained for this purpose, interviews the patient by telephone and track his health conditions using dedicated flow-charts. The patients must be able to answer in a suitable way to the telephone interview on which NCT is based. Therefore, all patients referring to nephrology clinic are trained to record and report properly by telephone some relevant clinical parameters (i.e., blood pressure, body temperature, heart rate, body weight, urine volume) and clinical signs (dyspnea, dysuria, diarrhea, nausea, vomiting, abdominal/lumbar/chest pain). On the basis of the information obtained by means of NCT, the nurse can identify the patient's need and classify its severity and priority by means of a color-coding system. The subsequent medical intervention (telephone conversation, scheduled appointment, hospitalization) is planned accordingly. The implementation of NCT may be useful to monitor the clinical course of outpatients with advanced chronic renal failure also when they are home, thereby reducing the risk of harmful complications and hospitalization.