Care in the ambulatory oncology setting occurs via an in-person or telehealth encounter. Telehealth encounters are defined as the delivery, management and coordination of care that integrates electronic information and telecommunication technology to increase access, improve outcomes and contain or reduce health care costs (AAACN, 2017). Nurses involved in telehealth are responsible for triage, education, disease coordination management of referrals, communication of diagnostic testing and medication management (AAACN, 2017). Telephone triage nursing has grown into a unique specialty and is especially important to support care transitions and assure that patients receive timely and consistent evidenced based care. Oncology patients or their caregivers frequently need to reach their care professionals 24 hours a day. Ineffective management of telephone calls from patients or caregivers can result in negative patient outcomes or experience, unnecessary re-admissions and risk management issues for the organization. A large metropolitan academic oncology quantified that over 2,000 calls were being received from oncology patients and/or caregivers outside normal business hours. A process improvement approach DMADV (define, measure, analyze, design and verify) was used to establish an after-hours nurse triage line. The after-hours nurse triage has been operational for over two years. The after-hours nurse triage call center currently manages about 2,500 phone calls per month from established patients. Using evidenced based telephone triage decision support tools, the telephone triage nurse can assess and determine a plan of care for the caller. Outcomes of this department have helped to prevent visits to the emergency room for symptom management issues and a secondary goal to help reduce re-admissions for patients. Dispositions for the telephone triage encounters vary based on the reason and severity of the call. Disposition data for the after-hours triage call center demonstrates that 29% of calls result in telephone advice, 26% require escalation to an on-call provider, 15% being directed to an emergency room and 5% to an urgent care center. Reason for call data is also being used to identify other organizational improvement opportunities. The organization has expanded the telephone triage process to daytime hours and will share results of this expansion as well as future plans for the expansion of the telephone triage program.