Using Nurse Triage to Improve Health Outcomes

by Charu G. Raheja, PhD

With all the talk about cost savings in health care, it is sometimes easy to overlook the crucial role that nurse triage plays in ensuring that patients receive care when they need it. Triage nurses play an important role in determining which callers need further assistance. The benefits of nurse triage in preventing unnecessary emergency room visits are often highlighted; however they play an even more crucial role in ensuring that people get help when they need it. This role deserves further attention by our policy makers, healthcare advocates, and health centers.

As people working with patients know, every patient interaction begins with a phone call. The people calling need help assessing the seriousness of their condition in order to get the appropriate level of care. The availability of a nurse triage system allows callers to depend on proven, high- quality guidelines to help them assess their needs instead of having to depend on their own intuition. While most people have a good sense of when they're facing an emergency, our studies and surveys show that it is not always the case.

Last year, we conducted a survey asking patients what would they do if they did not have access to telephone nurse triage. This survey revealed patients' own assessments of the seriousness of their situation, based on what they would have done if they did not have access to nurses by telephone. We were then able to compare the patient's assessment versus the nurses’ instructions following the disposition guidelines.

We normally expect people to overestimate the seriousness of their condition, thus causing too many people to go to the emergency room when an emergency visit is not necessary. While that is the case most of the time, we found several instances in which people thought that their symptoms were not serious and that they would just stay home. Instead, in these cases, the nurse instructed the patient to get immediate care.

Over 22,000 of the people surveyed said that they would stay home if they did not have access to nurse triage. A good number of those people, about 1850 callers, were told to seek emergency care.  Even more surprising was that 23 of the callers were actually told to call 911!

The table below shows the data and the other dispositions determined by the nurses for the patients who said that they would stay home. As the data shows, nurse triage goes well beyond reducing healthcare costs: it also improves health outcomes.