Nurse-led telephone triage is increasingly used to help manage demand for consultations across a wide spectrum of medical specialties. Even though we live in a world where many patients communicate via social media, the majority of patients will still attempt to reach their physician, clinic, or hospital via smartphone first. There is an increased call volume during the Pandemic as well, and this puts an added stress on your already overburdened human resources. If you do not currently have a nurse triage answering service for your practice, then it may be time to consider getting one. There are several benefits that you can reap from having a service that has been trained to follow your practices specific protocols. Takes the Load Off of the Physician or Switchboard The doctor’s offices are usually busy. That is why many physicians are overworked and are unable to spend enough time with their patients. A nurse triage service will help take the stress off of the physician or hospital switchboard. Registered nurses are able to give medical advice and direct medical care. Not only does this make things easier for the physician, but it also allows them to spend more time with their patients. This can lead to an improvement in patient care. Benefits Patients There are several reasons that patients call the doctor’s office. For example, they may suffer a minor injury and want to know what they need in order to treat it at home. Parents may call because their baby is running a fever and don’t know what to do, so they call their pediatrician. Additionally, some people call because they want to know when to go to the emergency room. Patients will have peace of mind knowing that they can get advice from a registered nurse. They will also know what to do in order to manage an illness or injury. Helps Determine if an Office Visit Is Needed There are some common health problems that can be handled at home. Most people would like to avoid going inside of a doctor’s office if it is unnecessary. A nurse triage service can reduce the number of unnecessary trips to the doctor’s office. After Hours Care The doctor’s office is the place that many people go when they are in need of care. However, medical problems can sometimes arise outside of the 9 to 5 hours. If you have a triage service, then patients will be able to get care outside of normal business hours. This can prevent someone from making an unnecessary trip to the emergency room, which can help them save time and money. Increased Patient Satisfaction Patient satisfaction is extremely important. If patients are happy with the care that they receive at practice, then they will likely come back to the practice. A nurse triage service can improve patient satisfaction. They will be happy with the fact that they can get professional medical advice over the phone. If you are interested in learning more about implementing a nurse triage service for your practice, clinic, or hospital, contact Call4Health for a complimentary consultation. We are a leader in customized nurse triage solutions for physician practices, health systems, health plans, and home care agencies. Crowding happens in all emergency departments and is associated with increased mortality, reduced quality of care and staff burnout. Triage scales are useful in identifying the least urgent cases. Senior doctor triage may help to reduce length of stay in the emergency department, but further research is needed to support any transition to possible models of doctor triage. Primary care staff in emergency departments may be useful but further research is needed to determine effective models of working. “Fast-tracking” less urgent patients can reduce the time to initial contact with a doctor and emergency department length of stay. BackgroundCrowding happens in all emergency departments and is associated with increased mortality, reduced quality of care and staff burnout.1 A well-organised emergency department can influence an entire hospital’s activities.2 Crowding has a number of causes, which have been categorised into input, throughput and output. Input refers to the increasing number of patients attending emergency departments; there has been a particular increase in elderly patients and those with complex medical problems. Throughput relates to emergency department processes from arrival in the emergency department to admission or discharge. Output refers to “access” or “exit” block, where there is a lack of appropriate hospital beds, or community arrangements to facilitate discharge.1 This issue of Effectiveness Matters summarises the evidence about strategies to improve patient throughput, improving the speed and appropriateness of treatment delivered in emergency departments. The bulletin is based on existing sources of synthesised and quality-assessed evidence. Triage is a very brief intervention that should occur within 15 minutes of arrival or registration,3 and aims to sort patients’ priority for treatment based on their clinical need. 4 Triage scales The evidence about the safety and validity of these scales is limited; the majority of studies use fictitious scenarios making it difficult to understand effectiveness in real-life settings.2,5,6 Scales may be useful in identifying non-urgent cases; the risk of death after triage is small in cases identified as the least urgent.2 However triage level has not to date been safely used to refer patients from hospital emergency departments to, for example, primary care settings. There is insufficient evidence to determine whether one scale is more effective than any other.5 A recent systematic review of 12 studies found the safety of the Manchester Triage Scale could be improved, as some urgent conditions were triaged as low urgency and non-urgent conditions were triaged with higher priority.6 Nurse triage, using such triage scales, is the predominant model in England and Wales,6 however other models of triage are in use in the UK and have been evaluated. Senior doctor triage A systematic review of 28 studies found senior doctors, working either in a triage team or individually, reduced the length of emergency department stay and the time to initial assessment by a doctor, although the studies included were mainly of poor quality.4 The role and responsibilities of the doctors varied between the studies included in the review, with some employing consultants or senior doctors and others employing junior doctors, working either in a triage team or individually. Such differences mean it is difficult to determine the most efficient model for senior doctor triage. The factors key to successful implementation need to be established before a transition to senior doctor triage can be recommended.4 A second review found the evidence evaluating team triage, led by a doctor, to be of limited quality and reached similar tentative conclusions about possible reductions in waiting time and length of stay.7 A forthcoming systematic review found team triage led by a senior doctor has the potential to reduce waiting times and may impact on length of stay in the emergency department.8 However, the quality of the evidence was relatively low and the authors concluded that it was insufficient to recommend the transition to senior doctor triage. Post-triage pathwaysOnce patients have been triaged they can be treated and further assessed in the most appropriate setting as quickly as possible. Primary care services in emergency departments A recent Cochrane review evaluated the effects of embedding primary care professionals in emergency departments to provide care for less urgent problems. There was insufficient evidence to draw any conclusions about the effectiveness and safety of care provided by general practitioners compared with emergency doctors. There is some evidence, although very low quality, to suggest there is the potential for cost benefits related to general practitioners ordering fewer tests and admitting fewer patients compared with emergency department doctors.10 An earlier systematic review found similarly weak quality evidence about GPs working in emergency departments and reached similar conclusions.9 Clearer evidence regarding costs comes from a Dutch economic evaluation, which found having a GP in the emergency department was cost effective.11 A triage nurse allocated patients arriving in the department to either a GP or emergency doctor. Compared with usual emergency department care, process times and costs were reduced, while patient satisfaction was increased. Streaming Rapid assessment zones are spaces within the emergency department where patients' assessment, investigation, and treatment can Examples of other forms of streaming, such as dividing patients in to those who would benefit from admission and those who could be discharged or treated as outpatients, are limited in the evidence.7 A triage process of identifying patients at very low risk of death and with no frailty issues who could be treated as outpatients was evaluated in Wales.14 Patients referred to the acute medical unit by GPs or emergency department doctors were assessed by an advanced practitioner who determined whether patients could be referred to a specialist or be discharged the same day following consultation with a senior doctor. This process reduced length of stay and appeared to be associated with reduced costs.14 Summary of triage position statement from College of Emergency Medicine 20113Triage A brief intervention - normally less than 5 minutes contact - within 15 minutes of arrival or registration Streaming Allocating patients to groups and/or physical areas of the department to manage queues and ensuring the right practitioner skills are available to the patient at first point of contact Triage staff Should be registered healthcare professionals trained and experienced in emergency/urgent care. Initial recognition of urgency may be undertaken by non-registered healthcare workers such as reception staff Training and competency Departments should have an agreed and documented triage training process for staff and provide basic training in red flag presentations for non-registered healthcare workers Triage governance Process should be robust, reproducible, clearly documented and auditable; should include time to triage and pain assessment; should support national standards in cardiac chest pain, stroke thrombolysis and early antibiotic therapy in sepsis What is triage and why is it done?Triage is the sorting of children into priority groups according to their medical need and the resources available. After these steps are completed, proceed with a general assessment and further treatment according to the child's priority.
What are the 3 categories of triage?The triage scale consists of 3 levels: category 1 (immediate), category 2 (urgent), and category 3 (non-urgent).
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