911 Triage Calls- How to Help Your Callers Follow Through
by Marci Lawing, RN and Ravi Raheja, MD
Patients call a Nurse Triage service for many reasons. Some call for advice on what to do for acute symptoms such as mild diarrhea, vomiting, or how to sooth their child that can’t sleep due to a mild cough and stuffy nose.
Every triage nurse at some point will have a caller that is experiencing severe chest pain or other symptoms that will require activation of 911. 911 triage calls can be among the most tense and most challenging calls a triage nurse can encounter. This can be even more challenging if a patient is hesitant to call 911. Understanding the caller’s reason for hesitating is essential to help the patient realize the need for calling the rescue squad.
Patients have many reasons for not wanting to call EMS. Sometimes it is fear, other times it is financial reasons or even embarrassment. I have had a patient tell me several times she didn’t want the neighbors to see her being taken away by ambulance because it would be embarrassing and would call attention to her vulnerabilities. Denial seems to be the major reason. Face it, no one wants to be sped to the Emergency Room, to wait for hours, and endure expensive tests only to be told they have a bad case of indigestion and that they just need some Tums!
What steps can the nurse take to improve the chances that the patient will be compliant when they call with potentially emergent symptoms?
1. Build trust with your patient early in the call. This is essential and improves the chances that they will be compliant with your recommendations. Treating your caller with respect, listening, and being professional are key to building that trust. Don’t try to bully or intimidate your caller with medical jargon or by threatening to go against their wishes and call 911 for them. This only builds a wall between you and your caller and may even cause them to hang up and not seek the care they need.
2.Be empathetic but stick to your recommendations. Sometimes saying, “I am sure what you are feeling is scary and no one wants to have to be seen in an Emergency Room, much less being taken by ambulance but you are having symptoms that could be heart related and the Emergency Room is the best place to determine that. The reason for calling EMS is that in the event you are having a heart attack, the paramedic can start lifesaving interventions immediately and can get you safely to the hospital.” Hearing this can cause more anxiety but it is information the patient needs to hear in order to process what is happening to him/her.
3. Don’t hang up until the 911 operator is on the line with the patient. If you have to hang up because they only have 1 phone line, then tell them you are going to call them back in 5 minutes and help them until EMS arrives and then be sure to call them back! The patient trusts you and will appreciate that you did what you said you were going to do.
4. Almost as important as what you say is how you say it. The nurse should remain calm and reassuring at all times. Listen to the caller’s concerns and address them honestly. Don’t minimize what they are going through.
5. Not everyone will follow your recommendations and make the phone call to 911. Some will insist on driving themselves to the Emergency Room or may even decide to wait until the morning to call their PCP. If the patient is of sound mind, the nurse must reluctantly realize that the patient has free-will to do as he/she feels is best for their own health. The nurse can offer to call the patients physician for a second opinion but the nurse should never change her disposition- it must remain “Call 911” and then document that patient refused.
Lastly: An important step that is often overlooked is to take 5 minutes to process this call. It can be stressful and mentally exhausting handling these calls. Sometimes taking a few minutes to stretch or talk with your manager about the call can help provide much needed closure.
Though 911 emergency calls do not usually happen every shift, it is important for triage nurses to always be prepared for whatever call comes up next. Nurses must be sure to remember these steps the next time they face a challenging emergency call. A well trained and prepared nurse saves lives.