Highlights of the interview:
Tell us about public health and healthcare costs today.
We know we need to improve the health care that is provided to everyone, but can we actually afford the type of care that we want? The answer is yes, we just need to be efficient about health care resources and make sure each person gets the care they need at the right place and right time.
Can you give us an example of an inefficient use of health care resources?
Overcrowding of emergency rooms is the biggest issue, because it decreases the effectiveness of care to the patients who need to be seen. The costs associated with unnecessary hospital visits include overloaded emergency rooms, infections acquired in the hospital, and lost income for patients. In addition, patients often end up in emergency rooms when they could have received care advice at home and visited their doctor the next day. A recent study by the World Health Organization reports that as many as one in ten patients in developed countries is actually harmed while receiving hospital care.
What can we do to solve these problems?
Technology has evolved significantly in the past 5 years and we need the medical system to change and adapt to the new technology. We can now communicate instantly via telephones, text messages, and smart phones. We need to use these tools to improve the access that patients have at the primary care level.
What role does your nurse triage play?
Nurse triage can provide universal access to everyone. Almost every health care encounter starts with a telephone call. If patients have access to a reliable, trained nurse, they can be directed to the appropriate level of care based on their current needs. As a society we need nurses to be available to help patients over the phone to determine the level of healthcare needed.
Isn’t this creating an extra layer of bureaucracy?
Absolutely not. Nurses help a lot of patients over the phone and send people to the appropriate level of care. We have conducted a significant amount of research to show the benefits of nurse triage and a nurse triage system. In a recent survey, we asked patients what they would have done if they did not have access to a nurse, and we asked nurses if patients were making the right decisions. Of all the patients who said they would have gone to an ER, only 30% actually needed to go. Alarmingly, 10% of the patients who said they would have stayed home needed to seek emergency care.
The nurses are not able to see, touch or feel the patients. Do you see this as a problem or risk?
I do not see this as a problem, because of the long, successful track record of triage centers around the country and especially with our advanced technology. The system is designed to address the fact that nurses cannot see patients. We use standardized guidelines that have been developed over the years specifically for nurse triage calls. These guidelines, developed by Dr. Barton Schmitt and Dr. David Thompson, are very conservative, and their purpose is to ensure that patients get the appropriate level of care at that particular time. It does not replace doctor visits, and our nurses tell patients to follow up with their doctor. It just prevents someone from going to the ER overnight unnecessarily.
Did you develop the protocols?
No, the protocols were developed by Doctors Schmitt and Thompson, who have dedicated more than 30 years to the development of world-class decision support. The symptom care guides are used by more than 400 hospital- and health plan-based nurse advice lines. They have been tested on over 150 million symptom calls.
What do nurses use when they get questions during office hours? Are the telephone triage protocol questions only important for night calls, since this is when you don’t have a doctor to call?
Telephone triage protocols are equally important for day calls. An average busy pediatric office can get as many as 50 calls in the morning. The nurses answering these calls need to figure out who needs to be seen. It is crucial for office nurses to make sure that they have asked all the relevant questions and that they have documented all the calls. We recently launched a computerized software program called TriageLogic Office Software Solution (now called myTriageChecklist™). This program is quickly becoming popular because it is an easy way to ensure that nurses are giving the right amount of care.
As healthcare demands have increased, going straight to the emergency room is no longer the best choice for all patients. Some patients are even at greater risk if they go to an emergency room, while others need emergency care right away. We now have the tools to ensure that each patient gets the right level of care at the right place and time. In this way, our nurse triage systems take advantage of the newest technology and help improve patient care while reducing healthcare costs.