How Telephone Triage Nurses Handle Patient Emergencies
There are many reasons why patients call a nurse triage service. Some call for advice on what to do for acute symptoms, such as mild diarrhea, vomiting, or how to soothe their child that can’t sleep due to a mild cough and stuffy nose. Every telephone triage nurse will eventually have a caller that is experiencing severe chest pain or other symptoms that will require them to call 911. In emergencies, every second matters and the nurse must be ready to instantly know what steps need to be taken. This is why it is vital for telephone triage nurses to be trained properly on how to handle patient emergencies.
911 triage calls can be among the tensest 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 in order 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. One patient told a TriageLogic nurse several times that 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. Other patients do not want the hassle of being taken to the Emergency Room, waiting for hours, and enduring expensive tests only to be told they have a bad case of indigestion and that they just need some Tums!
What steps can the telephone triage nurse take to improve the chances that the patient will be compliant when they call with potentially emergent symptoms?
1. Build trust with the patient early in the call. This is essential and improves the chances that the patient will be compliant with the nurse’s recommendations. Treating the caller with respect, listening, and being professional is key to building that trust. The nurse should not try to bully or intimidate the caller with medical jargon or by threatening to go against their wishes and call 911 for them. This only builds a wall between the nurse and the caller and may even cause them to hang up and not seek the care they need.
2. Be empathetic but stick to the 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 them.
3. Don’t hang up until the 911 operator is on the line with the patient. If the nurse has to hang up because the patient only has one phone line, then they should tell the patient that they are going to call them back in 5 minutes and help them until EMS arrives. The patient will trust and appreciate the nurse for following up.
4. Almost as important as what you say is how you say it. The nurse should remain calm and reassuring at all times. They need to listen to the caller’s concerns and address them honestly. The nurse should be sure not to minimize what the caller is going through.
5. Not everyone will follow the recommendations and make the phone call to 911. Some patients 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 patient’s physician for a second opinion, but the nurse should never change her disposition- it must remain “Call 911” and then document that patient refused.
6. Process the call. 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 their 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 triage nurse can save lives by making sure that the patient gets to the correct level of care.
For more tips and lessons on telephone nurse triage, check out the TriageLogic Learning Center.
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