- CATEGORIES: Data,Data and Research,Data for Nurses,Data for Providers,Doctors and Hospitals,Nurse Learning Center,Nurses,Research,Research for Nurses,Research for Providers
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By Charu G. Raheja, TriageLogic Chair and CFO
With the Affordable Care Act in full swing, an important question in the minds of health professionals is: what will the new population of insured patients look like? What will be their needs? What programs should be offered to help them stay healthy?
The first step in understanding the needs of this population is to look at some data and analyze current usage of healthcare resources. The second step is to study the effectiveness of the different nurse triage programs available to patients.
For example, we conducted a survey asking patients what they would have done if they did not have access to nurse triage. We then compared what those patients said they would do without this access, against what the nurse told them to do using standardized guidance protocols based on the patient's symptoms.
The table below shows patients’ responses to the question “what would you do if you did not have access to a nurse triage?” The information is broken down based on the patient’s type of insurance.
As Table 1 demonstrates, more patients in government insurance (Medicaid and Medicare) indicated they would have gone to the emergency room than would patients in private insurance.
- Approximately 33% (1,873) of the patients in government insurance said that they would go to the emergency room if no triage was available.
- Approximately 20% (1,919) of the patients in private insurance said that they would go to the emergency room if no triage was available.
Next, from the group of patients that said that they would go to the ER, we compared the number of private insurance and government insurance patients who were actually told to go to the emergency room by the nurse triage.
Table 2 shows the difference in the actual need for medial assistance, such as the ER or calling 911, between the two groups. It is important to note that the nurses did not know the insurance type of the patients they spoke to prior to the call. They simply followed protocols based on the patient’s description of their condition.
TABLE 2: The percentage of patients that would have gone to the ER, told to go to the ER by nurse triage (broken down by insurance type).
Review of the data indicates that of government insured patients that said they would go to the ER if they did not have access to nurse triage, following appropriate protocols, nurses referred only 24% to the ER. This reduction in unnecessary emergency room visits could result in huge cost savings, especially when spread across numerous ERs. Conversely, when looking at patients with private insurance, out of the patients that said they would go to the ER if nurse triage was not available, triage nurses deemed more than 30% of the private insurance patients were in need of ER or 911 services.
Another way to look at this data is:
- 1,873 of patients in government insurance said that they would seek ER, only about 459 of those patients were referred to an ER.
- 1,919 patients in private insurance said that they would seek ER care, only about 576 of those patients were sent to the ER.
On average, only about 25% of the patients who thought that they needed ER care actually needed to go to the ER!
With changes in healthcare access, it is increasingly obvious that data collection and analysis is crucial to understanding patient needs, while helping identify how best to use resources. This review of ER use by different patient populations is just one of numerous examples of how nurse triage can positively improve patient health, and the balancing of health care resources.