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By Charu Raheja, PhD, and Carla Price, RN
Numerous studies and countless articles have been written about the improper use of emergency rooms, and the resulting high financial burden on the U.S. healthcare system. One study by the RAND Corporation indicates that unnecessary trips to hospital ERs cost approximately $4.4 billion a year.
With the U.S. healthcare system is in serious need of cost-cutting, there is increasing pressure to minimize unnecessary use, while ensuring that people who truly need care receive it in a timely manner, thereby reducing the potential for life-threatening conditions.
Over the years, telemedicine has been gaining acceptance as a means of lowering healthcare costs, and telephone nurse triage has become part of the telemedicine solution. By using standardized protocols to advise patients to get to the right place at the right time, telephone nurse triage can decrease unnecessary emergency room visits resulting in significant healthcare savings annually.
However, one of the important aspects of nurse triage that is often overlooked is the profoundly human aspect of the service. Most callers are truly concerned and having access to a triage nurse provides reassurance and guidance. It is difficult to put a price on peace of mind. In addition, several patients may not realize the severity of the situation.
This real life case highlights the importance of nurse triage in improving health outcomes. 
Telephone Nurse Triage Case: It was a weekday morning when telephone triage nurse, “Linda G. RN”, received a call from the mother of an 8-week-old infant. The baby had been fussy for several days, was not eating well, and had a fever of 100.7. Nurse Linda used the Schmitt Thompson pediatric protocols, which prompted her to ask the mother if the baby had any recent immunizations. “No”, she replied.
“When is the last time he saw the doctor?” Nurse Linda asked. The mother indicated that the baby had been to the pediatrician the week prior for vomiting, diarrhea and fussiness, but no fever.
“Have you given him any medicines?” The mother replied, “no.”
At that point, with the baby having been sick for over a week, and now presenting with a fever, the guidelines recommended that Nurse Linda call the child’s pediatrician to inform him of the baby’s decreasing health status.
Concerned about sepsis and other potentially life-threatening problems, the doctor instructed the nurse to call back the mother and advised her to take the baby to the emergency room. The mother was genuinely surprised when Nurse Linda called back and relayed the pediatrician’s instructions, as she was completely unaware of the potential seriousness of her baby’s condition.
Without the guidance provided by telephone triage, protocols and the nurse, the infant may have experienced delayed treatment, leading to potential increased morbidity and even death if the baby had been septic.
CONCLUSION: Life Saving Calls
As telemedicine continues to expand into new services, providing innovative and cost-effective care, it’s important to remember that the benefits reach beyond budgetary significance. Cases such as the one described above are a lot more prevalent than what one would expect.
For example in a recent study, we found that as many as 7% of the patients who did not consider their case an emergency (and responded that they would have stayed home if they did not have access to a nurse) were actually told by nurse triage to seek emergency care (http://triagelogic.com/Using-Triage-Improve-Health). Even more alarming, about 1% of the patients who did not think they required emergency care were told to call 911!
The table below describes the results.
This means that a large number of patients are at risk of serious health issues as a result of not receiving timely medical attention. Every call answered by Linda G., and other telephone triage nurses, may be the difference between life and death. Fortunately, for one 8-week-old baby who wasn’t feeling well, a telephone triage process was in place, and he received the care he needed. While this is one case of many, a significant portion of the population does not have access to telephone nurse triage. Implementing telephone medicine to a greater population can save lives and improve health outcomes.
Centers for Disease Control and Prevention. (2013)
Emergency Department Visits. CDC FastStats. Retrieved Sept. 13, 2013 from http://www.cdc.gov/nchs/fastats/ervisits.htm
Genachowski, J. (2013). Telemedicine to Transform Healthcare for Underserved and Rural Communities. The Aspen Institute. Retrieved August 20, 2013 from http://www.linkedin.com/today/post/article/20130107232755-45735406-telemedicine-to-transform-healthcare-for-underserved-and-rural-communities
Harding, A. (2013) Telemedicine improves care for kids seen in rural ERs. Reuters Online. Retrieved August 20, 2013 from: http://www.reuters.com/article/2013/08/19/us-telemedicine-kids-idUSBRE97I0VK20130819
Nusca, A. (2010) Unnecessary trips to hospital ER cost $4.4 billion, study finds. Smartplanet.com. Retrieved Sept. 13, 2013 from http://www.smartplanet.com/blog/smart-takes/unnecessary-trips-to-hospital-er-cost-44-billion-study-finds/10504
Raheja, C. (2013) Comparing Private versus Government Insurance: Can Triage Care help balance proper use of ER services? TriageLogic Group. Available online: http://triagelogic.comhttp://triagelogic.com//wp-content/uploads/files2/research/HealthData-03-13-2013.pdf
Raheja, C (2013) Using Nurse Triage to Improve Health Outcomes. Available online: http://triagelogic.com/Using-Triage-Improve-Health
Raheja, C (2012) ROI from Nurse Telephone Triage Calls – Survey of Patient Calls. TriageLogic Group Available online: http://triagelogic.com/Nurse-Triage-ROI
Questions or Comments: please contact Charu at firstname.lastname@example.org
About the authors: Charu G. Raheja, PhD is the Chair and CEO of Triage Logic, and Carla Price is the nurse trainer for Triage Logic. For more information and related articles, please visit www.triagelogic.com