Using Telephone Triage to Reduce Heart Attacks in Women

Heart disease is the number one cause of death for women, yet many patients do not realize that they may have heart attack symptoms. Women often delay seeking medical attention. Denial is a common first reaction. No one wants to think that the symptoms they are having could be a life-altering heart condition that frequently needs surgery.

Telephone triage nurses must know the warning signs to help their patients get the correct care. A good triage nurse will start coming up with “working diagnoses” from the second they start talking with the patient.

There are various symptoms that lead telephone triage nurses to recommend immediate care at the ER for possible heart attack.  There are the obvious symptoms of a possible heart attack, including shortness of breath and pressure or pain in the chest. Chest pain can range from benign, or very mild, to a life-threatening cause.

Common heart attack symptoms include:

  • Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back
  • Nausea, indigestion, heartburn or abdominal pain
  • Shortness of breath
  • Cold sweat
  • Fatigue
  • Lightheadedness or sudden dizziness

When a triage nurse hears the patient say they have chest pain, she will first rule out the “ABC’s”- making sure the patient is not having problems with their “Airway, Breathing or Circulation.”

Heart attack symptoms can also start out subtle, especially in women.  For example, abdominal pain is a very common symptom and can be related to something as simple as overeating to something life-threatening such as a ruptured abdominal aortic aneurysm. Likewise, back pain can be indicative of a serious aortic aneurysm. Conditions such as heartburn, the flu or stomach ulcers that can mimic heart attacks. Other symptoms like unusual sweating, fatigue, anxiety, dizziness, and nausea are other symptoms that often go untreated.

Because it is so common and so many people experience these symptoms, it is important for triage nurses to use the protocols and consider other patient-related symptoms to diagnose the right plan of treatment.  

Here are 6 tips for telephone triage nurses can use to help patients experiencing heart-related 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 the 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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