By Michelle Holztrager, RN

With the healthcare industry focused on saving costs, TeamHealth Medical Call Center just received a nice reminder of our role in saving lives. Though we often receive feedback in the form of compliments about our services, it is rare that we receive such detail on an outcome and discover we had a role in saving a patient’s life.

A patient called after talking to one of our triage nurses. She stated, “I want to express my gratitude to ‘Anna’ on the 24 hour nurse line. Last Sunday, my husband was having severe stomach cramping, which we thought was food poisoning or a virus. We called the nurse line and Anna was very thorough and professional. She was insistent that we go straight to a hospital instead of a minor emergency center. We immediately went to the hospital where it was determined that he had a ruptured appendix. He had an emergency appendectomy. The surgeon said it was a very severe case and that he could have died in less than 24 hours. Please tell Anna thank you.”

One of our RN Clinical Directors analyzed this call and what went right:

After hearing about this particular compliment, I listened to the call and want to point out some things that could have caused the nurse to jump to an immediate conclusion or that might have distracted her or led her down the wrong path on this call. About 70% of our callers, who think they need to go to the ED, have non-emergent outcomes. However, there is another small percentage of patients who don’t think they are having a serious issue, but are in need of emergent care. This call fell into the latter category. I want to commend Anna for utilizing her critical thinking skills and not allowing the caller to persuade her otherwise.

Synopsis of call:

Patient having severe stomach cramps, vomited once the previous evening, chills, temp. of 99.9 orally, one hr. after taking Ibuprofen. Rated his pain 6 out of 10. Stated his pain had been constant since the previous afternoon.

What conclusions could this nurse have assumed that might have led her down the wrong path? 

She could have assumed that this was a viral illness, since the patient vomited, had a fever however he denied any diarrhea.  Unable to sleep because of the stomach cramps.

  1. The patient rated his pain a 6 on a scale of 0-10.  On a pain scale, that is considered moderate pain.  Although the patient states it has been constant since the previous day and gets worse at times.
  2. When asked by the nurse if anyone close to the patient had been recently ill, his wife stated their daughter had a gastrointestinal virus with diarrhea just a couple of days prior but stated this was very different.

I highlighted the above pertinent information in this call.  Initially, this looks as if this is possibly a virus when in fact this patient had a ruptured appendix and needed to be taken to surgery immediately.

What differentiated this call into an ED outcome?

“Pain was constant for a long period of time although it fluctuated in intensity.

Would an urgent care recommendation been appropriate on this particular call?

The patient’s wife stated that they were supposed to fly out of town that day and asked if they could go to a minor emergency/urgent care center.  Kudos to our nurse for sticking to her “guns” and for persuading her caller to take the patient to an emergency department rather than an urgent care center. Anna simply stated that the urgent care center would not be equipped to care for her husband and could delay his care if it were something more serious. One of the more difficult aspects of telephone triage is critical thinking and following the guidelines, regardless of the desire of the caller, and our nurse executed excellent critical thinking skills in this instance.

We want to thank Anna and all our triage nurses for their professional call handling and their critical thinking skills. At TeamHealth Medical Call Center, we’re proud to say we’re saving lives, one at a time.

 

Michelle Holtztrager, TeamHealth Medical Call Center Leadership, Director of Education and Staff Development

Michelle Holtztrager, RN

Michelle Holtztrager, RN, is the Director of Education and Staff Development for TeamHealth Medical Call Center.