By Gina Tabone – MSN, RNC-TNP

PuzzlePatient access to appropriate care and advice is a top priority for meeting managed care initiatives. Without medical advice, a new mom may make an unnecessary trip to the ED when her toddler has a fever at 2 am. A 43 year old sales representative with symptoms of indigestion, or a migraine sufferer, who is not getting relief from her usual meds, may decide to wait until morning to contact their doctors when immediate medical attention may be needed. What are their options to ensure that appropriate actions are taken? How can we, as healthcare providers, deliver the best care for a variety of patient populations to assure the best outcomes in a timely manner, while using the most appropriate medical resources?

Access to high quality 24/7 telephone nurse triage is a winning solution for meeting the objectives for managed care. Nurse Triage may be delivered by nurses within the organization, by partnering with an established healthcare call center, or a combination of the above. These specially trained nurses use decision support tools that are evidence based and relevant, along with critical insight to recommend the patient in need to the most appropriate level of care. The Triple Aim goals of improving patient care experiences, improving the health of patient populations and reducing the cost of healthcare are enhanced by offering access to triage nurses when patients need advice about care access.

Improving access to care is a major goal in today’s healthcare world. A CDC 2012 study entitled: Emergency Room Use among Adults 18-64 highlighted the finding that 79.7% of adults (who were not admitted) visited hospital ED’s due to lack of access to a provider. Many times nurses and appointment schedulers work together and have the ability to not only provide clinical care, but to also schedule a same day or next day appointment. The patient does not have to call back again for an appointment and there is comfort in knowing that the plan of care the triage nurse advised is being implemented. In cases where a more acute medical care is needed patients can be referred to preferred ED sites or Urgent Cares.

In a study at TeamHealth Medical Call Center, when patients were asked what they would have done if the telephone triage nurse advice was not an option, 60% of the patients who said they would have gone to the ED, were referred to a lower level of care or managed with home care advice. Going to the ED for non-emergent symptoms can result in long wait times, high copayment expenses to the patient, and expensive reimbursement payments for the health plan. Providing convenient access to telephone nurse triage contributes to the goal of helping create a culture of personal healthcare responsibility and leads to a more engaged and satisfied patient population.

The clinical and operational experts at TeamHealth Medical Call Center can partner with your organization to ensure that your existing triage service incorporates the clinical and operational processes required to optimally manage your patients. Or, if you are considering the prospect of launching an internal nurse triage service, the triage consultants at TeamHealth can guide you through the process and together design and implement an in-house call center that positions your organization for success in today’s new health care environment.

Gina Tabone, MSN, RNC-TNP, is the Director Strategic Clinical Solutions at TeamHealth Medical Call Center.