Laura Deuy experienced what she calls a “weird headache” and a “stitch” in her side for several days. Finally, when the “weird pain” did not go away, she called her primary care provider — an Asante Physicians Partner — to set up an appointment for the following week. The patient service representative conveyed her symptoms to a telephone triage nurse who quickly returned Deuy’s call.
Before the weekend was over, Deuy was in surgery to open up a blocked coronary artery.
Jasmine Thomas recalls one afternoon in early June when her 8-month-old daughter had a high fever. A first-time mom, she says she was “panicky” and “in tears,” fearful that Sophia was seriously ill and needed to be rushed to the emergency room. She called her primary care provider, but because it was closing time, her call was transferred to the Asante Contact Center. A telephone triage nurse instructed her on the appropriate care for her infant and arranged an 8 a.m. appointment the next day with her provider.
Thomas’ conversation with the nurse saved her the time, expense and stress of an unnecessary visit to the emergency department.
Stories like these are why Asante’s Telephone Nurse Triage program was created, says clinical manager Cathy Meinerts.
The mission is getting patients “the right care at the right time and at the right location.”
Meinerts says post-triage surveys indicate that if a patient had not spoken to a triage nurse, most would have done the opposite of what was eventually advised, either risking complications waiting for symptoms to worsen or going to the next, more expensive level of care unnecessarily.
The triage nurse service was established in December 2016 as a pilot program at the Asante Physicians Partners’ White City family clinic. It was soon expanded to APP’s State Street and Black Oak clinics in Medford.
Meinerts is hopeful the telephone triage nurse service will be available to patients at all of the clinics in the Asante system within the next year.
Meinerts says her staff is on the front line in Asante’s strategic plan to “better meet the needs of patients” and “give better care over the phone.”
Telephone triage nursing is one tool the health care industry is utilizing nationwide to streamline the rising costs of health care, make more efficient use of hospital staff, and more importantly provide patient access to appropriate medical care in a timely manner.
It is a remedy for patients who otherwise might wait out symptoms, not realizing those “weird pains” may signal a life-or-death emergency. For others, it gives them reassurance in the intervening 24 to 48 hours before an appointment can be scheduled.
While Asante’s telephone triage nursing service is relatively new, advice nurses like those employed by large HMOs have been around for awhile. However, thanks to technology, Asante and Providence Health & Services have more tools to determine whether symptoms are life-threatening, emergent, urgent, acute or non-acute.
In addition to the telephone triage nurse program for its Providence Health Plan members, called Prov RN, Providence Health & Services offers a program in which patients can visit with a nurse or a primary care provider via video conferencing, internet chat or email.
“Thanks to smartphones and tablets, the Express Care virtual service has really taken off,” says David DeRurange, communications specialist with Providence Medford Medical Center.
“As the U.S. healthcare environment continues to evolve due to changes in reimbursement, legal issues and shrinking healthcare resources, the expanding role of telehealth nurses will continue to evolve,” reports the American Telemedicine Association.
“Telehealth nursing is practiced in the home, health care clinic, doctor’s office, hospitals, call centers and mobile units,” says ATA. “Telephone triage, remote monitoring and home care are the fastest growing applications.”
In Southern Oregon’s distant, rural, small and sparsely populated areas, telephone triage nursing — or telenursing — can remove time and distance barriers between providers and patients.
Misty Moschella is one of Asante’s five telephone triage nurses. A registered nurse with 10 years under her stethoscope, she helped Meinerts get the program up and running last year. She says “it’s the most rewarding thing” she’s done in her career.
She and Meinerts both tout the benefits of centralized patient care.
In addition to cost savings to the patients and insurance companies, it allows the emergency departments to focus on the most critical cases, rather than be bogged down by non-emergencies.
“Also, the patients are satisfied that they are being listened to and cared for,” says Moschella.
Without a telephone triage nurse, she says, a non-medically-trained staff person is left to determine based on the symptoms presented whether the caller should dial 911, visit urgent care or head to the emergency department as soon as possible. Some callers are content to have the patient service representative fit them into the primary care provider’s schedule.
“Quite often, however, the patient cannot or should not wait until the next available appointment,” she adds.
Such was Deuy’s case one Friday in late March.
Using the Schmitt-Thompson protocol — what Meinerts calls the “gold standard” in telephone care — Moschella asked open-ended questions and allowed Deuy to tell her story.
“I thought I would be fine if I waited until I had an appointment on Monday or Tuesday,” Deuy recalls. “I still didn’t feel particularly bad.”
But, after listening to Deuy's symptoms such as “a headache in front of my ears” and “eyes blurry enough to be annoying” as well as that aggravating stitch in her side, Moschella calmly urged her to go to the emergency department at Rogue Regional Medical Center ASAP.
Because she lives in the Applegate Valley some 30 minutes away from the hospital, every tick of the clock was critical in what Moschella believed was the precursor to a “heart event.”
The emergency room at RRMC was given a heads-up and Deuy was quickly admitted for an overnight stay and monitoring. By 3 a.m., cardiac markers indicated there was a significant obstruction in a coronary artery. Further tests revealed 99 percent blockage. A stent was implanted to keep the artery open and reduce the chances of a heart attack.
Deuy, 67, says she felt healthy walking into the hospital, but “obviously, at least to the nurse, there was an indication that something serious was going on."
“If I had stayed home any longer, I would have caused irreparable damage to my heart,” she says. “By Monday, would I have been alive?”
Deuy is now in cardiology rehabilitation, further strengthening her heart muscle to resume a full and active life.
In baby Sophia’s case, her mother was advised on how to keep her “calm, cool and comfortable” until the next day’s visit to her family physician.
She was told to watch and make sure the fever did not spike above 103 or 104 degrees.
“We were both able to sleep through the night,” Thomas recalls. “I am not a fan of trips to the emergency department. I am very happy we did not have to go.”
Sophia is a healthy baby and doing fine, her mother says.
Thomas and Deuy are among the more than 2,000 patients who have been served since the program’s implementation eight months ago. About half were directed to primary care providers, with the triage nurse facilitating a timely appointment, sometimes as soon as the same or next day. More than a third, however, required quick intervention.
In many instances, Moschella explains, “it’s a matter of giving the caller peace of mind."
“There are clues and symptoms we can tell a patient to watch for” in non-emergent cases, she says.
In addition to over-the-phone guidance, a triage nurse can email further instructions or educational material to a patient. A Spanish-speaking triage nurse and patient service representatives are also available to assist.
Moschella says one downfall of not interacting with a patient face-to-face is that she doesn’t always know the outcome of the medical crisis, but when she does have the opportunity for follow-up it’s particularly gratifying to know that she may have saved a life.
She recalls a recent case.
A gentleman called in with rectal bleeding. He needed coaxing, she says, “making up his mind about going to the ER.”
Even though he was “losing lots of blood” and lived only a few blocks from RRMC, he was reluctant at first to head to the hospital.
In the end, he did go. Within two weeks of the call, the man was undergoing chemotherapy for colon cancer.
“He was able to get appropriate treatment right away,” Moschella says.
Moschella says when she learned of the man’s diagnosis and case management, she was “beyond words” with relief.
“It was like WOW!”
Reach Grants Pass freelance writer Tammy Asnicar at email@example.com.