Triage Nurses Handle Non-Urgent 911 Calls in Washington, DC

Everyone knows that every second matters in emergency situations. 911 call centers are usually loaded with calls, but unfortunately, 1 in 4 of these calls is not a real emergency. Almost 30% of the calls from urban areas requests for a medical ambulance, even for non-emergency situations. This kind of situation is considered a misuse of the emergency medical services (EMS) because it forces other patients with real medical emergencies and have their care delayed. 

The need for transportation, lack of knowledge, and inaccessible access to primary care are the reasons why EMS units are misused. Inappropriate use of medical services puts the EMS unit and personnel at risk as they speed on busy streets to attend to cases that they think are an emergency. Improper use of medical services demoralizes the responders who are trained to act in real emergency situations.

The overuse of emergency services causes a significant increase in emergency care cost. Not to mention that it also increases patient costs. The emergency department then becomes overcrowded, which makes it difficult for healthcare personnel to provide the satisfactory care needed by patients. 

To prevent the abuse of EMS and call overload, triage nurses are now being trained in handling emergency dispatches. Recently, a new program has been launched in Washington, D.C. to redirect non-urgent 911 calls to triage nurses. On April 19, 2018, the District of Columbia Fire and Emergency Medical Services Department (FEMS) launches the “Right Care, Right Now” program. This program aims to improve patient’s health and to preserve the use of EMS services for patients that are injured and require emergency assistance immediately.

What is a Triage Nurse?

A triage nurse is a registered professional that is assigned to an emergency department (ED) and is responsible for patient assessment and determines the patient’s level of need for assistance. A triage nurse evaluates patients' needs depending on the level of illness or injury, the symptoms, and its severity. The responsibilities of a triage nurse are as follows:

• Assess the patient and takes the vital signs.
• Provides initial medical treatment if necessary.
• Reassess patients.
• Educate the patient and family as needed.
• Inform doctors and co-nurses of the patient’s status.

Who gets prioritized in the Emergency Department?

In an emergency setting, patients are prioritized depending on the level of their medical needs. The process of sorting and determining of a patient’s treatments is called a triage. One being the highest priority, which means that the patient needs immediate medical attention and five being the lowest, which means that that particular patient can wait for care. Triage levels can be classified as follows:

1. Resuscitation

This requires immediate and life-saving medical intervention without delay. Patients with massive bleeding, have suffered from cardiac arrest, and are unconscious belong to this level.

2. Emergent

Patients on this level are at risk of deterioration. Stroke, trauma, cardiac-related chest pain patients are on this level.

3. Urgent

This includes stable patients that require undergoing laboratory tests for further investigation. High fever with a cough and abdominal pain are categorized under this level.

4. Less urgent

Patients that are stable but may require test such as x-ray falls under this level. Chief complaints about this level include a headache and chronic pain.

5. Non-urgent

Patients who fall under this level are stable and may not require any laboratory procedure. This includes prescription refills, rashes, and sore throat.

The Right Care, Right Now Program

• This program aims to filter out a call that is not an emergency and redirect them to a triage nurse.  
• It also aims to decrease over taxation on EMS system.
• This program hopes to reduce overcrowding in the emergency department.
• With the implementation of this program, the EMS will be used exclusively in real emergency situations.

All calls to 911 that are non-emergency are redirected to the “Right Care, Right Now” hotline. With 23 clinics, the telephone lines will be managed by triage nurses. The assigned triage nurses will follow a triage protocol and determines the course of action needed for the patient. Listed below are the roles of a triage nurse in emergency dispatch.

The Roles of a Triage Nurse in Right Care, Right Now Program

• A triage nurse sits beside a 911 dispatcher and will record the patient’s symptoms and assess the urgency for medical assistance.
• If the calls do not require an emergency assistance, the triage nurse will assist the caller to find suitable care.
• The triage nurse will help the caller find a doctor or health clinic closest to their area.
• The triage nurse will make the appointment on behalf of the caller.
• Also, the triage nurse can coordinate Lyft rides for non-emergency patients that require clinic transport. Medicaid beneficiaries and D.C. Healthcare Alliance are also provided with free transportation to and from the clinic. This also includes a stop at any pharmacy if needed.

Communication is by far the most vital part in a clinical setting. Triage nurses need to establish rapport with the caller to facilitate an effective gathering of data and compliance of the patient. A patient-centered approach promotes a trusting relationship and increases the patient care satisfaction. To strengthen the nurse-patient relationship in a telephone triage call, communication practices have to be followed.

Directly speak with the patient

The triage nurse should address directly the need for medical assistance of the patient. This will improve effective collection of information and promotes the patient’s compliance.

 Provide adequate time

There are no shortcuts in a telephone triage. Allowing adequate time during a call facilitates critical thinking and decision making.

Use of layman’s term

Using a plain language that is easily understood by the patient promotes proper communication. The triage nurse should provide instructions in minimum and concise sentences.

The use of open-ended questions

Open-ended questions facilitate an effective gathering of data. This encourages the patient to describe any symptoms he/she experiences. However, there is an exception to the rule. For crisis-level calls that need an immediate response, it is much better to use leading questions.

To facilitate effective decision-making, cognitive biases should be avoided. The following are common cognitive biases:

Confirmation bias

This tends to gather information in support of a certain conclusion while ignoring other facts that are relevant to support other conclusions.

 Jumping to conclusions

This terminates the need to search for other evidence that is relevant to the patient’s situation.

Selective perception

Stereotyping patient symptoms or the patient itself is not effective in decision-making.

Recency

Focusing on recent information and ignoring patient information from the past (medical history) which can be relevant to critical thinking.

Optimism biases

Giving the patient false reassurance is a no-no in a medical setting.

Source credibility bias

Risk of bias can be crucial in critical thinking and medical decision-making.

The launch of the said program took two years before it was put into action. The DC Fire and EMS Department considered this as a major success with the hope that the triage line will benefit the patients and will save the insurers and the city’s money. The triage nurse line is to be tested for the first six months and is expected to receive at least 500 medical calls per day

With the latest technology, the telephone triage line will benefit patients who will need medical assistance, urgent or non-urgent. This will create an opportunity for healthcare professionals to help people with medical needs.