By Justin Miller

Nurses have always been primarily responsible for triaging patients that present at the ER. These trained professionals perform cursory exams, determine the acuity level of patients, and prioritize care based on need, ensuring sicker patients are treated first. However, in recent years, the concept of performing the act of nurse-based triage prior to an ER visit has started to gain traction.

The primary goal of performing nurse-based triage as part of the dispatch call process is to ensure more effective ER utilization. A UnitedHealthGroup report showed that two-thirds of annual hospital ER visits by privately insured patients—18 million out of 27 million—are avoidable. In other words, these visits are not actual emergencies and can be effectively treated via a primary care visit. Examples of non-emergency conditions frequently treated at ERs include bronchitis, cough, dizziness, headache, nausea, and low back pain.
Overutilization of the ER contributes to higher care costs and places unnecessary stress on ER staff. Needless ER wait times can also place patients at risk or lead to a poor patient experience. Ensuring the ER is reserved only for those truly in need of emergency treatment can help reduce provider burnout and improve patient outcomes.

Nurse navigator programs can play an integral role in this process.

Global medical response offers nurse navigator proof of concept
Global Medical Response, Inc., a global emergency medical transportation company based in Colorado, is testing the nurse navigator concept as part of its emergency dispatch center in Lewisville, Texas. The program helps triage patients who have called 911 by first ascertaining if they truly need an emergency visit or can be more efficiently treated at an urgent care center, primary care office, or via telehealth. If the dispatcher believes the caller does not require an ambulance, they connect them to a nurse navigator. This nurse performs a clinical assessment over the telephone, seeking to understand the patient's condition and needs before an ambulance is ever dispatched.

According to the nurse navigators participating in the program, most calls forwarded to them by dispatchers don’t require an ambulance and are better candidates for other forms of care. For example, patients in need of a medical service such as an x-ray sometimes dial 911 for an ambulance simply because they have no other means of transportation to a hospital or urgent care center. In these instances, the nurse can coordinate a taxi or rideshare (e.g., Uber, Lyft) to transport the patient to the most effective point of care, eliminating the unnecessary ambulance expense.

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