Sometimes nurse navigators realize a caller does require immediate care, but not necessarily an ambulance or an ER visit. In these scenarios, the nurse navigator can schedule an immediate consultation with a qualified physician via telehealth, helping the patient register electronically for the virtual visit. These patients can usually get connected with a physician in less than five minutes where conditions can be assessed, and necessary treatments provided.

In rare instances, nurses determine forwarded callers do require emergency care. When this determination is made, the nurses simply transfer the patient back to 911 and an ambulance is dispatched. Nurse navigators are under no pressure to use alternate methods of care in true states of emergency. Instead, the nurse navigator program provides nurses with all the tools necessary to get patients to the most appropriate care option as quickly as possible.


Nurse navigation supports value-based care, triple aim
While currently incentivized by CMS funding, the long-term vision for nurse navigator programs like the one in Lewisville is that they will be significant contributors to delivering value-based care (and maximizing contract-based reimbursement) by improving care quality and lowering costs.

Nurse navigator models are designed to address all parts of the Institute of Healthcare Improvement’s (IHI’s) Triple Aim, decreasing the total cost of care, while keeping quality and patient experience high. The following are three examples of how these programs support each part of the IHI’s strategy.

1. Lower costs
Including nurse-based triage in the dispatch process has a measurable impact on cost. Namely, this effort significantly reduces avoidable hospital transports and unnecessary hospitalizations, keeping patients out of the ER and inpatient environment—the most expensive settings to receive care. Effective nurse navigation can also help prevent hospital readmissions by providing ambulance alternatives.

2. Improve patient experience
Positive patient experiences typically don’t originate in an ER waiting room. Nurse navigators at dispatch can help guide care at the onset of a treatment journey, connecting patients with the most appropriate and effective means of care. Nurse navigators can assess the patient condition to determine if it’s truly an emergency or if the issue is related to medication or surgical side effects, a mental health issue, or something as minor as lack of transportation. The nurse navigator is then empowered to connect the patient to a physician, counseling via telehealth or arrange non-emergency medical transportation for issues that aren’t life threatening. This level of individualized care helps to create a better overall care experience for the patient.

Business Affairs Homepage