Health care’s health equity challenge is especially pronounced in rural communities. Today, rural residents are more likely to die of certain heart conditions because they lack access to common procedures like cardiac catheterization. They are also less likely to receive remote patient monitoring while receiving cancer care, an approach that can help avoid hospitalization. But behind these numbers is the impact that occurs when people need care in the moment and are unable to find it.
In Boise, Idaho, for example, one woman drove two hours through a mountain pass to stay with family before the birth of her child. The only maternity unit within 40 miles of her home had just closed, and she wanted to be close to a hospital when her contractions started.
In rural Oregon, stark disparities in access to cancer trials meant rural residents have had to travel hours to receive new therapies, undergo testing to monitor the impact, and receive medications—significantly limiting the pool of participants.
For individuals in communities like these, nurse-first triage offers a path to more equitable access to care and care advice.
The Power of Connection
At a time when many people in rural or frontier regions lack the high-broadband Internet access and, sometimes, the technology necessary to start a virtual visit, telephone-based nurse triage can help provide high-quality care advice that is tailored to an individual’s unique needs. It’s a safe, fast and less costly alternative to seeking treatment in an emergency department (ED), where clinicians are ill-equipped to meet a broad range of patients’ needs even in well-resourced urban facilities.
Just as advanced nurse triage holds strong potential to reduce ED wait times by providing nurse-directed treatment for minor injuries and illnesses, nurse-first telephonic triage eliminates barriers to care in areas where one-to-one evaluations by the right professional are hard to secure.
Each phone call is answered by a registered nurse. This removes the slowdowns in care that occur when a call is answered by an administrative assistant with the promise of connecting the patient to a nurse “soon.” Moreover, instant availability of a health care expert, 24 hours a day, using the device people use most—their phone—ensures people receive the right level of care when they need it, regardless of where they are located.
Consider an instance where an elderly parent is experiencing abdominal pain in the middle of the night. He’s in such distress that his spouse wants to call an ambulance to take him to a hospital half an hour away. With nurse-first triage, a registered nurse can evaluate the man’s symptoms and ask questions that help uncover the cause of the pain. In some instances, there might be a non-emergent cause that the family hasn’t considered. In others, such conversations might point to an underlying health condition that has not yet been diagnosed.
From there, the nurse will provide direction on next steps, including whether an emergency visit is needed and, if not, what the right level of care would be, such as an urgent care setting or physician office visit. They then facilitate the appropriate next steps. When a visit with the patient’s primary care physician is recommended, the nurse can assist with scheduling an appointment.
Such an approach not only offers assurance for patients, but also their caregivers and families. It’s a resource that conveys the information needed in minutes, despite geographical limitations for in-person care. It also gives patients and their families a clear understanding of next steps in care, offering peace of mind when their situation and their location prompt feelings of isolation and fear.
A Lifeline for Rural Communities
Nurse-first triage began making an impact years before the pandemic, but COVID-19 shined a light on the ways this access point could improve both quality of care and patient satisfaction.
In recent months, federally qualified health centers such as Unity Care NW in northwest Washington, Tuolumne Me-Wuk Indian Health Center in Sonora, Calif., Kenosha Community Health Center in Wisconsin and Clackamas Health Centers in Oregon have partnered with Conduit’s nurse-first triage service to deliver better care for underserved populations. In these communities, nurse-first triage supports federal safety-net providers in meeting the health care needs of 40,000 people. This helps avoid unnecessary ED visits and the wait times and cost associated with these visits. It gives patients who are managing complex conditions a basis for determining whether an immediate visit with a provider is needed. It also empowers care teams to focus on inpatient care—critical during a time of nurse staffing shortages and in areas where access to physicians is limited.
Employers, too, are leaning into options for nurse triage as a quality-of-care and expense-control measure. Today, one out of five employers is exploring utilization control services, including nurse advice lines that help steer employees to the right care in the right location. One large health system with 65,000 covered lives decreased ED visits from 229 visits per 1,000 associates to 176 per 1,000 associates through the use of nurse-first triage.
Ultimately, nurse-first triage is about health equity.
If we are committed to taking care of vulnerable populations, we need to give these communities the level of access to care that they deserve, however we can provide it. Nurse-first triage is a powerful tool that is proven to make a difference.
Cheryl Dalton-Norman
Cheryl Dalton-Norman, MBA, BSN, RN, is the president and co-founder of Conduit Health Partners, which connects patients to much-needed care in more than 350 locations across 48 states. She has more than 40 years of experience as a nurse.
