Nurse-First Strategies to Improve Patient Care and Reduce Strain

By Matt Phillion

With patient volumes ever on the rise and staffing shortages not going away any time soon, emergency departments and other departments and teams face relentless challenges. Areas like nurse-first triage and transfer strategies can help alleviate some of these challenges, build better operational efficiency, and open the door for more innovation.

Cheryl Dalton-Norman, president of Conduit Health Partners, notes that much of the industry still fights against a sort of barrier in how it addresses care:

“I know even as I’m caring for my own family, whenever I’m engaging with triage models it tends to be: someone picks up the phone, someone not clinical, and they take the information and let us know a nurse will call you back,” says Dalton-Norman. “That’s not very helpful when I need help right now.”

Conduit’s model, she explains, is to cut out the wait.

“Our model is built on the idea that most of us are impatient people and we want to talk to someone who can help us in that first call,” she says. “We want to make sure folks are getting to that immediate access to care—one call and we’re done unless there’s something that requires further care for that patient.”

The nurses answering the line answer as the client, whether that is a hospital, health system, or physician practice.

“If you’re calling after hours, you get a nurse who helps immediately,” says Dalton-Norman. “Say you call in just after office hours to get your lab results—you don’t want to wait until tomorrow for the results.”

The nurse triaging the case can determine if this is something that can be helped with guidance over the phone, a call to 911 for an actual emergency, or if they should set up an appointment in person the next day.

“In being able to speak as our client, it helps foster a positive relationship built on concern and care and demonstrates that our clients care for their patients,” says Dalton-Norman.

The impact on the ED

Conduit measures the movement of each patient or case: how many were sent immediately to an emergency department, or how many needed next day appointments? How many were able to get the guidance they need over the phone and stay home?

“We really like giving our clients exhaustive actionable data,” says Dalton-Norman. “We can say, ‘This was the severity of a call that came in at 7 p.m. on a Tuesday and we can break it down by gender, age, the chief complaints the patient had, and bucket those for further analysis.’”

Those results can provide actionable steps. For example, if the client is getting a lot of post-op calls, there might be an opportunity to provide more and better education to the patient or arrange for post-op visits to happen sooner.

“Nobody wants to go to the ED at 9 p.m., not parents, not the elderly, nobody,” says Dalton-Norman. “By talking to a nurse first, we can direct them. ‘I’m going to call 911, or you really do need to go to the ED right now, or you need to take some Tylenol and ice the area, or here’s an urgent care that is close by.’”

Alleviating a burdened profession

Another thing that a nurse-first triage option or transfer center does is lift some of the burden from the bedside nurse or physician.

“They get to sleep at night or minimize the number of calls the ED would be hit with,” says Dalton-Norman.

They engage with licensed nurses across the country, something that has been able to keep many of those nursing professionals in the industry they want to be in.

“Our nurses are able to work remotely, and it gives them a really interesting way to work,” says Dalton-Norman. “We look for great, empathetic nurses.”

One of the biggest safety risks for both physicians and nurses, Dalton-Norman says, is when you’re trying to do hands-on work and someone is constantly pulling you away from that work and you suddenly need to split your focus.

“That’s a huge opportunity for risk,” she says. “When we’re able to take that administrative piece away and let the nurse at the bedside deliver the care they need to, that eliminates risk.”

Interestingly, Dalton-Norman notes, the type of nurse this job attracts is not the one they first expected.

“When we first started out, we thought we’d be a landing place for nurses at the end of their career,” she says. “But it’s such a fast pace and very IT heavy. We look for both technical skills as well as being truly empathetic. Our work requires you to be a good listener, able to walk people through very lengthy stories that requires amazing clinical knowledge and the ability to problem solve, think through situations and be technically adept. Often that technical adeptness is the hardest piece to find.”

Before triage, Conduit started as a transfer center option to help address an overburdened system.

“As a clinician, I was responsible for emergency departments in an organization, and I remember having a patient with a hot belly in a very rural facility. He needed to be operated on but it was 2 in the morning, and that was a slow transfer,” says Dalton-Norman. “Systems aren’t built to expedite the care of people. We have overworked, burned out providers, we have nurses who are emptying beds as quickly as possible, and people can’t take a breath.”

And if those same clinicians oversee managing the movement of patients, that adds a staggering burden on top of their other duties.

“There’s a tendency to say, when you’re in the moment and caregivers are overwhelmed, let me slow this down so you can take a breath, but that’s a hard decision. We believe that having a transfer center that is able to take a look at the big picture, to know which facilities have a stroke center or perform brain surgery, that helps remove that burden,” says Dalton-Norman. “We’re able to look at things from the 30,000-foot view and get you to the right level of care.”

It’s often the case where organizations think they can handle these tasks on their own internally, but the question is: Is that the most efficient call?

“You absolutely can, but should you? Because if you are struggling to staff your units, or having a hard time finding nurses, why would you use those nursing resources when you could have a remote, outside partner and use those nurses for hands-on care of your patients?” says Dalton-Norman. “We’re able to be very objective in speed, tracking, and monitoring. We know if we’re accepting cardiology patients within 30 minutes of the first phone call, for example.”

Utilizing a service for things like triage or transfers can help organizations focus on the things they are best at, Dalton-Norman says.

“Just because I’m smart and can do something doesn’t mean I have the time, expertise, or focus to do it as well as it can be done,” she says. “So what if we had a partner that was great at this and that helps us be great across the board for the patient’s benefit?”

It’s one thing to build a process into a policy, Dalton-Norman says, but what really happens at 2 a.m. on a Saturday when that call comes in or the patient needs to be transferred to a higher level of care? There’s an opportunity for advancement that can look at bed management, staffing levels, all the elements to make sure you have the right tools, the right people, the right beds, and the right care for patients.

“It’s really demonstrating they care for their entire patient population,” says Dalton-Norman. In the long run, it will ensure great care, save the patient money, save the organization money, and be a great equalizer across the board.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.