In July 2009, leaders at Midland Memorial Hospital, a 223-bed hospital in Midland, Texas, established a 24-hour hotline for community members to call when considering an ED visit. At least one dedicated triage nurse manages the hotline at all times, and two additional nurses provide coverage during the peak interval between 11 a.m. and 5 p.m.
After listening to a caller’s concerns, the nurse provides guidance on whether or not an ED visit is warranted. If an ED visit is necessary, the triage nurse can page the patient’s physician or call 911 to dispatch an ambulance.
If an ED visit is not necessary, the nurse can arrange an appointment at a nearby urgent care center, federally qualified health center, or physician’s office. A unit coordinator follows up with all patients within 24 hours to ensure they have attended or plan to attend their scheduled appointments.
Importantly, the hotline’s dedicated triage nurse does not use clinical judgment alone to make each assessment. An evidence-based algorithmic system prompts the nurse with questions specific to the caller’s symptoms and provides guidelines that help inform the nurse’s decision.
Widely advertise hotline to community members
To ensure community members are aware of the hotline, leaders at Midland promote the resource through multiple channels, including newspaper articles, radio interviews and advertisements, television commercials, refrigerator magnets, and flyers.
For institutions interested in replicating Midland’s practice, the precise wording of the community hotline flyer is included below:
Inappropriate demand, bad debt decline
Since implementing the triage hotline, Midland has observed not only an overall decline in ED demand but, more significantly, a reduction in inappropriate demand. Of the more than 50,000 hotline calls since 2009, nearly two-thirds were triaged to lower-level care settings.
Leaders at Midland credit the hotline with helping to achieve a $5.5 million reduction in bad debt from non-emergent ED patients. Routing patients to a lower level of care also reduced costs to patients by 40%, or about $122 per call.
Twelve nurses in total staff the hotline, but Midland reports that—as a result of reduced ED volumes—the hospital did not need to add any FTEs to support the telephone triage position.
Nursing Executive Center members, download our study, Nursing's Role in Safeguarding Acute Care Margins, to learn more about preventing unnecessary hospital utilization. Not a member of the Nursing Executive Center? Learn more on our website.
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