One in every 3 adults who calls a nurse triage line is told to go to the ER. Find out why.
By: Charu G. Raheja, PhD
Often times, as adults, we think that we are better than children at determining if our symptoms are serious enough to require further care. As a result, many of us deny very serious symptoms. We think the severe headache is just a migraine. Or that the chest pain is not caused by a heart attack – that only happens to other people.
The truth is that it is difficult to be objective about our symptoms and we don’t always want to interrupt our day or “bother” our doctor to find out that we have a minor symptom. We also don’t always know how to recognize the warning signs of something serious or sometimes we may simply be scared to find out that we have a dangerous condition. As one of our Nurse Managers, Marci Lawing, observed, “Adults will try everything without any assistance and usually only call their doctor or nurse triage line as a last resort. Parents, on the other hand, tend to be a lot more proactive about calling right away if their children experience unusual symptoms.”
We studied treatment advice data from our nurse triage call center for the months of April, May, and June 2016. In those 3 months, our nurses triaged close to 42,000 callers. Out of these callers, about 9,200 (22%) were adult callers. Table 1 shows the disposition results for all the callers and table 2 shows the data for the adult callers.
Dispositions for the Overall Population
Table 1: Data from April to June 2016 (out of 42,000)
Dispositions for Adults (18 and up)
Table 2: Data from April to June 2016 (out of 9,200)
Surprisingly, adults had a significantly higher rate of ER referral and a much lower incidence of home care advice. Compared to the entire population, here is what we discovered about patients 18 years and above:
- Less than ¼ of adults are given home care, in comparison to closer to ½ of the overall population.
- Adults also show the highest amount of cases where the patient is sent to the ER: Close to 1/3 were told to go to the ER, as compared to only 1/6 of the overall population.
- In both groups, about 1/3 of the patients needed to follow up with a doctor’s office in the next 24 to 48 hours.
The data in this blog post seems to align with the general observation that adults tend to wait until they are decidedly sick before calling for professional medical advice. Our next goal then is to try to understand the main reasons why adults are referred to an ER.
Top Reasons why adults are referred to the ER or Urgent Care
People are sent to the ER for several different symptoms such as injuries, blood in the stool or suicide concerns, among others. However, the results on the higher incidence of adults being sent to the ER as compared to the entire population highlights the need for education about the warning signs of a serious condition. The top 5 reasons why adult callers are sent to the ER are:
- Chest Pain
- Abdominal Pain (females)
- Back Pain
- Breathing Difficulty
- Post-op Symptoms/questions
While not everyone calling with the above symptoms needs to go to the ER, when patients have contact with their primary care providers, they need to be told that these top 5 symptoms could be the sign of a serious illness and that they need to contact a medical professional for an assessment. Nurse triage is a perfect bridge to provide 24/7 access for patients to ask questions without adding a significant burden for the doctors. In addition, patients tend to be more comfortable calling a nurse because nurses are trained to provide comfort and evaluate if a symptom even requires a doctor visit. Doctors, on the other hand, tend to be seen as someone you call when you are truly sick, further discouraging patient phone calls.
If medical facilities implement proper education in the office and access to high-quality nurse triage or another form of telemedicine, patients are able to access a trained medical professional and get directed to the appropriate level of care, providing reassurance or preventing morbidity and mortality. In addition, providing a telehealth advice line when the office is closed allows the patients to stay with their providers and receive continuity of care.
In my next article, I will be considering the ER referral rates and the reasons why children under the age of 1 are sent to the ER.