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Health Aff (Millwood). 2018 Dec;37(12):1997-2004. doi: 10.1377/hlthaff.2018.05079.

Tele-Triage Outcomes For Patients With Chest Pain: Comparing Physicians And Registered Nurses.

Author information

1
Dana R. Sax ( danakindermann@gmail.com ) is an emergency physician at Kaiser Permanente Oakland Medical Center, in California.
2
David R. Vinson is an emergency physician at Kaiser Permanente Sacramento Medical Center, in California.
3
Cyrus K. Yamin is an emergency physician at Kaiser Permanente Oakland Medical Center.
4
Jie Huang is a programmer/analyst in the Division of Research, Kaiser Permanente, in Oakland.
5
Troy M. Falck is regional assistant clinical director at the Appointment and Advice Call Center, Permanente Medical Group, in Oakland.
6
Reena Bhargava is an internist in the Department of Internal Medicine, Kaiser Permanente Santa Clara Medical Center, in California.
7
Debra J. Amaral is a leader of strategic innovationat the Appointment and Advice Call Center, Permanente Medical Group.
8
Mary E. Reed is a research scientist in the Division of Research, Kaiser Permanente.

Abstract

We took advantage of a change in protocol in an integrated delivery system's telephone consultation service-routing callers complaining of chest pain to physicians instead of registered nurses, whenever feasible-to explore whether tele-triage outcomes differed by staffing type. Comparing outcomes of 11,315 physician-directed calls to those of an equal number of nurse-directed calls in 2013, we found that the physician-directed calls were briefer (eight minutes versus thirteen minutes), produced fewer ED referrals (10 percent versus 16 percent), and resulted in higher patient adherence to the providers' site-of-care recommendation (86 percent versus 82 percent). Mortality rates at seven days were low for both physician- and nurse-directed calls (0.1 percent). We suspect that providers' immediate access to callers' comprehensive electronic health records and patients' rapid access to outpatient care likely contributed to the program's success. Our findings suggest that tele-triage can be used to safely and effectively manage an emergent complaint, and that physicians' expertise may bring additional efficiency to the process.

PMID:
30633669
DOI:
10.1377/hlthaff.2018.05079

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