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Gayla Spears, RN, would like to come to her senses, but
as a telephone triage nurse and supervisor of a free medical
advice line at NorthEast Medical Center in Concord, N.C.,
everything comes through just one sense: hearing.
No visual assessment. No touching. No sniffing.
"I'm used to that hands-on assessment, so the
hardest part for me was getting out that role of being
right there with the patient," said Spears, a former
emergency room nurse who has led the 24-hour Ask First
call center since its inception five years ago.
Spears, 50, has a staff of seven registered nurses
and three support personnel to cover every hour of every
day. It's the evenings and nights, though, when telephone
triage has its greatest effect on the hospital, reducing
the number of costly and unnecessary emergency room
visits.
"With hospitals today working to keep people out
of the hospital, and managing [patients'] care outside
of the hospital because of insurance restrictions, they're
relying more on call centers," Spears said.
In an indication that telephone triage is on the rise,
National Credentials Corp., a nonprofit organization,
added it two years ago to its nursing specialty certifications.
Through testing that covers theory, such as legal issues
and nursing practice, it certified 544 RNs as telephone
triage specialists last year. Spears and several of
her staff were among them.
People feel as though they can get in touch with advice
nurses more easily than their physicians, Spears said,
"and, in most cases, they're more comfortable speaking
to a nurse than a doctor."
Ask First nurses bring experience from emergency, medical/surgical
and oncology units as well as an outpatient clinic.
But they never know who or what kind of problem is on
the other end of the line.
"For the most part, we try to speak with the patients
themselves," and that is the case about 98 percent
of the time, Spears said. "I try to picture the
patient by the questions I'm asking and get in my mind
what's going on and what the patient might look like."
In some cases, nurses ask callers to become their eyes.
"Say someone calls and their throat is sore. We
want to know what that throat looks like, so we're asking
them to look-to take a mirror and look" for the
white patches that might indicate strep or redness,
Spears said.
Based on the assessment, nurses then explain options
to callers, refer them to physicians, to the emergency
room or, in some hair-raising instances, to 911. "We
experience the situation where patients call hoping
we would tell them that it was not a serious thing going
on," Spears said, when they should have dialed
911 for a heart attack or stroke.
Spears recalled one case in which a caller quit responding,
leaving her nurse in the dark with no option other than
to call for an emergency rescue. "She stayed on
the line and could hear the police and the ambulance
when they got there. They had to break in. This person
was a substance abuser, but we didn't realize that at
the time, and had passed out," Spears said.
By day, when medical calls tend to thin out, Ask First
nurses move back toward the origins of the service,
which started as a way to find a physician, register
for health care classes and obtain general health information.
When nurses aren't fielding advice calls, Spears said,
they're dispensing disease management information, such
as how to handle diabetes, and following up with NorthEast's
discharged patients.
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