Key Success Factors in Centralized Nurse Triage: A Profile of UNC Health’s Nurse Connect
A growing area in patient access is centralized nurse triage. Using a patient “Pre-Call Intent” metric to strategically breakdown and measure patient access opportunities, Laurie O’Bryan, Director of Outpatient Access Center Nurse Connect at UNC Health, examined the value of the metric outcomes in improving the right level of care for patients at the right time.
At the 2023 Virtual Call Center Conference, O’Bryan relayed to the Patient Access Collaborative that what began as a nurse triage to support a single campus health system in North Carolina over 20 years ago has now grown to serve a large, state-wide geographic network of hospitals and health systems. O’Bryan discussed the immense growth in the last few years and the opportunity this development has provided their nursing team, which is centralized and supports an expansive footprint of patients throughout North Carolina. The Nurse Connect team aims to better serve the well-being and access of patients across North Carolina, as well as focusing on diversity and health equity.
When a patient calls Nurse Connect, the patient is asked what they would have done if they had not called Nurse Connect. The pre-call intent is bucketed into the following care sites: (a.) emergency department, (b.) urgent care, (c.) made a primary or specialty care appointment, (d.) sent a UNC Chart (patient portal) message, or (e.) waited at home and monitored symptoms. The pre-call intent is then compared with the recommended RN clinical disposition using decision support software. When the RN disposition is a lower level of care, it demonstrates cost-saving and resource allocation opportunities. Conversely, an RN disposition that is a higher level promotes better patient outcomes and reduces care delays.
O’Bryan suggested that the “Pre-Call Intent” metric used to measure access supplements the already available patient access information. However, the value of the metric could be used to provide additional information about what drives patient access decisions. O’Bryan revealed that gathering the intent helped to evaluate and answer questions surrounding the drivers of patient access decisions. O’Bryan and her nursing team used the information to understand more about “what” kind of access is needed, “where” and “when” access is pertinent to the patient's care, and to further evaluate “how” to provide the access and, last, “why” make the access available.
This “Pre-Call Intent” metric was used to evaluate the value the nursing team provides in optimizing patient outcomes and reducing unnecessary emergency department and urgent care usage. 3,000 patients were queried, and their responses were measured surrounding: “What would you have done if you had not called Nurse Connect?” Here, O’Bryan examined the significant role the nursing team played in advising “higher” or “lower” levels of care when the patients contacted the Nurse Connect line. The results showed favorably that the RN tele–triage navigated patients using clinical decision-making and supportive clinical algorithms to the “right level of care at the right time.”
While a patient can communicate what level of access care they may need, it is the expertise of the nurse to suggest what level of care is best and in the optimal timeframe. The UNC Health Nurse Connect metric provided valuable information, which included the “RN advised a higher level of care than the patient intended 20% of the time and advised a lower level of care 22% of the time.” Overall, patient outcomes improved by sending them to the right place at the right time, and this process motivated better health outcomes. The RN tele-triage saw benefits ranging from risk mitigation to cost reduction while advancing opportunities to improve resource allocation.
Exploration of the direct implications of the work with impacted stakeholders in Emergency Departments, Urgent Cares, clinics, and virtual care is ongoing. It is believed that the “Pre-Call Intent” provides valuable insight into patient behavior and assumptions around nurse triage and virtual care and will serve as important guideposts in the build of digital front door scheduling tools (i.e., ongoing scheduling, live chats, automated texting, and My Chart messages).