Practice Improvement|Articles in Press

Reducing Nonemergent Visits to the Emergency Department in a Veterans Affairs Multistate System

Published:March 26, 2023DOI:


      Study Objective

      The purpose of this quality improvement study was to reduce nonemergent visits to the emergency department attendance within a multistate Veterans Health Affairs network.


      Telephone triage protocols were developed and implemented for registered nurse staff to triage selected calls to a same-day telephonic or video virtual visit with a provider (physician or nurse practitioner). Calls, registered nurse triage dispositions, and provider visit dispositions were tracked for 3 months.


      There were 1606 calls referred by registered nurses for provider visits. Of these, 192 were initially triaged as emergency department dispositions. Of these, 57.3% of calls that would have been referred to the emergency department were resolved via the virtual visit. Thirty-eight percent fewer calls were referred to the emergency department following licensed independent provider visit compared to the registered nurse triage.


      Telephone triage services augmented by virtual provider visits may reduce emergency department disposition rates, resulting in fewer nonemergent patient presentations to the emergency department and reducing unnecessary emergency department overcrowding. Reducing nonemergent attendance to emergency departments can improve outcomes for patients with emergent dispositions.

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      Bonnie Sommers-Olson is Veterans Affairs Section Chief, Yale University School of Nursing, New Haven, CT.


      Jacqueline Christianson is a Nurse Practitioner, United States Department of Veterans Affairs, Madison, WI; and PhD Candidate, Marquette University College of Nursing, Milwaukee, WI.


      Tonya Neumann is Emergency Room Physician, United States Department of Veterans Affairs, Madison, WI.


      Scott A. Pawlikowski is Veterans Integrated Service Network 12 Acting Chief Medical Officer, United States Department of Veterans Affairs, Chicago, IL.


      Storm L. Morgan is MSN, Associate Director Ambulatory Care, Virtual Care, and Clinical Contact Centers, United States Department of Veterans Affairs, Washington, DC.


      Maria C. Bouchard is Director, Veterans Affairs Health Connect/Clinical Contact Center Modernization, Veterans Health Administration Office of Integrated Veteran Care, United States Department of Veterans Affairs, Washington, DC.


      Kristi S. Esch is a Deputy Associate Director, Patient Care Services, United States Department of Veterans Affairs, Madison, WI.


      Laura K. Andrews is an Associate Professor, Yale University School of Nursing, New Haven, CT.