Abstract
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.
Methods
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.
Results
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.
Conclusion
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.
Key words
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Biography
Bonnie Sommers-Olson is Veterans Affairs Section Chief, Yale University School of Nursing, New Haven, CT.
Biography
Jacqueline Christianson is a Nurse Practitioner, United States Department of Veterans Affairs, Madison, WI; and PhD Candidate, Marquette University College of Nursing, Milwaukee, WI.
Biography
Tonya Neumann is Emergency Room Physician, United States Department of Veterans Affairs, Madison, WI.
Biography
Scott A. Pawlikowski is Veterans Integrated Service Network 12 Acting Chief Medical Officer, United States Department of Veterans Affairs, Chicago, IL.
Biography
Storm L. Morgan is MSN, Associate Director Ambulatory Care, Virtual Care, and Clinical Contact Centers, United States Department of Veterans Affairs, Washington, DC.
Biography
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.
Biography
Kristi S. Esch is a Deputy Associate Director, Patient Care Services, United States Department of Veterans Affairs, Madison, WI.
Biography
Laura K. Andrews is an Associate Professor, Yale University School of Nursing, New Haven, CT.
Article info
Publication history
Published online: March 26, 2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of Emergency Nurses Association.
