Healthcare's Online Triage

The role of a triage nurse is to categorize patients in order of urgency

TRAUMA If you have ever walked into an emergency room department or urgent care facility for treatment, no doubt you have encountered delays. Research from Press Ganey Associates, a group that works with healthcare organizations to improve clinical outcomes, found that in 2009, patients admitted to hospitals waited an average of six hours in emergency rooms. Nearly 400,000 patients waited 24 hours or more. [1] Ambulance arrivals take precedent over walk-ins and bypass the triage nurse. So if your condition requires immediate attention, phone 911 (or the emergency number in your area).

A triage nurse checks vitals and assesses a priority to waiting patients. Those with life-threatening conditions are escalated. Categorizing is necessary to maximize the resources of available medical staff, examining rooms and equipment. Occasionally what a nurse perceives as non-urgent can be more serious, [1] perhaps because because of inacurate descriptions.

Moving to The Head of The Line

A growing number of hospital emergency room departments are taking phone reservations for a fee (with dubious implications). [2] Some healthcare providers, like Kaiser Permanente, allow patients to email physicians. Response time is variable, taking anywhere from 4 to 24 hours or more — about the same as a wait in a typical ER. This may provide a useful avenue for questions about non-urgent symptoms. Other health plans include access to a nurse 24 hours a day for immediate consultation and advise.

Whether communicating over the phone or via email, it is important to provide sufficient pertinent information so the medical professional can make an informed assessment. Most patients limit responses to something like, "My head hurts," "I have a rash" or "I need strong pain medication." When seeking advise via email, a clear digital photograph allows the physician to see what you see when there is question about a visible skin manifestation.

Many patients are looking to the Internet for immediate answers. For some, an online triage report can provide a useful summary that is suitable for emailing to a personal physician. From this information, a doctor can determine if an office visit or trip to the ER is warranted. In some cases, a prescription may be made available.

Receive An Online Triage Evaluation

At freeMD.com patients are "evaluated" by a virtual doctor. The site comes with a disclaimer: Dr. Schueler has been an emergency physician, teacher, and author for over twenty five years. Although he designed freeMD to feel like a real physician visit, it is a computer program and not a live doctor. FreeMD is provided for educational purposes only and should not be used as a substitute for an evaluation and treatment by a physician. [3]

After typing in or selecting a primary symptom, the virtual Dr. Schueler interviews you with multiple-choice (generally yes/no) questions. The "examination" concludes with a recommendation and summary of positive and negative findings using appropriate medical terminology. Text can be copied and pasted into an email. There are obvious drawbacks to this procedure. No one actually sees you or listens through a stethoscope. Some questions require taking an accurate temperature or blood pressure. Additionally, the exam is generally limited to a symptom presented at one location. Multiple reports may be required, for example, if pain is present in the shoulder and knees.

Likely, online services like freeMD or WebMD Symptom Checker (also available on iTunes Store) will alert patients to schedule an office visit or go to the ER. Patients may discuss with their doctor whether online triage summaries provide helpful email correspondence. Most will likely prefer their own examination.

Tags: clinic, diagnosis, self-help, symptom checker, waiting room

References
  1. Don't die waiting in the ER. CNN.com, January 13, 2011
  2. Hospitals take online reservations for ER appointments. www.fiercehealthcare.com, January 31, 2011
  3. freeMD.com