Nurse telephone triage is a critical component of healthcare delivery, providing initial assessment and guidance to patients seeking medical advice. This study compares daytime nurse triage calls received by a suburban pediatric practice with those received by a hospital-based, inner-city pediatric practice, revealing key similarities and differences. Understanding these distinctions can inform training programs and resource allocation for triage services in diverse settings.
Comparing Suburban and Urban Triage Calls: Key Findings
This research involved a prospective coding of all calls received by nurse triage telephone offices in two distinct pediatric practices over six months. One practice, located in a suburban area, primarily served commercially insured patients. The other, a hospital-based practice in an inner city, largely served patients with Medicaid or no insurance.
The study found that the chief medical complaints were remarkably similar between the two practices, suggesting that children in both settings experience comparable types of illnesses and injuries. However, significant differences emerged in other aspects of the calls:
Language Barriers: Language difficulties were significantly less frequent in the suburban practice (1%) compared to the urban practice (17%). This disparity highlights the importance of multilingual staff in urban settings to ensure effective communication and accurate assessment.
Reasons for Calling: The reasons behind the calls differed notably. While medical problems related to illness or injury constituted the majority of calls in both settings (55% suburban vs. 40% urban), the urban practice received a higher proportion of calls related to social issues (9% vs. 1%), documentation requests (7% vs. 2%), and requests for laboratory work (4% vs. 0.3%). The suburban practice fielded more calls concerning well-child advice (9% vs. 5%). These variations reflect the broader socioeconomic context and healthcare access challenges faced by families in urban environments.
Call Disposition: The way calls were handled also varied. Telephone advice was provided significantly more often in the suburban practice (32%) than in the urban practice (20%). Conversely, fewer calls in the suburban practice required access to medical records (2% vs. 12%). This finding suggests that suburban patients might present with less complex medical histories or have readily available documentation.
Implications for Triage Services
The similarities in chief complaints suggest that core medical training for triage personnel can be universally applied across different practice settings. However, the significant differences in language barriers, reasons for calling, and call disposition underscore the need for tailored training and resource allocation.
Urban triage services may require higher staffing ratios to address the increased complexity and volume of calls related to social issues and documentation requests. Furthermore, ensuring staff proficiency in multiple languages and knowledge of community support services is crucial in urban settings. These findings have significant implications for optimizing triage efficiency, improving patient access to care, and addressing health disparities.
Conclusion
While children’s medical needs appear similar across suburban and urban settings, the context surrounding those needs significantly impacts nurse telephone triage. Understanding these differences is crucial for developing comprehensive training programs for triage personnel and ensuring equitable access to quality healthcare for all children. Further research exploring the underlying causes of these disparities could inform targeted interventions to address the unique challenges faced by urban families.
