Care in one call: Spotlighting primary care triage nurses

Imagine you have flu-like symptoms that include a fever that has not improved in multiple days. You wonder if you need to seek professional medical care: “Maybe I can get an appointment at my doctor’s office, but what if it’s just a virus that will go away on its own? But then what if it doesn’t and I get sicker?”

Ultimately, you call your primary care office and are connected to a triage nurse who uses their clinical judgement to recommend next steps in your care. Your fever is not serious enough to warrant a visit to the emergency room, so you are prescribed medication and at-home remedies to treat your illness, with the suggestion to schedule an appointment with your doctor if your condition worsens. Thanks to the triage nurse, you now feel relief with the knowledge and treatment needed to get healthy again.

Since the implementation of a nurse triage program across the Philadelphia region, this scenario has become a reality for patients of most Penn Medicine Medical Group (PMMG) practices, which include 323 primary care providers at 50 clinical locations across Penn Medicine. When patients reach out to their doctor’s office for care, receiving quick and efficient answers to their health-related questions is paramount.

The goal of the nurse triage team is to provide “care in one call.” A triage nurse determines if the patient needs to be seen immediately at the Emergency Department, should schedule an appointment in the primary care office, or if their concerns can be managed over the phone.

The team receives a wide range of calls every day, according to Holly Good, LPN, a practice nurse from Delancey Internal Medicine in Philadelphia. “We get calls about urinary tract infections, COVID-19, anxiety, or even more urgent calls such as if someone is having chest pains or shortness of breath,” she said. “We give the patients advice, schedule an appointment for them, or if needed, tell them to seek immediate care. We also are sometimes just someone to listen, and this can really help.”

The right type of care, at the right time

The nurse triage team not only provides the patient with expedited care, but also helps providers. The schedulers, triage nurses, and physicians collaborate to provide the right type of care, at the right time, for each individual patient. Because some patients can be helped over the phone with nurse triage, providers have more availability and flexibility to see those patients who do need to see them in-person.

“First thing in the morning, the provider schedules are reviewed to have a sense of how much availability there is for same day sick (SDS) appointments,” said Abhilasha Kumar (Abha), BSN, RN, who is also a triage nurse at Delancey Internal Medicine. “Knowing the provider’s availability ensures we don’t overload their schedules with patients and allows our team to step in if patients’ concerns can be managed over the phone.”

Throughout the day, triage nurses balance incoming patient calls and outgoing follow-ups while also providing education, which patients appreciate. “We receive plenty of gratitude from patients when we are able to help them, at times, in their most vulnerable condition,” said Kumar.

Helping patients while fulfilling career goals

Both Good and Kumar have found the triage nurse role satisfying as they are able to positively impact patient care and patient experience. And at the same time, they have been able to explore their career interests.

Before becoming triage nurses, Good and Kumar held different hospital nursing roles within Penn Medicine and other health systems, but they both were looking for a change of pace in their careers. After serving in the triage nurse role at Delancey Internal Medicine, Good’s role has since grown as she is now a practice nurse at the same location. Kumar has been part of the triage nurse team for 18 months after working as a bedside nurse in pediatric oncology and GI/endocrine.

“I learned pretty quickly that ... I was very interested in working in a health care setting that is more focused on preventative care and patient education,” said Kumar. “Being a triage nurse in family medicine allows me to do this.”

The role also comes with variety and the opportunity to use the full breadth of knowledge and skills. “Being a triage nurse, every day is different. You never know what to expect and it keeps you on your toes and can challenge you,” Good said.

Both Good and Kumar believe that triage nurses play a pivotal role in the primary care setting. “We help improve access to health care for our patients by bringing them in as needed for urgent visits or by providing them with important education and advice when applicable,” Kumar said.

Creating a positive impact now—and in the future

Karen Lyons, director of Ambulatory Operations for the Philadelphia region, said that the triage nurses enjoy having relationships with providers and patients. “Patients like knowing they can consult with a licensed clinical nurse to review their concerns and receive personalized care from their primary care practice.”

In addition, Patient Service Associates and Access Center Agents (office staff who schedule and provide appointment check-ins for patients) appreciate having a clinical resource to oversee medical concerns immediately.

The triage nurse program is currently available to Penn Medicine primary care patients at Philadelphia and Main Line locations, as well as in PPMG’s locations in New Jersey and Bucks County. The program continues to grow with the recent implementation of the triage nurse team within the Chester County region, with plans for future expansions in 2024.