Hunter nurses pioneer triage phone service

Health hotline must be local and linked to GPs, say staff

A national health hotline staffed by triage nurses will not succeed in easing pressure on hospitals unless it is locally-based with the ability to obtain after-hours medical appointments for callers.

So say staff at GP Access After Hours (GPAAH), Australia’s first local area medical hotline in the NSW Hunter region.

The federal government plans to establish a national hotline to relieve pressure on hospital emergency departments, by advising those with minor health problems to go elsewhere.

RN Sally Grahame, an operator at GPAAH says there is not much point in advising a late-night caller to see a doctor or go to a chemist if you don’t know which local clinics and pharmacies are open and cannot arrange an appointment.

‘If you are recommending the caller see a doctor in the next four hours but don’t know the local services and can’t access an after-hours GP, where else is the caller going to go other than ED?’ Sally said.

She said nurses who operate the phone lines must be highly skilled.

‘Most of us have had a lot more than 10 years service with at least five years in either ICU or ED,’ she said.

‘To deliver consistency of advice we use computerised algorithms as a clinical decision support tool. The algorithms are fairly conservative and offer another level of safety.

‘The software takes you through different levels of questioning which you can supplement with your own questions.

‘New starters get intensive training dealing with various scenarios, and there is ongoing training for all nurses.

‘We are regularly monitored and reviewed: all calls are recorded and there is random sampling to determine the appropriateness of our advice.’

Sally and her colleagues now handle about 1200 calls a week and have processed almost 120,000 calls over the past two years.

It is an arm of the Hunter Urban Division of General Practice and is available for use by more than 500,000 people in Newcastle, Lake Macquarie and the Lower Hunter Valley.

The service is jointly funded by the federal government and the local area health service which also provides support such as use of premises and services such as pathology and x-ray.

The Hunter hotline was launched in July 2003 following the success of its forerunner, the Maitland After Hours GP Service (MAGS), which operated for four years.

Manager of the telephone triage service, Simon Gould, said a recent survey of callers showed ‘overwhelming support’ for the service.

‘The public rated it as very efficient, they heeded the nurses’ advice with a high compliance rate, and generally were very happy with how they were treated on the phone and the professionalism of our nurses,’ Simon said.

He said GPs who see patients referred by nurses on the advice line are similarly pleased with the service.

‘We have done audits of the appropriateness of appointments made by our nurses, also looking at nurse triage of patients, and there is a very high approval rating from GPs.’

Simon said the hotline has resulted in a decrease of up to 40% in the number of category fours and fives presenting at EDs in the local area health service.

He puts this down to the ability of hotline nurses to arrange doctors’ appointments for callers.

‘Unless the call results in an outcome for the patient then there is the potential to generate more patients going to ED than before,’ he said.

‘Also, if you have really conservative algorithms and you don’t give the nurses any power to downgrade advice to home care or a follow up visit with a daytime GP, you’ll end up clogging the EDs with category fours and fives.

‘The software we use is a bit different to the system the government is proposing because ours allows nurses more flexibility in decision making.’

A cautionary note

Triage traps to avoid

Hotline services are a new way for nurses to operate in their profession. They have provided challenges in establishing appropriate pay and conditions that reflect the skills and experience required for these new roles.

If you apply for a job in this sector there are some things to remember:

  • find out what award and agreement you are covered by
  • read carefully any documentation given to you by your employer
  • seek advice from your union prior to signing any documents