Patient Symptoms and Outcomes


Nurse triage is a perfect bridge to provide 24/7 access for patients to ask questions without adding a significant burden for the doctors.

By Charu G. Raheja, PhD

Often times, as adults, we think we are better than children in determining if our symptoms are serious enough to require further care. As a result, many of us deny very serious symptoms. We think the severe headache is just a migraine. Or that the chest pain is not caused by a heart attack – that only happens to other people. However, we tend to be more cautious when it comes to our children. We often ask for advice when our children have a cut, suffer a fever, or are crying inconsolably.

The truth is that it is more difficult to be objective about our own symptoms than the symptoms of our loved ones. We don’t always want to interrupt our day to find out we have a minor problem, but we do tend to worry when it comes to family members, especially our children.

As nurse manager Marci Lawing observed, “Adults will try everything without any assistance and usually only call their doctor or nurse triage line as a last resort. Parents, on the other hand, tend to be a lot more proactive about calling right away if their children experience unusual symptoms.”

We studied treatment advice data from our nurse triage call center for the months of April, May, and June 2016 and compared the triage advice given to adult callers and the advice given to patients ages one and under. In those three months, nurses triaged close to 42,000 callers. About 9,200 were adult callers, and 9,400 were babies under the age of one. Surprisingly, adults had a significantly higher rate of ER referral and a much lower incidence of home care advice.

Compared to the entire population, here is what we discovered about patients 18 years and above:

  • Less than one-fourth of adults are given home care, in comparison to about one-half for the overall population.
  • Adults have a high ER referral rate: one in every three adults is sent to the ER, compared to one in six for the overall population.
  • In both the adult and child groups, about one in three needed to follow up with a doctor’s office within twenty-four to forty-eight hours.
  • We also observed that by following the protocols, nurses most often sent adults to the ER for pain symptoms, particularly chest, abdominal, and back pain.
  • Breathing difficulty and post operation complications were also one of the top five reasons why adult patients were sent to the ER.

Next, we compared the disposition of adult callers to that of babies ages one and under. We initially predicted that babies would have the highest incident of ER or urgent care dispositions, with newborn having the highest rate of ER referral. Because of the different nature of care advice for newborns, we separate newborns between up to sixteen weeks and babies between seventeen weeks and one year.

The results of this comparison are surprising. Contrary to what we predicted, we found babies are sent to the ER at a much lower rate than adults. The results are:

  • More than half of the babies were given home care advice. This is more than double the percentage of adults given home care advice.
  • Babies have a relatively low ER referral rate: only one in nine babies are sent to the ER.
  • Newborns have a higher incidence of being sent to the ER than babies, but this rate is still much less than adults. Roughly two in every eleven babies are sent to the ER, compared to almost one in three adults.
  • Finally, as one would expect, the reasons babies are sent to the ER are very different from adults. The top five protocols used by nurses when they determined the baby needed to go to the ER or urgent care were cough, vomiting (with or without diarrhea), wheezing (non-asthma), and head injury.

This surprising result on the higher proportion of adult callers being told to go to the ER also brings into question whether the age of the caller makes a difference in ER referral rates. Are older adults more likely to be told to go to the ER than younger adults? I divide the adult data in three groups: eighteen to forty year old, forty-one to sixty-five, and over sixty-five years of age.

Again, the results are surprising. Most people would expect that the older adults to be the most likely to be sent to the ER. The oldest adult groups were in fact the least likely to be told to go to the ER at only 29 percent.

The data in this article aligns with the general observation that adults tend to wait until they are decidedly sick before calling for professional medical advice. Parents, on the other hand, seem to be much more proactive about calling as soon as unusual symptoms surface, allowing nurses to give home care advice or send babies to the doctor before the symptom becomes a serious condition.

Of course, it is possible that the adult population is overall more sick than the baby population since the data does not allow us to measure the overall health of the caller prior to the symptom that led them to call the nurse.

This study also presents the top five protocols used on each group when the nurse determined an ER visit was needed. While not everyone calling with the above symptoms needs to go to the ER, patients need to be told by their primary care providers that these top five symptoms could be the sign of a serious illness and they might need to contact a medical professional for assessment.

Nurse triage is a perfect bridge to provide 24/7 access for patients to ask questions without adding a significant burden for the doctors. In addition, patients tend to be more comfortable calling a nurse because nurses are trained to provide comfort and evaluate if a symptom even requires a doctor visit. Doctors, on the other hand, tend to be seen as someone to contact only when you are truly sick, discouraging patients from calling.

If medical facilities implement proper education in the office and access to high quality nurse triage or another form of telemedicine, patients are able to access a trained medical professional and be directed to the appropriate level of care, providing reassurance or preventing morbidity and mortality. In addition, providing a telehealth advice line when the office is closed allows patients to stay with their providers and receive continuity of care.


Charu G. Raheja, PhD is the chair and CEO of the TriageLogic Group, founded in 2005. TriageLogic is a URAC accredited, physician-led provider of high quality telehealth services, nurse triage, triage education, and software for telephone medicine. Their comprehensive triage solution includes integrated mobile access and two-way video capability. For more information visit