TRIAGE
Why Nurses Should Come First in Triage
Tips for improving hospice & home health operations with nurse-first triage
By Daniel Reese
Editor’s note: This is the first of a three-part series; parts two and three will be published online at homecaremag.com.
When people think about the end of their lives, the answer is increasingly clear: they want to be at home, surrounded by the people they love. While being in their comfortable and familiar environment can bring an immense amount of peace to someone in their last days and months, the right processes and programs must be in place to provide that kind of support.
Think about a caregiver calling at 2 a.m. because they’re unsure if what they’re seeing is normal or something more serious. At that moment, they’re not just looking for an answer; they’re looking for reassurance, clarity, and guidance.
Now consider the broader system those moments depend on:
- High burnout: There’s a 25% turnover rate amongst hospice nurses.
- Aging population: By 2030, approximately one in five Americans will be over 65.
- Hard-to-reach patient population: Nearly one in four Americans live in rural areas of the U.S.
- Growing workforce shortage: By 2030, the already significant shortfall of registered nurses needed to meet rising demand is estimated to increase by another 5%
Put all of this together, and you understand the significant strain on the system. One of the most important and often under-optimized parts of making this system work for patients, their loved ones and the clinical team is nurse-based triage.
What this looks like can vary depending on the organization. For larger systems, triage can help with centralization, standardization and the reduction of overhead across multiple locations. For smaller organizations, it’s about something more immediate: ensuring there’s enough coverage to support patients and caregivers without overburdening a limited clinical team.
The way triage is integrated into those organizations’ processes can positively or negatively impact both the patient/caregiver experience and the bottom line.
In this series, I’ll look at triage through three lenses: how it can improve operations, how it shapes the caregiver experience after hours and where it’s headed as more care moves into the home. This first article focuses on the operational role nurse-first triage plays in making home and hospice care more scalable, consistent, and sustainable.
Nurse-First Triage Can Help Scale High-Quality Care
I’ve spent enough time in home health and hospice to know that people don’t end up in this work by accident. Delivering high-quality, compassionate care is always the goal, but doing that consistently and at scale requires more than good intentions. The right systems must be in place behind the scenes.
One of the most important among them is how organizations handle incoming calls from patients and caregivers. In many organizations today, that process is fragmented. Calls may be routed through answering services, passed between team members or delayed before reaching a clinician. Each step adds time, uncertainty, and, in some cases, risk.
A nurse-first triage model changes that dynamic. It ensures that when a patient or caregiver calls, they are connected directly and quickly to a nurse, without unnecessary handoffs or delays. That shift has meaningful implications for both patients and operations.
For smaller organizations, it can reduce the burden on a limited number of on-call nurses, helping prevent burnout and ensuring more consistent coverage. For larger organizations, it creates an opportunity to centralize and standardize triage, improving efficiency across locations while reducing redundant staffing and overhead.
In both cases, it allows clinical staff to focus on the work they are trained to do while ensuring that every patient and caregiver concern is addressed in a timely manner.
In a system that is already under strain, that kind of clarity and consistency matters.
The way triage is integrated into organizations’ processes can positively or negatively impact both the patient/caregiver experience and the bottom line.
Data Tracking Can Unlock the Right Systems & Processes
You can’t fix what you can’t see. And when it comes to triage, the data can tell a more nuanced story than many organizations realize.
In hospice, the nature of care means not every call can (or should) be resolved remotely. About 40% of after-hours calls require escalation to a nurse in the field. But within the subset of calls that a triage nurse can address, the majority can be resolved on the first call.
In home health, the picture looks different. With different patient acuity and regulatory parameters, remote triage can resolve nearly all after-hours calls, reducing unnecessary visits without negatively impacting outcomes.
Understanding the story behind the data on calls for either service helps improve communication and collaboration across teams and organizations. Over time, patterns emerge that inform structural and organizational processes that can improve patient and business outcomes. For example, a high volume of medication refill calls may point to gaps in daytime visits or discharge planning. Repeated non-urgent calls from the same patient may signal a need for reassurance, education, or a deeper clinical check-in. Every after-hours call represents a moment of need. Being able to connect a patient or caregiver with a nurse quickly can provide reassurance, de-escalate concerns, and ensure that field clinicians are only called in when truly needed.
Those call volume trends—e.g., time of day, drivers, specific patient populations—can highlight opportunities to improve care. In that way, triage data doesn’t just help manage calls but also provides a window into how care is delivered across the organization.
In Hospice & Homecare, How We Show Up Matters
Home and hospice care is deeply important—and deeply human—work. Patients and their loved ones look to those of us who work in this field to help them through some of the hardest moments of their lives. That’s why we need to not only show up with compassion, but in a way that reduces the stress and burden of these days, weeks and months. Having the right triage processes and systems in place not only helps lighten the weight of caregiving, but allows organizations to provide care more efficiently and effectively and scale the high-quality care they provide to more patients and their families.
When executed properly, nurse-first triage can become a core operational function that protects clinical capacity, improves patient experience and strengthens the entire care model.
In the next article, I’ll take a closer look at the after-hours caregiver experience and why it’s one of the most critical parts of getting triage right.
Daniel Reese is CEO at IntellaTriage, where he oversees all operations and strategic direction. He has spent his entire career in operations and loves the tangible results achieved every day. In previous roles, Reese worked in an investment firm managing a fast-growing consumer-facing platform. He has also overseen new market development for his family business and served in the U.S. Navy as a submarine officer. Daniel received his bachelor’s degree from the United States Naval Academy and his MBA from Harvard Business School. Visit intellatriage.com.
Photos courtesy of Drazen
