by Gray Gailey

While some call them the “gatekeepers” of Island Primary Care - Orcas, the Nurse Triage Team plays a more intricate role than that for our healthcare ecosystem. Every day, they are tasked with the intake, review, and prioritization of the health care needs of 100+ patients seeing our six Clinic providers. Whether in-person, by email, Patient portal or phone, they are often the first contact a patient has when they need help, and it is their job to quickly assess a patient’s condition and priority level for treatment.

The Triage Team consists of RNs Maressa Chord, Jessica Haug, and Cheryl Holland, who are quoted in this interview, and RNs Jaime Coon and Valentina Rivera. They are a tight-knit group, who exercise mutual respect, collaborate on patient needs, and rely on their varied experiences and backgrounds.

According to Holland, at times, their job requires them to be detectives. “For instance, if a patient comes in with itchy bumps on their arm, we must determine whether it’s mosquito bites, cellulitis, or sepsis, all of which present similar symptoms. Sepsis, however, can be a life-threatening medical emergency... if not treated promptly.” Thankfully, statistics show that our triage team is prompt.

The acute medical appointment wait time on Orcas is well below the national average. According to Clinic Manager Aaimee Johnson, “The Nursing Triage Team’s knowledge and skills help our patients get the care they need so much faster than I think our community realizes. The average ER wait time in the U.S. is around an hour and a half, and walk-in clinic wait times average 45 minutes. Our nurses see walk-in acute medical patients within 5 minutes. I can’t say enough amazing things about our triage team.”

That promptness is sometimes aided by our community’s smaller size and the close relationships nurses have with their patients here. Chord highlighted how “knowing [their] patients’ voices, mannerisms, and behavior can help identify changes that could indicate potential health issues.”

The triage team also shared the unique difficulties of caring for patients in a small community. Because triage is often the first medical interaction at the Clinic, patients occasionally take their frustration out on them and want to see their doctor immediately. “We try not to overbook our providers,” Haug explained. “Walk-ins can cause scheduled patients to not be seen as quickly, and provider illness or other absences cause more delays that we must juggle.” “Negative patient interactions definitely take an emotional toll.” These interactions can result in the nurses being less interested in being out in the community, due to fear of bumping into patients they’ve had a negative interaction with. Despite those interactions, they love what they do, and realize that their jobs are more effective the more the community is informed. When asked what they would like the community to know, when to seek immediate medical attention versus calling or walking into the Clinic was top of the list. They report that many people feel hesitant to call 911 due to insurance coverage or fear of bothering emergency services. Many people also downplay their symptoms. The RNs encourage people to seek immediate medical attention through 911. Time is brain. Time is heart. When it comes to strokes and heart attacks, these words, as well as “If it’s so URGENT, it may be EMERGENT,” are always on the minds of triage teams. The Clinic works closely with EMS. If EMS declares a patient as non-emergent, they will work closely to refer you to the Clinic, sometimes the same or next day.

The triage team also mentioned some quick reminders to help those with stroke or heart attack related symptoms. The best protocol is to call 911. EMS is staffed by EMTs, who can provide certain life-saving medical interventions–such as IVs–that our Primary Clinic does not. Emergency services can also better facilitate flights to mainland hospitals. We’ve had patients with chest pain drive to us at the clinic or to the fire department. The right choice is to call 911, as driving during symptoms could cause a car accident and often EMTs are out on calls, not at the fire hall, and could possibly be closer to your home or current location. Getting treatment and intervention as soon as possible is critical during a stroke or heart attack.

The Island Primary Care - Orcas Nurse Triage Team quite literally have their fingers on the pulse of our community. As part of our Hospital District-funded rural health clinic on island, they take on much more than a typical primary care clinic nurse team. They take pride in helping our community members navigate their medical needs and helping to make the jobs of the rest of the clinic team easier, all while keeping our island as healthy as possible.