Reducing medical costs and helping injured employees get back to work safely through nurse triage services


On-the-job injuries present various challenges for employers and their employees. After a workplace injury, an employee’s first interaction can impact the trajectory of the claim. In other words, whoever they speak to or whatever happens first could set the tone for their experience. Nurse triage can support the claims handling process and encourage a positive claim journey for everyone involved.

After an occupational injury occurs, Careworks’ nurse triage services help determine the appropriate medical care and offer the injured employee support throughout the process. Each registered nurse is available 24/7/365 and trained to provide guidance in referring injured employees to top-tiered network or client-preferred providers, determine whether self-care is the most appropriate treatment and manage next steps.

A blended model

A unique aspect of Careworks’ triage program is the capability to offer a blended intake option that combines claim reporting and care guidance in a single call. Through connectivity with claim systems coupled with our innovative intake technology, clients can tailor criteria for routing to clinical support early in the claim’s lifecycle leading to an enhanced claims experience for the injured employee and improved outcomes.

Having one point of contact for workplace injuries helps to ensure a timely start of the claim and prompt support from a nurse. It not only helps the claim move along faster without back-and-forth phone calls, but also most importantly helps the injured employee receive the care they need sooner and simplifies the claim reporting process for employers.

Is self-care the answer?

If a nurse advises self-care as the recommended treatment as opposed to an urgent care or emergency room visit, it eases the burden on the healthcare systems and helps employers avoid unnecessary medical bills, which makes a significant difference in claim costs and outcomes. By contacting a nurse at the time of injury, employers and their employees can be assured they will receive care recommendations based upon gold-standard medical triage guidelines. Without receiving proper recommendations and treatment instructions from a medical professional, the injury’s recovery may be prolonged or even exacerbated. For instance, if the initial injury has not been addressed properly or healed and the employee is attempting to continue work without advisement of a medical professional, they could experience more pain or need further treatment and drive higher medical costs.

An empathetic approach 

Few situations are more delicate than those that have the potential to alter someone’s life. One of our nurses triaged a case in which the employee was involved in a physical altercation where non-intact skin was contaminated with blood and saliva from an assailant with a known HIV-positive diagnosis. Not only is this a potentially life-changing situation, but such exposures also still carry negative societal implications and are difficult to discuss. The natural response to HIV exposure is fear and anger.

The nurse responded to this case with professionalism, empathy, and attention to detail. She took the time to complete a thorough assessment, give comprehensive care advice, provide assurance and comfort, and coordinate immediate care and evaluation for the employee. The nurse directed the employee to an urgent care for lab draw with instructions to follow up with the clinic, claims examiner or supervisor for any additional care needed. Because of the nurse’s accurate assessment, appropriate care advice and prompt referral, the employee was confirmed HIV-negative six weeks later.

For many employees who experience workplace injuries, it is their first interaction with a Careworks colleague. Because of this, our nurses are encouraged to be empathetic, thoroughly review guidelines, and ensure the employee receives proper care as quickly as possible while still articulating all the information and answering questions about their injury. This not only soothes the injured employee in the moment, but it grants them peace of mind surrounding the process ahead.

Above all else, listening to an employee’s needs is the most important part of the nurse triage process. Reassuring injured workers that they are not alone, while guiding them properly toward next steps, relieves them of going through their injury in an unsafe manner or having to make their own decisions. Creating connection and a space of understanding within the claims process will protect and aid employees — and result in positive outcomes.

Written by:

Lauren Gafford

Director, Clinical Consultation, Careworks

July 9, 2024