The Registered Nurse Prescriber-Led Triage-Treatment-Continuity Model in Family Medicine: A Practice Innovation and Service Evaluation from Cranston Ridge Medical Clinic

Background/Objectives: Primary care clinics increasingly receive urgent and semi-urgent requests from patients who may otherwise attend emergency departments or urgent care centres when same-day physician or nurse practitioner appointments are unavailable. A meaningful proportion of emergency department visits involve conditions that could potentially be managed in primary care [1,2], and the Canadian Institute for Health Information reported that 15% of Canadian emergency department visits between April 2023 and March 2024 involved conditions that could potentially have been managed in primary care [3]. This article describes the Registered Nurse Prescriber-led Triage-Treatment-Continuity model developed at Cranston Ridge Medical Clinic in Calgary, Alberta, Canada. Methods: The manuscript is reported as a clinic-based practice innovation and service evaluation using aggregate, non-identifying operational service data. The model includes medical office assistant emergency recognition, RN prescriber-led structured triage, a traffic-light urgency classification system, a booking algorithm, clinical support tools, diagnostic test ordering and prescribing within authorized scope, and communication with the patient's primary care provider through the electronic medical record. No patient-identifiable information, patient-level chart review, interviews, surveys, biological samples, or experimental interventions were used. Under TCPS 2 Article 2.5, quality improvement and program evaluation activities conducted exclusively for assessment, management, or improvement purposes do not constitute research for that policy and do not fall within Research Ethics Board review [4]. Results: During a 12-month service evaluation period from April 2025 to April 2026, 5032 patient calls or encounters were managed through the RN prescriber-led pathway. These encounters are interpreted as internal urgent and semi-urgent primary care capacity and potential diversion, not as confirmed emergency department avoidance. Conclusions: The model reframes triage as an integrated primary care intervention rather than a passive sorting process. Further ethics-approved research is required to evaluate patient-level outcomes, safety events, comparative effectiveness, confirmed health-system utilization effects, and cost-effectiveness.