It’s Been A Journey

Sheila Quilter Wheeler had no intention of pioneering a new nursing subspecialty.   While managing advice calls as an ED nurse, she requested guidelines for the process. The response -- she "was an ED nurse and knew what to do", Wheeler was not reassured. Her new mission: finding solutions – ultimately enhancing practice in a new clinical subspecialty.

Initially, she suggested two books, both written for the layperson by physicians (Vickery, Fries and Pantell).   Currently, in 9th and 10th editions, they contain instructions for assessing, triaging and home treatment for common adult and pediatric symptoms.

Later, as a clinical call center advice nurse, Wheeler developed and taught an in-house telephone triage class. In the early 1990’s, telephone triage was an embryonic field, fraught with uncertainty.  Many nurses were "worried about their license" -- anxious to know safer practice methods.

The training syllabus gradually evolved, into a book proposal. Wheeler and medical writer, Judith Windt completed the training manua,l including real-life case-study audiotapes. “Telephone Triage: Theory, Practice and Protocol Development" published in 1993.

Due to the ongoing scarcity of pre-existing research, Wheeler extrapolated, applied and relied upon findings from foundational clinical subspecialties.

Ms. Wheeler served as Editor-in-Chief, directing a 23-member Nurse Task Force for the first and only three volume, age-based, five-level telephone triage guidelines.. It is also the first complete nurse-driven system for nurse triage in ambulatory to ED settings.

From 1995 to 2023, Ms. Wheeler has served as an expert witness on 35 malpractice cases. In 1994, she founded the first national Telephone Triage conference for nurses Teletriage.com has served as an informational resource in a fledgling field since 1989.

It Took a Village

Over a 40+ year period, Wheeler developed a complete triage system.

Major influencers included a legal nurse consultant, an attorney and a physician-mentor. Barbara Siebelt, RN emphasized the importance of the “duty of due care” emphasizing that expert witnesses request the "paper trail" — written evidence of a system— in the form of nurse triage documentation, protocols or guidelines, clinical training, and standards — components representing a complete triage system.

Robert Smith, JD, advised that components be integrated, cautioning against having " just bits and pieces". He added that each component served as a “layer of protection” — like “an overcoat for safety”, but working together.

Jeff Clawson, MD, pioneer of 911 - Emergency Medical Dispatch —served as Ms. Wheeler’s mentor and role model early on, deeply influencing Wheeler’s work. Both Clawson and Wheeler respectively pioneered their unique, innovative fields for four decades..

Nurse Triage research

Researchers discovered that nurses used context, heuristics and pattern recognition as decision-making strategies. (Lephrohon, Patel, 1995). Researchers also theorized that medical diagnoses are unnecessary in nurse triage.

They found that heuristics -- a rapid problem-solving technique where precision is traded for speed -- achieved estimates based on understanding and responding to the urgency of the situation.

While serving as an expert witness (1995-2023) on 35+ malpractice case, Ms. Wheeler discovered patterns of recurrent error (Atul Gawande, MD), in nurse triage. She began devising a Universal Guideline and improving and integrating methods to avoid recurrent error.

CERNO - I Perceive

Innovation and leadership guided the first and only Age- Based, 5-level triage guidelines with a Users’ Guide built for fast—paced nurse triage.

2025 Recurrent practice and system error will continue to threaten patient safety.

Without substantive research and a a professional platform - a National Association encompassing all of Nurse Triage — Pre-hospital, telephone-triage, clinical call centers and virtual settings — it is difficult to make significant progress.

There is still much work to do.