Researchers have found that the introduction of  electronic guidelines have not significantly reduced decision making errors. No evidence supports the idea that software takes the place of  training for clinical making in telephone triage.   Some CDSS (Computerized decision support systems) might not be user friendly and actually contribute to errors.

Wheeler’s training emphasizes how applying transferrable clinical skills to telephone triage — the nursing process, gathering a symptom history and patient history — enhances metacognition and risk management. Clinical training helps nurses to compensate for the effects of algorithmic software that actually functions like a computerized decision making system (CDMS), tempting less confident nurses to outsource their clinical judgement to the CDSS,  or prompting more savvy nurses to ignore the electronic software altogether.

International Feedback

Nurses practicing telephone triage in Dublin, Ireland:  “Your article — Telephone Triage: Solutions for Recurrent Errors in Ambulatory Care, Urgent Care & ED— was very useful as it addresses all the aspects of telephone triage. I work in the maternity emergency department and our small team receive over 40 calls/day. There is no designated service and this is what I am looking at.  Your articles are useful to see the pitfalls and how they might be overcome. There is very little research in relation to maternity care but much of it is transferrable. Documentation is a huge issue – we are looking at recording calls but cost might be an issue. Thanks again for sharing your research.”  Nurse at a Maternity Hospital, Dublin, Ireland

“We’ve learned that automation does not eliminate errors. Rather, it changes the nature of the errors that are made, and it makes possible new kinds of errors. The bottom line is this: Systems that integrate the best of human abilities and technology are the safest for all concerned”.  Captain Sully Sullenber

35+ years of experience in the field, as well as expert witness consulting, has led Sheila Wheeler to develop  a wide array of telephone triage Continuing Education courses.  They are unique, essential and practical, meeting both clinicians’ and managers’ needs in a timely way.  Managers:  take a course to train your staff, or use it to get new hires up to speed quickly.

Training for clinical decision making is essential to telepractice.  Even with introduction of electronic decision support guidelines, research demonstrates that clinicians still make basic errors (Wheeler, 2015, 2019). These CE courses are specifically designed to reduce recurrent errors — failures of assessment communication, continuity, informed consent and human error — all root causes of error in Medicine (Joint Commission).

Ms Wheeler designed the courses to be as evidence-based and standards-based and as “real world” as feasible,  instantly available, without additional costs of  travel, lodging and conference attendance.