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Telephone Triage FAQ

FAQ about Telephone Triage

How is telephone triage defined?  Telephone triage involves the safe, appropriate and timely disposition of patient symptoms via phone, by trained, experienced clinicians (licensed medical professionals).  Clinicians use problem-solving strategies such as pattern recognition, clinical assessment to formulate a “working diagnosis”. Clinicians elicit details about symptoms, and patient medical history and make timely referrals — right time, right place with right person — also known as dispositions.

By assessing unseen patients by phone, nurses and other clinicians estimate symptom urgency, rather than diagnose symptoms.  The essence of telephone triage is the ability to make safe clinical decisions under conditions of uncertainty and urgency (Lephrohon). Nurses use assessment and communication skills as well as pattern recognition, identified by experts as a decision-making skill. The over arching goal is the safe, timely, appropriate disposition (referral) of patient symptoms (Wheeler). In other words, the purpose of telephone triage is to “get the patient to the right place, at the right time, for the right reason”. TM

One expert that triage “requires professional judgment, since ruling out urgency is more difficult than identifying it”(Champagne, 1995). To rule out urgent symptoms, (or to estimate symptom urgency) requires clinical assessment — a prelude, but not synonymous to, asking questions from the guideline or protocol.  Assessment is the pro-active elicitation of information from the patient, to gather a relevant symptom history, details and context. It also requires the ability to  perform clinical prioritization and to clinically interpret patient responses to questions.  The passive solicitation of yes/no answers from a list of questions, (or placing the entire burden of providing information on patients) does not qualify as clinical assessment.

How long has telephone triage existed?  Telephone triage is as old as the telephone — and has been practiced informally for over 100 years.  Formally, nurse telephone triage has been practiced since around 1989.  Although this new field is about 35 years old, Telephone Triage is still considered an emerging clinical subspecialty.

How is telephone triage performed?  Clinicians typically use specialized electronic (or paper) protocols or guidelines to determine when, where and by whom patients will be seen (the disposition).   They also typically document calls, using an Electronic Medical Record (or paper or audiotaping). Clinicians are usually trained to perform thorough symptom assessments and to use a process to determine whether symptoms are life threatening, emergent, urgent, acute or non-acute.

What are the qualifications to perform this work?  Clinicians are qualified by medical education, training and experience to identify, estimate and rule out urgent symptoms and to provide safe, timely dispositions — “right time, right place, for the right reason”.  Clinicians may advise patients to call 911,  to go to the emergency department,  to make a same-day or future appointment and/or to carry out home treatment advice.

What is the purpose of telephone triage?  From the patient’s perspective, they typically contact the clinical call center because they are unsure how serious their symptoms are. Systems are marketed to lead patients to expect safe, timely access to clinicians who can assess their symptoms and recommend on-site care and treatment, or home treatment advice via phone.

From the institutions’ perspective, the purpose of telephone triage is to help the healthcare system operate more cost effectively:  to reduce innappropriate Emergency Department, Office and Clinic visits, by serving as an “access facilitator” for patients.

What is a Delay in Care?   A delay or denial of care occurs when  symptons worsen, and the patient is not adequately assessed and advised to seek treatment in time to prevent injuries or even death.  Problems arise when institutions use the service more as a gatekeeper than access facilitator.  Delay in care may lead to nursing or medical malpractice, and may be caused by institutions’ overly restrictive access policies.

Other polices leading to delays in care include:  clinician understaffing,  inadequate call processing times (leading to inadequate assessments), and inappropriate use of non-clinicians to pre-screen symptoms.  Some facilities appear to expect the patient to provide all needed information (or even self triage), instead of placing the responsibility and duty of eliciting and communication significant information on the clinician.

Can non-clinicians perform telephone triage?  Symptom-based calls require clinical assessment and clinical decisionmaking by medically-trained, licensed and experienced clinicians.  Non-clinicians are only qualified to take messages for clinicians.

What is a telephone triage system?  A telephone triage system is typically composed of five components:  qualified staff (clinicians), guidelines, documentation, training program and standards (policies and procedures).  When these components are inadequate (the responsibility of the employer), system error may occur.

What is a Computerized Clinical Decision Support System (CDSS)?   Computerized Decision Support Systems are expert software systems (containing protocols or guidelines for a range of symptoms) that remind experienced decision makers (like physicians and nurses) of issues to consider that s/he once knew but may have forgotten

What is a Computerized Clinical Decision Making System (CDMS)?  Computerized Decision Making Systems are expert software system (containing protocols or guidelines for a range of symptoms)  that allows an unqualified person (non-clinicians, like emergency medical dispatchers) to make a decision that is beyond his/her level of clinical training and experience.

What is the definition of Telehealth?  According to Wikipedia, Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth is an expansion of telemedicine, and unlike telemedicine (which more narrowly focuses on the curative aspect) it encompasses preventive, promotive and curative aspects.

Originally used to describe administrative or educational functions related to telemedicine, today telehealth stresses a myriad of technology solutions. Soon, telephone triage will be subsumed by telehealth.  Telemedicine is defined as “telephonic medical diagnosis of patients’ problem and their medical treatment”  (Reisman).   Telemedicine typically refers to the practice of medicine by phone by physicians.

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