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Telephone Triage: A Future Calling?

Written in 1987 by Sheila Wheeler  Telephone triage is the process of evaluating, advising, educating and making safe disposition of client health problems by phone. It is a specialized field, still in its infancy. Generally, it includes screening of medical, emotional and informational problems. Telephone triage is often practiced in areas outside of the hospital setting; it may also be used as a marketing tool.   Organizations such as Ask-A-Nurse, Physician Referral Systems, and 911 have alot in common — helping patients via phone.  Clinicians are becoming increasingly involved with telephone crisis intervention, computer literacy, marketing, “product lines,” medical librarian skills, and telemedicine — the future of telephone triage.

The Trends

Healthcare consumers are becoming more knowledgeable, assertive, involved and sophisticated. There is a shift to home healthcare, as patients go home “quicker but sicker.” Along with a veritable explosion in healthcare information during the last 10 years, the healthcare market has become extremely competitive, as HMO’s and hospitals compete for clients and revenue.

All of this activity has produced a need for quick, accessible, comprehensive medical advice and healthcare information. Some hospitals have now taken telephone triage one step further, creating what is called a “product line.” This is a service which can be used to market the hospital’s own programs. A product line can also be sold or leased to other hospitals. In all cases, telephone triage is the ideal vehicle for meeting diverse needs of client and provider.

Who Uses Telephone Triage?

The most obvious example of  telephone triage is found within the HMO setting – such as 15-year- old advice lines at Kaiser Permanente and the consulting nurses of the Puget Sound Group Health Cooperative, Seattle.

Hospitals are leasing programs such as Ask-A-Nurse, MED-INFO, and Nurseline for as much as $35,000 down and $250 a month. Ask-A-Nurse includes a computer system for protocols, and a “generic” advertising campaign by the advertising agency, Doyle, Dane, and Burnbach. These “Cadillac” programs serve as advice lines as well as referral systems for physicians, hospital programs and services, and community resources such as self help or support groups. Ask-A- Nurse is a telephone triage system within a larger marketing program aimed at enhancing the hospital’s stature in the community, while marketing hospital services and medical staff.

Most informal telephone triage is practiced in emergency departments. Physician’s offices, home health, hospice, public health agencies, and by independent nurse practitioners. Often, these calls are handled by untrained non-professionals, without benefit of protocols, standards, training, or quality assurance Such examples of informal telephone triage present medical- legal dilemmas and thus become an area of high risk management.

Implications for Clinicians

Novices Clinicians seeking entry- level positions should acquire a broad medical/surgical background. Pediatric and OB-GYN experience is also very desirable. Critical care or emergency department experience bolstered by formal training can prepare nurses for the often stressful, high volume work one often encounters in telephone triage. Finally, nurses must already possess or develop a calm, reassuring, patient and mature manner. Public relations is a large component of this work.

Current Telephone Triage Practitioners: Nurses currently working in high volume, wide spectrum (callers presenting with many different types of symptoms) call areas such as emergency departments or advice centers, will need to constantly upgrade their skills and knowledge. Such skill refinement can be accomplished through formal training, including specialty review, refreshers and updates (i.e., pharmacology, and AIDS), and protocol revision training. All nurses will also need to brush up on “medical librarian skills,” for they will act as advocates and referral agents to the latest and best medical information.

Emergency Departments: Emergency department managers will be forced to raise standards and formalize their call screening system as legal liabilities increase. Nurses will need to develop skills in telephone crisis intervention, CPR, and Heimlich coaching, just as 911 medical dispatchers are currently doing. These nurses will need to develop better systems to interface with 911 as telephone systems become more complex and high tech.

Marketing: Nurses working in systems such as Ask-A-Nurse. which are heavily marketing-oriented, will need training in “telemarketing” skills. Nurse marketers within hospitals may want to develop their own “mini- programs” or “product lines,” to promote their hospital, as well as to market to other hospitals. Some examples of such programs are hospital- sponsored hotlines for new parents, and advice hotlines for the elderly.

Computers: All nurses working on computerized systems will need to be come “computer literate,” or at the very least, possess basic typing skills. As all systems become more sophisticated, nurses with computer back grounds may be instrumental in the design and development of a form of “computer-assisted diagnostics” — a field even younger than telephone tri age. Thus, some protocols may be come “interactive.”

Management Consultants: Nurses with many years of experience in management will be designing and developing training and quality assurance programs in addition to “product lines” for in-house systems. They will be training nurses, physician’s assistants and possibly medical assistants to work in telephone triage.

What Lies Ahead?

Biotelemetry, the monitoring of vital signs through the use of the telephone, may soon fuse with telephone triage to create a new form of “telehealth”, allowing visual as well as verbal communication with patients in distant locations. Sophisticated phone computer systems will make all this possible. In summary, here’s a prediction for the 1990s: telephone triage and management will be a major vehicle for delivering healthcare services. Is there a role in telephone triage in the future for you?

Written by Sheila Wheeler (15 Posts)

SHEILA WHEELER, RN, MS, is acknowledged as an international expert in the field of telephone triage. She has practiced nursing for over 30 years, primarily in critical care, emergency department and clinic settings. An accomplished writer, educator, researcher and consultant, Ms. Wheeler is currently President of TeleTriage Systems in San Anselmo, California.