Telephone triage training, consulting and expertise -- trusted by medical professionals since 1985
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Universal Guideline


Current CDSS does not appear to significantly reduce error in telephone triage (Wheeler et al, 2015).  This failure might be related to an overly deterministic approach fostered by an algorithmic design.   Download the Comparison of Algorithmic vs. Pattern Recognition Approach to Guideline Design for a detailed description of both approaches.

Telephone triage work involves the extraordinary challenge of making safe decisions under conditions of uncertainty and urgency.   Thus, electronic guidelines must both reduce human error (through built-in fail-safe measures) and support metacognition (knowing when & how to use certain strategies for solving a problem).  Download the Power Point presentation for the Universal Guideline to learn how it addresses these challenges.

Ms. Wheeler’s approach to telephone triage has used a 5-Level approach from the beginning.  Her adult and pediatric guidelines, developed in 1995, pre-dated current 5-Tier Triage Strategies developed by ESI and Manchester Triage Group.

Ms. Wheeler seeks to collaborate with software and EMR (EHR) companies to refine their existing Clinical Decision Support Systems. Please call 415 453 8382 to arrange for a demonstration of the prototype.

Built-in Standards-based Fail Safes will Reduce Root Causes of Error and Failures of:

  • Assessment (Gawande)
  • Communication/Documentation
  • Continuity
  • Informed consent
  • Human Error

Integrated System 

  1. Universal Guideline (Standard, Procedure)
  2. EMR (Paper trail, track/trend)
    1. Audiotape via:  Voice Recognition Software (Paper Trail, QA, legal
  3. Training using Electronic Flash Cards
    1. Pattern Recognition for Sepsis & 10 Key Presenting Symptoms in ED setting (CDC)
  4. Standards (Procedure/Policies)
    1. Built in to Guideline, EMR, Training

Call Ms. Wheeler at 415 453 8382 to inquire about licensing or to arrange for a demonstration of the Universal Guideline.