TeleTriage Systems’ Guideline Task Force was originally composed of 23 expert level nurses, nurse-practitioners and three physician reviewers. Over a two-year period, and then bi-annualy, additional clinicians joined in. They developed teletriage guidelines with end-user clinicians in mind. The goal was to create guidelines that were safe, effective, “real world” and that made it “easy to do the right thing” (Institute of Medicine/National Academy of Medicine).
In order to accomplish those tasks, we relied on three key agencies for teletriage guideline criteria: American Academy of Ambulatory Care Nursing (AAACN) for nursing standards, the Institute of Medicine (2001) (now known as the National Academy of Medicine), and the Manchester Triage Group (MTG). Each element is described below:
Teletriage Guideline Standards (AAACN, 2018)
Safe: No malpractice cases are linked to the use of TeleTriage Systems’ guidelines. Spotless safety record, since publication (1995).
Multi-Purpose/Multi-Setting: Applicable to a range of clinical settings: Home Telehealth Visits to Face-to-Face Encounters, Emergency Department, Urgent care, and Ambulatory Settings (Office, Clinic, Surgicenter and Student Health Settings).
Five-Level Triage: A unified method for assigning triage that is innovative and exclusively unique to this system (AAACN Telehealth Standard 2, 3). Includes defined clinical prioritization nomenclature: acuity classifications, descriptions, time frames and sites for follow up.
Uniquely Patient Centric & Age-Specific. Explicitly state the population to which they apply (IOM). Content is customized to three unique age groups: Infant-Child (Birth to 6 Years), School Age (Age 6-18 Years)and Adult (Age 18 +years ) (AAACN Telehealth Standard 1)
5-8th grade literacy level Assessment questions and home treatment Instructions facilitate communication and call brevity. Developed to serve all literacy levels, (AAACN Telehealth Standard 1, 5, 6)
All economic levels: Originally developed for a large facility serving low-income, high risk, multi-cultural populations. Advice for home treatment and first aid features low-cost, treatments commonly available in the home, plus recommendations for free self-help and support groups.
ACCESS — Round -the -Clock Design supports 24/7/365 patient access policy — not just office hours. (AAACN Telehealth Standard 1)
Clinical Decision Support Triage Guideline Criteria (IOM, 2011)
1. Explicit: clearly state the populations to which they apply
2. Reliable: designed to result in safe, timely outcomes. 5-Level Triage
3. Reproducible Outcomes (EBM-ready): different groups of clinicians are likely to choose same safe dispositions
4. Clarity: a user-friendly presentation, written in unambiguous language, using precisely defined terms
5. Transparent: Users can clearly understand how they work
6. User’s Guide: A Unique feature — 30 page operating instructions, describing assumptions and exceptions to recommendations
Adapted from Clinical Practice Guidelines We Can Trust, IOM, 2011
TRIAGE DESIGN REQUIREMENTS (MTG, 2015)
In 2015, the Manchester Triage Group set forth the below requirements for on-site triage. Triage requirements also apply to remote triage system designs. The Teletriage guidelines described here meet these requirements.
Nomenclature: Basic terminology and descriptions.
Definitions of terminology. Clearly defined classification levels
Robust Triage methodology. 5-Level Triage with clear instructions on when, where and why patients are to be further evaluated as appropriate
Acuity classification. Based on Five-Level Triage (Emergency Severity Index or ESI) i.e. Life threatening, Emergent, Urgent, Acute, Non-acute.
Clinical Training Program. Robust clinical training program
Audit (QA, QI). QA Audit
Adapted from Manchester Triage Group, 2015
TeleTriage Systems Copyright Statement
Copyright 1993 -2024 by Sheila Wheeler and TeleTriage Systems Publishers. All Rights Reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means – electronic, mechanical, photocopy, recording or otherwise – without prior written permission of the publisher, except for brief quotations embodied in critical articles and reviews. For Information and permissions, write to Sheila Wheeler 44 Madrone Ave, San Anselmo, CA 94960 or contact her by phone 415 453 8382
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TeleTriage Systems Copyright Statement
Copyright 1993 -2024 by Sheila Wheeler and TeleTriage Systems Publishers. All Rights Reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means – electronic, mechanical, photocopy, recording or otherwise – without prior written permission of the publisher, except for brief quotations embodied in critical articles and reviews. For Information and permissions, write to Sheila Wheeler 44 Madrone Ave, San Anselmo, CA 94960 or contact her by phone 415 453 8382