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Adult & Pediatric Telephone Triage Guideline Development FAQ

FAQ about Telephone Triage Guideline Design and Development Process

Sheila Wheeler answers frequently asked questions about Telephone Triage Guidelines, regarding the Task Force, developer philosophy and the rationale for the unique design.

Who is the developer?   Sheila Wheeler has practiced in and pioneered the field of telephone triage since 1982.  Her expertise derives from her vision of the field, experience as a telephone triage practitioner, author of a training manual and protocols, product developer/researcher and conference developer/founder. In 1993, Wheeler authored the best-selling text – “Telephone Triage: Theory Practice and Protocol Development” – the first training manual and audiotape for novice practitioners. It was the first text to describe how to write telephone triage guidelines and remains a classic. It is used by over 35,000 – 60,000 nurses currently.   In 1993, Ms. Wheeler served as Editor-in-Chief for development of “Telephone Triage Protocols for Adult and School Age Populations”.

Is it possible to license guideline content to create customized electronic versions or for resale?  Yes, TeleTriage Systems licenses the protocol content to companies wishing to develop or enhance existing electronic protocols. The content may be licensed for the following uses of any type, to be customized and modified in any manner.

Does TeleTriage Systems have electronic Guidelines?  Ms. Wheeler recently developed a prototype for an electronic Universal Guideline. It is designed to reduce human error, to address root causes of error and to enhance the process of metacognition in telephone triage.  Please contact Sheila Wheeler at 415.453.8382 to arrange for a demonstration.

How were the guidelines developed?  Over a two year period,  a task force of 20 expert level nurses and three physician reviewers developed all three volumes of guidelines, under the direction of Sheila Wheeler, the Task Force Leader. Ms. Wheeler trained the task force for eight hours, they then broke into three specific groups: Pediatrics, Adult and Women’s Health. Each group worked collaboratively under the direction of Wheeler and created approximately 10-20 drafts of each protocol (Total 50). These, in turn were proofed and rekeyed by editorial assistants and reviewed by Wheeler for consistency and accuracy. Finally, each protocol was reviewed by physicians, revised and approved.

Who were the medical reviewers?    Medical reviewers for the project include Robert Pantell, M.D., Chief of General Pediatrics at the University of California, San Francisco, Edwin C. Pigman, M.D., Medical Director of World Access, Richmond, Virginia, and Russ Kino, M.D.,Medical Director of ER on Call, St. Joseph’s Medical Center, Santa Monica, CA.

Who were the contributing authors?  The guidelines represent the collective expertise of the task force members, most of whom had 20 or more years of experience. Over twenty five nurses and nurse practitioners were selected for their expertise in Adult and Geriatric Medicine, Pediatrics, Women’s Health. Several nurses were expert practitioners working at Santa Clara Valley Medical Center.

 What references were used as resources for the guidelines?  In developing the design the task force referred to other protocols and standard medical references currently on the market. They synthesized and distilled information from over 200 of the latest classic and “gold standard” medical and nursing texts, listed in the reference sections.

 Who were the medical reviewers for the Guidelines?   Physicians listed as contributing authors or reviewers in the book served as medical reviewers for the protocols.

How are the guidelines organized?  The Institute of Medicine advises developing systems (structure and processes) that “make it easy to do the right thing” — user friendly and transparent.  The protocols are organized by age agroup and then alphabetically and by site (i.e., anatomically — abdomen, back, chest, ear, neck, urinary, etc). This unique feature enables nurses to quickly locate the correct protocols, using lay language.  This simple but very effective design streamlines the “search” process by using lay terms beginning with symptom site, followed by associated symptoms.

For example, when a patient presents with “eye problem”, whether a foreign body, trauma, contact lens problems, pain, visual problems, red eye, sudden loss of vision, or discharge, the nurse will always start with the Eye Problem protocol, thereby eliminating time consuming and frustrating searching for the “correct” protocol.

Patients can usually tell nurses where the problem is located. Location of symptoms provides the best starting point for pattern matching and further questioning.  A small number of symptoms that are not site based (dizziness, fever, fainting, burns, bites, vomiting, nausea, etc.) are integrated alphabetically.

Have these guidelines or their developers ever been implicated in malpractice lawsuits? No. These guidelines have an impeccable safety track record since first published in 1995.  No guideline or any Task Force Member has ever been involved in a malpractice lawsuit related to any use of these guidelines.

Under Ms. Wheeler’s direction, the Telephone Triage Task Force developed guidelines conceptualized as age-specific (Infant-Child, School Age, Adult), patient centric and 5-tier triage from their first publication in 1995.  Please see more information about these innovative systems here:

Adult Telephone Triage Guidelines or Protocols

Pediatric Telephone Triage Guidelines or Protocols (School Age)

Pediatric Telephone Triage Guidelines or Protocols (Infant-Child)

“Clinical Systems to Help Clinicians Get Patients to the Right Place at the Right Time for the Right Reason” TM

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