Sheila Wheeler’s 40-year Track Record

Innovative Teletriage Projects

TELEPHONE TRIAGE CONTINUING EDUCATION

Telephone Triage: Essentials for Expert Clinical Practice  

Structure, Process and Outcomes for 5-Level Telephone Triage

Course Description

This course is the update to Ms. Wheeler’s 1993 pioneering training manual: “Telephone Triage: Theory, Practice and Protocol Development”. It can also serve as a preceptor program for experienced telephone triage nurses. It is as evidence- and standards- based as is achievable and focuses on the essential elements of telephone triage practice: Structure, Process and safe Outcomes. It also emphasizes strategies to reduce root causes of error in assessment, communication, continuity, informed consent and human error. 

Right Assessment, Right decision-making process, Right Disposition. We examine the Role, Risks, Rules of Thumb, Red Flags and Red Herrings unique to telephone triage clinicians serving a wide range of adult and pediatric populations, including low-income, low literacy and developmentally disabled populations. 

This course uses methodologies of reading, workbook exercises, role-play, discussion, analysis and critique.  Using an Audit QA score sheet, participants will take turns as patient, nurse and scorekeeper to role play several case studies, to evaluate other participants and to be evaluated.

Objectives:

Upon completion, participants will be able to act as preceptors to less experienced nurses.  They will be able to coach these nurses to a higher level of competency in these areas:

  1. ·       How to avoid root causes of error related to telephone triage

  2. ·       How to utilize Rules of Thumb and Red Flags to make better decisions

  3. ·       How to utilize relevant assessment methods and purpose of each

  4. ·       Improved clinical decision-making process, with an emphasis on assessment and communications

    Table of Contents

Chapter 1:  Overview of Telephone Triage         

Chapter 2:  Telephone Triage Risk Management: The Duty of Due Care, System Error                                

Chapter 3:  Rules Of Thumb as Decision Support Tools                         

Chapter 4:  Assessment Tools & Strategies                                              

Chapter 5:  Clinical Decision Making Process                             

Chapter 6:  The Universal Guideline                                                    

Chapter 7:  Communication Strategies                                                   

Chapter 8:  Documentation Essentials                                                   

Chapter 9:  Avoidable Human Errors                                                       

Chapter 10: Assessment By Proxy                                                

Chapter 11: Crisis Calls & “War Stories”                                        

 APPENDICES                                                             

1.     Stress Reduction & Care For The Caregiver

2.     Critical Thinking & Intuition

3.     Sample Clinical Training Program

4.     Telephone Triage Patient Brochure

5.     Telephone Triage Sample Policies

6.     Sample Telephone Triage Practice Standards

7.     Telephone Triage & Elderly Populations

8.     Telephone Triage & Low Literacy Populations

9.     Telephone Triage & Guideline for Suicidal Caller

10.  Telephone Triage References

Innovation - Evidence-Focused Projects

  • 1985  First CE program in telephone triage. Author, Trainer for onsite program “The Fine Art of Telephone Triage”, 

  • 1990  First training video for emergency medical dispatchers EMDs on 911. Original concept, Assistant Producer, “Anonymous Hero”.

  • 1993  First telephone triage training manual. Author, Delmar Publishers. This best selling text,, with audiotapes of real life case studies, considered the definitive work in the field. Over 30,000 copies sold since 1993.

  • 1994 – 2001 First national clinical telephone triage conference Founder, Chairperson, Speaker:  “Telephone Triage: Essentials for Expert Practice”, 6,000 attendees

  • 1995  First telephone triage website and clearinghouse for teletriage information. Website Developer, teletriage.com

  • 1995 - 2020 Served as legal nurse consultant on 35 malpractice cases

  • 1995  First age-specific, 5-level triage, 3-volume Adult,and Pediatric guidelines. “Telephone Triage Protocols of Pediatric and Adult Populations” Santa Clara Valley Medical Center, San Jose, CA Author, Editor-in-Chief of 25+ Clinical Task Force Free Telephone Triage Guidelines (2017)

  • 1997 Early Software Developer Collaboratively developed electronic software with LVM Systems, Mesa, AZ for six VA hospitals in northern California and Hawaii.  Clinical Informaticist, Content Author

  • 2000 Member, Expert Task Force for National Certification Corporation, telephone triage certification examination

  • 2002 Telephone Triage Protocols for Adult and School Age Populations, Second Edition, Author, Editor-in-Chief, Revised Edition Aspen Publishers.

  • 2009 Telephone Triage Protocols for Adult Populations Author, Editor-in-Chief, included New 10 Audio case studies, Third Edition McGraw Hill.

  • 2010 First International Training Program in China: Expert, Trainer, Consultant.  The Fine Art of Telephone Triage for The Hospital Authority, Hong Kong, China

  • 2011 First Nurse-led Physician Training Telephone Triage Essentials for Expert Practice for Physicians, Consultant, Keck School of Medicine, University of Southern California, Los Angeles, California

  • 2014  First Telephone Triage Preceptor Program: Essentials for Expert Practice Preceptor Program,  Program Developer, Consultant, Trainer. Sutter Health Call Center, Salt Lake City, UT

  • 2014 Telephone Triage: Essentials for Expert Practice Preceptor Program, Program Developer, Consultant, Trainer. Adult Primary Care, University of California San Francisco, CA

  • 2015  Lead Author, “Safety of Clinical and Non-Clinical Decision Makers in Telephone Triage: A Narrative Review” (Journal of Telemedicine and Telecare, 2015).

  • 2015 -2023  Lead Author Telephone Triage CE article with Wild Iris

  • 2015 Presentation: AAACN Conference.” To Err is Human, To Delay is Deadly” Consultant, Trainer.

  • 2017 Presentation: Safety in Teletriage, to Physicians in Bhopal, India Program Developer, Consultant, Trainer.

  • 2017 – 2019 Telephone Triage: Essentials for Expert Practice Preceptor Program, Program Developer, Consultant, Trainer.

  • 2015-2019  First Working Prototype for a Universal Guideline for Teletriage, Developer

  • 2024  Research, “Teletriage Safety in Israel and US:  A Tale of Two Systems” Co-Author

Client Feedback

“Your work is a godsend. I am truly grateful to have found it. Thank you for all you do.” D.L, RN, MSN, PHN. California.  

Feedback from 120 nurses attending a 2016 day-long Telephone Triage training near Washington, DC at a State Health Agency Regional Office

  • Learned a lot. Can’t think of anything that was missing.

  • I loved it!

  • Excellent content!

  • Such a great day with much needed information!

  • I didn’t want to miss anything!

  • Great job!

  • Information clear and needed!

Telephone Triage CE Courses

Six+ CE Courses: Books or long articles, post test & answer key.

Telephone Triage CE Courses & Training 1985-2024

Telephone Triage Research (2024)

Background: The safety of telemedicine in general and telephone triage (teletriage) safety in particular have been a focus of concern since the 1970s. The telehealth industry — an umbrella term — includes teletriage. Clinical call centers have variable systems intended to promote patient and practitioner safety. However, these systems are not standardized and may compromise patient safety. From a technological and professional perspective, the COVID-19 pandemic accelerated rapid, but uneven telehealth growth. Within five to ten years, AI, advanced EMRs and patient wearables will be a given. Such advances may outpace professional development. The need for an evidence-based teletriage practice and systems is urgent.

Safety of clinical and non-clinical decision makers in telephone triage: a narrative review (2015)

Patient safety is a persistent problem in telephone triage research; however, studies have not differentiated between clinicians' and non-clinicians' respective safety. Currently, four groups of decision makers perform aspects of telephone triage: clinicians (physicians, nurses), and non-clinicians (emergency medical dispatchers (EMD) and clerical staff). Using studies published between 2002-2012, we applied Donabedian's structure-process-outcome model to examine groups' systems for evidence of system completeness (a minimum measure of structure and quality). We defined system completeness as the presence of a decision maker and four additional components: guidelines, documentation, training, and standards. Defining safety as appropriate referrals (AR) - (right time, right place with the right person), we measured each groups' corresponding AR rate percentages (outcomes). We analyzed each group's respective decision-making process as a safe match to the telephone triage task, based on each group's system structure completeness, process and AR rates (outcome). Studies uniformly noted system component presence: nurses (2-4), physicians (1), EMDs (2), clerical staff (1). Nurses had the highest average appropriate referral (AR) rates (91%), physicians' AR (82% average). Clerical staff had no system and did not perform telephone triage by standard definitions; EMDs may represent the use of the wrong system. Telephone triage appears least safe after hours when decision makers with the least complete systems (physicians, clerical staff) typically manage calls. At minimum, telephone triage decision makers should be clinicians; however, clinicians' safety calls for improvement. With improved training, standards and CDSS quality, the 24/7 clinical call center has potential to represent the national standard. 

Keywords: clinical; decision; non-clinical; safety; telephone triage.

Clients & Collaborators

Ms. Wheeler has worked collaboratively with clients from a range of settings: academia, medicine, software companies, military facilities and health maintenance organizations. She has consulted internationally and worked with experts from relevant clinical disciplines.

    • AAACN Conference

    • 2014-2015 - UCSF Ambulatory Care Clinics

    • 2013 - Sutter Health Clinical Call Center

    • 2010 - SF Dept. Public Health, Telephone Triage Training

    • 2011 - Telephone Triage for Physicians, Keck School of Medicine, USC, Los Angeles

    • 2014 - Sutter Health, Preceptor Training and Consultation                                             

    • Calgary Health Link, Calgary, Alberta, Canada

    • Hospital Authority, Hong Kong, China

    • Presentation: Safety in Teletriage, to Physicians in Bhopal, India 

    • Martin Army Hospital, Ft. Benning, GA

    • Veteran’s Administration: Omaha, Nebraska

    • Lemoore Naval Air Station, Lemoore, CA

    • Offutt Air Force Base, NB

    • Langley AFB, VA

    • Pt. Hueneme Naval Base, CA

    • Davis-Monthan AFB, AZ

    • Beale AFB, CA

    • Walson Air Force Base, New Jersey

    • Veteran’s Administration Medical Center (San Francisco, Palo Alto, Sacramento, Fresno, Hawaii, 

    • Massachusetts General Internal Medicine Associates

    • St. Mary’s Medical Center, San Francisco, CA

    • Children’s  Hospital, Minnesota

    • Kalamazoo Center for Medical studies, Kalamazoo, MI

    • Santa Barbara Public Health Department, Santa Barbara

    • Nurseweek Seminar, Los Angeles, CA

    • Lorman Education Services, Eau Claire, WI

    • Emergency Nurses Association, Management Conference, CA

    • Oregon Medical Group, OR

    • Care Management Resources, MD

    • Pediatric Partners, San Francisco

    • Healthcare Partners, Los Angeles

    • Midland Hospital, TX

    • Pfizer Pharmaceuticals:  Boston; Chicago

    • Marin Community Clinic, CA

    • Marin Maternity Services, CA

    • OrNda Healthcorp, CA

    • Santa Clara Valley Medical Center, CA

    • Stanford Health System, CA

    • Kaiser Permanente: San Diego, Los Angeles,  South San Francisco, Oakland, San Rafael, Cleveland

    • Future of Ambulatory Nursing - San Francisco General Hospital

    • Telephone Triage - Crisis Intervention.  Emergency Nurses  Scientific Assembly, New Orleans

    • Ambulatory OB/GYN Nursing Conference, San Francisco

    • HealthLine Corporation, CA

    • Cigna Healthcare, AZ

    • Palo Alto Medical Foundation, CA

    • 1994 – 2001 Founder, Chairperson, Speaker:  “Telephone Triage: Essentials for Expert Practice”, first 3-site national clinical telephone triage conference, 6,000 attendees

    • 1994 - American Academy of Ambulatory Care Nursing, San Diego, CA

    • 1986-1990 - Kaiser Permanente, Cleveland Heights, OH