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Key Symptom List for Non-Clinician Pre-Triage: A Risky Practice


Key List of Symptoms of Non-Clinicians to Pre-Triage?

I am often asked about a recommended “list of key symptoms for clerical staff to use to pre-triage patients”. I do not have such a list, nor do I recommend this risky policy. If your facility implements such a task delegation policy, I recommend that nurses meet with the hospital counsel in regard to this matter, as well as getting the policy in writing.

While symptoms such as chest pain, difficulty breathing and severe pain are obviously urgent symptoms, to date, there is no research evidence that any list of key symptoms enables non-clinicians to safely “pre-triage” symptoms. While many facilities currently allow this in order to reduce costs, based on my experience as an expert witness, it is risky, and especially with pediatric populations.  It is likely that this unwise practice — common in physician’s offices — has spread to ambulatory care settings, possibly due to confusion over policies about who (physicians, corporations or nurses) is legally authorized  (and accountable) to delegate clinical tasks to unqualified staff. READ MORE  New Article about Task Delegation and Misrepresentation

Questions About the Process and Outcomes of Telephone Triage

  • What is the First Step of Telephone Triage Process (Nursing Process)?  Is it critical thinking and a standardized, comprehensive assessment (i.e. performing a Symptom & Patient History)? Or is it just a matter of quickly selecting a guideline and beginning the questioning process without the preliminary assessment?
  • Triage is defined as the “assignment of degrees of urgency of illnesses to decide the order of treatment, or determining the priority of patients’ treatments based on the severity of their condition” (Wikipedia). Are telephone triage guidelines designed to help sort patient symptoms into categories of urgency (life threatening, emergent, urgent, acute or non-acute) with corresponding Dispositions (when, where and why patients need to be seen)?
  • Is our Goal safe, timely dispositions —  or differential diagnoses?
  • Finally, is there evidence that demonstrates that pre-triage by non-clincians is safe?  Where is the research?

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