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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?

Telephone Triage Rules of Thumb

Posted by on Dec 23, 2016 in Articles of Interest, Current | 0 comments

Clinical Decision Making in Telephone Triage Experts (including clinicians) frequently use Rules of Thumb to make decisions.  These are rules that are generally correct but not scientifically proven.  Rules of Thumb can be useful in telephone triage, when estimating urgency quickly is more important than determining a diagnosis.  Here are several Rules of Thumb below from the Preceptor Workbook, an update to Telephone Triage: Theory, Practice and Protocol Development (1993), and exclusively available with select CE Courses. Practice Rules Two...

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Telephone Triage Task Delegation & Misrepresentation: Risk Management

Posted by on Aug 16, 2016 in Articles of Interest, Current | 0 comments

Delegating Tasks to Unqualified Staff 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...

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What is a Telephone Triage Nurse? Current Role and Skills

Posted by on Jul 22, 2014 in Articles of Interest, Current, FAQ Telephone Triage, FAQ Teletriage Systems | 0 comments

Telephone triage nurse: current role and skills from Sheila Wheeler Share this...

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Are Telephone Triage Guidelines Safe & Reliable ?

Posted by on Feb 14, 2014 in Articles of Interest, FAQ Telephone Triage, FAQ-Protocol | 1 comment

How to Evaluate Telephone Triage Guidelines and Protocols It is safe to say that telephone triage guidelines are still in “early days”.  No independent, peer-reviewed, comparative study has found one guideline system to be safer than all others.  In fact,  errors and delays in care still plague telephone triage. According to the Institute of Medicine, error is defined as the “unintended use of the wrong plan”, as well as “the failure to use any plan”.  Whether in paper or electronic versions, Telephone...

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Are Telephone Triage Nurses Using Guidelines?

Posted by on Feb 13, 2014 in Articles of Interest, Current, FAQ Telephone Triage, FAQ Teletriage Systems, FAQ-Protocol | 0 comments

RECENT RESEARCH has found that Computerized Decision Support Systems (CDSS) do not perform effectively (or possibly safely)as decision support tools. Technical deficiencies included: not supportive of decision making, inconsistent documentation leading to mistriage, unintended self-care recommendations, information missing or outdated, questions subject to variable interpretation, clinical information captured incorrectly, lack of lay language, overly long algorithms prolonging the triage process and hindering communication. (Ernesater,...

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Clinical Call Center of the Future:

Posted by on Feb 13, 2014 in Articles of Interest, Current, FAQ Telephone Triage, FAQ Teletriage Systems | 2 comments

In a recent article in Healthcare Call Center Times entitled “Thoughts from a Telephone Triage Pioneer”, Sheila Wheeler shared her vision of the future of telehealth.  She has developed a list of features for the clinical call center of the future.  Call centers are currently implementing many of these ideas, based on new research related to clinical telephone triage. New Title Telephone Triage Nurse becomes obsolete Clinical Triagist subsumes the titles telephone triage and telehealth nurse Integrated Clinical Call Centers The...

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Emergency Department Telephone Triage

Posted by on Dec 6, 2013 in Articles of Interest, Current, FAQ Telephone Triage, FAQ Teletriage Systems, FAQ-Protocol | 0 comments

Are Current Policies Safe? Recent research found a link between Oregon patients on Medicaid and increased ED visits, with possible implications for theAffordable Care Act (ACA).   For several decades, the issue of ED overutilization has been identified as a problem.  Historically, ED visits may be preceded by a telephone triage call to the ED for assessment and disposition — which most EDs do not currently provide.  Now a “perfect storm” of ED overutilization threatens, due to the following factors: 1. ACA pent-up demand for access, 2....

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Decision making by Telephone Triage Nurses

Posted by on Nov 26, 2013 in Articles of Interest, Current, FAQ Telephone Triage, FAQ Teletriage Systems, FAQ-Protocol | 0 comments

Pattern Recognition and Estimation of Symptom Urgency Recent research on decisionmaking has implications for clinical decision making in telephone triage, CDSS, clinical call center policies, and industry regulations — worker fatigue, understaffing, over scheduling. Thinking Critically about Critical Thinking “In the beginner’s mind there are many possibilities. In the expert’s mind there are few.”   Shunryu Suzuki Whether you call it critical thinking, intuition, or pattern recognition, it is the core activity of telephone triage. In...

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Is Current Telephone Triage Research Disconnected?

Posted by on Nov 15, 2013 in Articles of Interest, Current, FAQ Telephone Triage, FAQ Teletriage Systems, FAQ-Protocol | 2 comments

 False Assumptions about Electronic Guidelines, Clinical Assessment & Decision Making Research and “Real World” Practice: A Major Disconnect Since the mid-nineties, the telephone triage industry has experienced breathtaking growth. Still, there is a lack of consensus about everything from scope of practice to terminology. For example, which title describes most accurately what clinicians do:  Telephone -advice, -triage, -consulting or telehealth, e-health, informatics, or tele-practice? Thus, the new field endures the prodding and testing...

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Telephone Triage in Year 2000

Posted by on Nov 10, 2013 in 1987-2001, Articles of Interest, FAQ Telephone Triage | 0 comments

Past, Present, Future Experts project that in the near future, telehealth will subsume telephone triage, with telemonitoring and visualization of all patients from home. Disease management will grow as home health assessment includes heart, lung, and bowel sounds, blood pressure and pulse readings, gait, neuro exams and mood assessment. Training programs will grow to 40 hours and will include internet-based training based on “real life” problems. Sophisticated training programs will provide simulations with “patients”...

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