Telephone triage training, consulting and expertise -- trusted by medical professionals since 1985
tel. 415-453-8382

Safety of Telephone Triage Decision Makers (2015)

This course provides an in-depth understanding of issues related to safety of clinical and non-clinical decision makers performing aspects of telephone triage.

6 CE Hours for $85 (Includes a 26-page article recently published in the Journal of Telemedicine and Telecare)
Provider: Sheila Wheeler is a CE Provider and has been approved by California Board of Registered Nursing, Provider #10680

Course Description: The authors of this narrative review used Donabedian’s structure-process-outcome model to examine groups’ systems for evidence of system completeness (a minimum measure of structure and quality) of four groups that are involved in telephone triage – clinicians (physicians and nurses) and non-clinicians (EMDs and clerical staff). They defined common terminology and created a framework to compare these groups. This article is a unique and in-depth examination of current safety in telephone triage. The authors make recommendations with safety implications for process, structure and outcomes in this emerging field.


Audience: RNs, NPs and other clinicians (novice and experienced) who are interested in safety in telephone triage

Methodology: Participants will read a 23-page research article, and answer 50 multiple-choice questions.

Behavioral Objectives: Upon successful completion of this home study, the participant will be able to:

  • Discuss differences between clinicians and non-clinicians in telephone triage activities
  • Discuss reasons for increased lawsuits related to negligence in telephone triage
  • Define appropriate-, under- and over- referrals.
  • Relate research on safety in telephone triage to their practice

Faculty: Sheila Wheeler, RN, MS. Ms. Wheeler has been a consultant in telephone triage since 1985. During that time, she has authored several texts on the topic and has served as an expert witness for both plaintiffs and defendants in telephone triage malpractice cases.

Provider: TeleTriage Systems. Provider has been approved by California Board of Registered Nursing, Provider #10680 for 6 contact hours.



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.


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



  • Order the Post Test online through PayPal. You will receive a link to an earlier version of the article, submitted to the Journal of Telemedicine and Telecare for publication.

  • Read the required article.

  • You will receive the link to the Post Test via email. PLEASE CHECK YOUR SPAM FILTER

  • Complete the post test and submit it via email

  • If you pass with 70%, you will receive a Certificate of Completion via email!

  • Please Note:  The peer reviewed version of the published article may be obtained from Journal of Telemedicine and Telecare,  and may be purchased separately.

If you haven’t already done so, you may earn 30 CE hours by taking “The Fine Art of Telephone Triage”.    If you have already taken that course, check out TeleTriage Systems’ other courses that can earn you up to 18 CE’s

It’s quick and easy– online courses are sent via email within 1-5 business days.

6 CE Hours for $85