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Telephone Triage Preceptor Program

Preceptor Workbook

Description: This 190-page workbook emphasizes a Standard Operating Procedure — Nursing Process and diagnosis, assessment tools, communication techniques and a 5-Level triage approach. It focuses on the essential elements of telephone triage practice: the Role, the Risks, Rules of Thumb, Red Flags, Red Herrings, Right Communications, Right Assessment, Right Decisionmaking and Right Disposition.  A  training manual with “real world” approach that supports clinicians in getting patients to the right place, at the right time, for the right reason.

  • End of Chapter Exercises: 10 end-of-chapter exercises, 50-item certification exam
  • Case Studies:
    • 25 written adult and pediatric case studies with exercises for telephone triage skill practice using 5-Tier triage outcome approach
  • Answer key for all tests

This training program and tools, processes and strategies utilized in it represent best practices grounded in an evidence- and standards- based system to refine nurse competency in these areas:

  • How to avoid five root causes of error related to telephone triage
  • How to utilize Rules of Thumb, Red Flags to make better decisions
  • How to utilize five assessment Check Lists and purpose of each
  • Improved clinical decision-making process (nursing process), with an emphasis on assessment and communications
  • Consistently select one of five dispositions from 5-Tier System that is safe and timely

The content contained in this workbook is based on recent research on telephone triage decision-making. A recent article from the American Society of Risk Managers is referenced throughout: Groszkruger, D. (2014) Diagnostic Error: Untapped Potential For Improving Patient Safety? Journal of Healthcare Risk Management, Vol 34, No 1, P 38-41.

In the article, the author stresses the current lack of knowledge about the extent of diagnostic error, and uncertainty about error characteristics and variations in definitions (While telephone triage is not intended as a diagnostic process, it is designed to estimate symptom urgency — a first phase of diagnostic process).  The author of the article recommends remedies such as evidence-based guidelines, remedial education, organizational efforts to reduce human error, improved decision support systems, triggers to identify high risk populations, simulations, post mortem examinations, audits and patient involvement. These recommended strategies apply to telephone triage and are included in the Preceptor Workbook.

Table of Contents

Chapter 1: Overview (Who, What, When, Where Telephone Triage) Definition, Purpose of Telephone Triage, Job Qualifications

Chapter 2: Risk Management  Why Clinicians must perform Telephone Triage,  Telephone triage as a clinical task, Practice Error and System Error, Root Causes of Error, Negligence, Delay in Care, Clinical Standards, Controversies

Chapter 3: Rules Of Thumb as Decision Support Tools  Cardinal Rules,  Population- and Symptom- Specific Rules   

Chapter 4: Assessment Tools & Strategies  Nursing Process Modifications for Telephone Triage, Step One: The Preliminary Assessment,  Pattern Recognition and Context, Assessment Tools,  SAVED: A “Global Assessment” “Red Flag Patients and Symptoms”,  The Symptom History (Chief Complaint),  Patient History (The “Back Story”),  Difficult to Assess Patients, ADL: Activities of Daily Living,  A DEMERIT: Non-verbal patient

Chapter 5: Clinical Decision Making Process Nursing Process Modifications for Telephone Triage Steps 2-4,  Select Guideline that best matches info, Step 2: Formulate A Working Diagnosis Or “Impression”, Step 3: Disposition and Advice From Guideline, Step 4: Instruction for Self-Evaluation, Follow up Instructions

Chapter 6: Intro to Generic Guideline Rationale for a Generic Guideline (Why),Pre-emptive or “Go To” Guideline, Contingency or “Fall Back” Guideline, “General Clinic Policy” or Training Tool for Telephone Triage,  5-Tier Triage (What), How Generic Guideline Works (How), Definitions of Life threatening to non-acute, Time Frame, Place, Rationale (Disposition)                                                                        

Chapter 7: Communication Strategies Role of Telephone Triage Nurse, Domains of Nursing Expertise (Benner)

  • Estimate and rule out urgent symptoms
  • Eliciting pertinent negatives
  • Noncompliance and negotiation
  • Use Lay Language
  • Patient buy-in
  • Develop patient-centered communication

Chapter 8: The Documentation Tool Documentation 101: Cryptic but Informative, Documentation by Inclusion vs. Exception.

Chapter 9: Avoidable Human Errors  System Error May lead to Human Error, Common cognitive biases   

Chapter 10: Assessment By Proxy Using Callers as a Proxy for assessment process,  Using self-assessment information,  Pain assessment, Red Flags,  Rules of Thumb Red Herring

Chapter 11: Crisis Calls  Medical Crises, Stay with the caller, “Warm Transfer”, “Minding the Gap”,  Ingestion Calls, Sexual Assault, Psychological Emergencies: Suicide