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Adult Telehealth Guidelines

Adult Telephone Triage Guidelines — A unique, innovative, standards-based system

\In addition to being standards-based (Clinical Practice Guidelines We Can Trust, IOM, 2011) unique features include:

  • Five-Level Triage:   Guideline acuity levels were adapted from three levels defined in 1989 by American College of Emergency Physicians.   In 1995, they were further refined to a 5-level triage.  These guidelines pre-dated concepts later described by Manchester Triage Group and Emergency Severity Index (all designed for face-to-face triage). The guidelines contain nomenclature:  acuity classifications, definitions, time frames.  The 5-Level Triage provides for clinical prioritization, and a unified method for assigning triage (Standard 2, 3)
  • “Round the clock”, not just Office Hours: “Round the Clock” Disposition recommendations, not just for Office Hours.  Dispositions are covered 24/7/365 not just 9-5, M-F, providing a  “real world”,  practical tool.  5-Level Triage provide clear directives or dispositions explicitly state when, where and why patients should follow up, by stating the site, time frame and level of urgency of symptom pattern elicited by the nurse (Standard 1)
  • Age-specific:  Explicitly state the population to which they apply. Content is customized to three unique age groups: Infant-Child (Age Birth to 6 Years), School Age (Age 6-18 Years) and Adult (Age 18 years +) (Standard 1)
  • A Generic Guideline supports nurses in several ways (Standard 4,5,6):
    • as a “Fall Back” or contingency guideline in cases where existing protocols may not applyPhoto-10
    • as a “Go To” guideline before using a specific one
    • as a training tool for new staff
  • Patient-centered guidelines. Uniquely “Patient Centric” (Standard 1, 5, 6)
    All Literacy Levels:  To facilitate communication accuracy and call brevity, we wrote guideline content at 5th to 8th grade literacy level for condition descriptions and home treatment instructions.  No need to translate from medicalese to lay language, or college level to grade-school level.

    All economic levels: Advice features low-cost, accessible home treatments, support groups for comprehensive coverage of all populations.

  • Site-based titles:  Presented in lay language, the way that patients typically present symptoms

Standards-Based The features listed above meet and surpass current standards for decision support systems:

  1. Explicit:  guidelines explicitly state the populations to which they apply
  2. Reliable: Designed to lead to correct outcomes. 5-Tier Triage disposition designate where, when and why patients should be seen
  3. Reproducibility:  Five-tier triage facilitates different groups of nurses to choose same dispositions
  4. User’s Guide contains complete operating instructions, including underlying assumptions and exceptions to recommendations
  5. Clarity: Written in unambiguous language, using precisely defined terms, in a user-friendly presentation
  6. Transparent: Users can clearly understand how they work

Clinician-Developed Developed by practicing clinicians for practicing clinicians, reviewed by Expert Physician Reviewers

  • Safe: Spotless safety record, no malpractice events have been linked to these guidelines since publication in 1995
  • Multi-Purpose for Home Telehealth Visits, Face-to-Face Encounters: Emergency Department, Urgent care, Ambulatory Settings (Office, Clinic, Surgicenter  and Student Health Settings)
  • Customizable when used with three ring binder and Tabs

User-Friendly, Transparent and Intuitive

  • The unique pattern recognition design  mimics the brain’s natural problem solving method through synthesizing both algorithm and pattern recognition. The guidelines utilize a symptom recognition/matching strategy to support safe decision making. This “real world” approach to decision-making has been validated by medical decision expert Vimla Patel in her research of telephone triage nurses practicing in the ED setting.  It is also a practice standard for Emergency Medicine physicians.
  • Unlike systems with hundreds of protocol titles (which can lengthen the search process), this system is complete and concise.  Fifty guidelines address over 1,500 common and rare but predictable conditions. Each guideline includes screening questions, home treatment and/or first aid directives, and supplemental patient teaching information.  
  • Fast and User Friendly The guidelines are detailed enough to assure confident decision-making, yet concise enough to eliminate excessive and time-consuming cross-referencing.
  • Authoritative The protocols were collaboratively developed over a two-year period by a task force of over twenty expert-level nurses, nurse practitioners and physicians, offering a multidisciplinary perspective.
  • Easy on your budget Electronic protocols can cost hundreds of thousands of dollars. And “growing your own” paper protocols is extremely time consuming and expensive as well. This four-in-one manual has it all, and is extremely cost effective – an investment worth its weight in gold!

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

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