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FAQ Adult & Pediatric 5-Level Telephone Triage Guidelines


 FAQ About Adult & Pediatric Telephone Triage Guidelines

What is unique about these guidelines? Several features make these protocols unique; they are first and only paper-based guidelines that:

  • utilize a 5-Level Triage approach to dispositions  since 1995
  • are age-specific: Infant-child (Birth- 6 Yrs), School Age (6 -18 Yrs) and Adult Populations
  • are 24/7/365 — “round the clock”, not just Office Hours — 9-5 M-F.
  • are nursing process-based
  • are standards-based (IOM)
  • have a robust Universal Guideline
  • are written at patient-centered 5th-8th grade literacy level for ease of communication and for the widest application

The Institute of Medicine advises developing systems that “make it easy to do the right thing”.  The Clinical Task Force worked tirelessly to make them user friendly, standards- and evidence-based, and transparent. Each of the three volumes addresses presentations, diagnoses, dispositions and treatments unique to each age group.  Each volume covers approximately 1500 possible diagnoses and over 500 informational topics, these volumes are one of the most comprehensive products on the market. At the same time, there are only 50 Guidelines — information-packed, concise and structured to facilitate rapid interactions, making them quick and easy to use.

Do these guidelines have a 5-Level Triage approach?  These telephone triage guidelines have always used a 5-Level Triage approach, predating work of the Manchester Triage Group and 5-Tier Triage for Emergency Departments.   The five levels have been consistent since 1995:  life threatening, emergent, urgent, acute and non-acute, each with a definition, time frame and place for patients to be seen.  These guidelines “help patients to get to the Right Place, at the Right Time, for the Right Reason”. TM

Why is clinical training important? Regardless of which guidelines one uses — whether electronic or paper based,  clinicians must be trained in telephone triage (malpractice avoidance, assessment, communications, documentation skills, in medical decision making, critical thinking, nursing process, metacognition and more) — one of the five basic system components.  Software training does not supplant clinical decision training.  Ms. Wheeler provides clinical training for telephone triage guidelines, on-site and on-line.

How are the guidelines organized?  The Institute of Medicine advises developing systems (structure and processes) that “make it easy to do the right thing” — user friendly and transparent.  The protocols are organized by Pediatric and Adult age group.  We organized symptoms by site and alphabetically (i.e., anatomically — abdomen, back, chest, ear, neck, urinary, etc). This unique feature enables nurses to quickly locate the correct protocols, using lay language titles. Patients can usually tell nurses where the problem is located. Location of symptoms provides the best starting point for pattern matching and additional assessment to rule out trauma, infection, or other possible conditions.

This simple but very effective design streamlines the “search” process by using lay terms beginning with symptom site, followed by associated symptoms. For example, when a patient presents with “eye problem”, whether a — foreign body, trauma, contact lens problems, pain, visual problems, red eye, sudden loss of vision, or discharge — the nurse starts with the Eye Problem guideline, thereby eliminating time consuming and frustrating searching through hundreds of different protocols for the “correct” one.

Are the guidelines in an algorithmic format?   While some experts believe that strict algorithms are the more scientific approach to medical decision making, to date, this approach is very diagnostic and deterministic. To date there are no outcome studies that demonstrate that algorithms result in safer outcomes when compared with pattern elicitation, recognition and matching. Some experts feel that algorithms are a form of “automated thinking”– and unsuitable for the assessment of invisible patients.

Our design is a hybrid of broad algorithm and pattern matching approaches. A study performed by Vimla Patel (1995) has found that telephone triage nurses use context, or pattern recognition to make medical decisions. Pattern recognition approaches mimic the way the human brain naturally solves problems. Thus, we have based this design on a combination of semi-algorithmic and pattern recognition models.

Are these guidelines useful in all settings? They are suitable for call centers, internet based services, HMO, group practice, student health, school nurse, office, Student Health Centers, county or private hospitals, community clinics, Emergency Departments, public health or home health settings.  They may be used for face-to face triage in ED, Clinic, Office, School or Student Health settings.

 Do these telephone triage guidelines include Women’s Health?  If you review the Table of Contents carefully, you will see that Women’s Health primary care for both adults and adolescents is addressed throughly. Core Women’s Health Protocols address common symptoms and informational questions such as: Abuse: Sexual and Physical/Elder; Breast Problems, Breast feeding Problems, Emotional Problems, Post Partum Problems and Concerns (Discomforts), Pregnancy Problems and Concerns (Discomforts), Urinary Problems, Vaginal Problems and Bleeding, and Women’s Health Issues: Birth Control and Menopause Concerns and Frequently Asked Questions.

What are the underlying assumptions of these guidelines?   Our Adult and Pediatric guidelines are decision support tools, not decision making tools (algorithms).  Like standing orders from physicians, pattern-recognition guidelines remind users of information they may have once known, but may have forgotten.  Trained, experienced clinicians are autonomous professionals, and the ultimate decision maker, not the protocols. Algorithms rely on “Automated Reasoning” which requires accurate, discrete patient information (lab results, physical exam).  They are deterministic and diagnostic; intended to establish a cause for symptoms.

Are these telephone triage guidelines available for research  Ms Wheeler welcomes the use of these guidelines in any evidence based research or comparative studies. Please contact her at 415 453 8382 to discuss this option.

Learn more about the Task Force who developed the Guidelines

Telephone Triage Guidelines or Protocols: Supplemental Information

Adult Telephone Triage Guidelines or Protocols (Age 18+)

Pediatric Telephone Triage Guidelines or Protocols (School Age: 6 -18 Years)

Pediatric Telephone Triage Guidelines or Protocols (Infant-Child: Birth to 6 Years)

Universal Guideline

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