CONCLUSION
Telephone triage is a recognized specialty in primary care and specialty practices. The telephone triage system is composed of five components: qualified staff, training program, standards, guidelines, and documentation. Its structure and process are integrated to help reduce common errors—failures of assessment, communications, continuity, informed consent, and human error.
Critical-thinking skills and a systematic approach can remedy many potential pitfalls. These include the following practices:
- Identify what is salient and ignore what is not.
- Apply rules of thumb to make timely decisions.
- Recognize “red flags” to quickly identify high-risk problems or populations.
- Employ consistent, comprehensive assessment and data-collection strategies.
- Use the nursing process, modified for telephone triage.
- Use a documentation form with the nursing process embedded.
- Apply guidelines that support the nursing process.
Telephone triage nurses use the nursing process and professional judgment to achieve safe, timely outcomes, getting patients to the right place at the right time for the right reason.
RESOURCES
Telehealth care and after hours care (American Academy of Pediatrics)
Telehealth manager’s toolkit (American Academy of Ambulatory Care Nursing)
REFERENCES
NOTE: Complete URLs for references retrieved from online sources are provided in the PDF of this course.
Accreditation Council for Graduate Medical Education (ACGME). (2019). ACGME program requirements for graduate medical education in emergency medical services. Retrieved from https://www.acgme.org
Agarwal PK. (2017). Retrieval practice. Retrieved from http://www.retrievalpractice.org
American Academy of Ambulatory Care Nursing (AAACN). (2018). Scope and standards of practice for professional telehealth nursing (6th ed.). Pitman, NJ: AJ Jannetti, Inc.
American Board of Emergency Medicine (ABEM). (2016). 2016 model of the clinical practice of emergency medicine. Retrieved from https://www.abem.org
American College of Emergency Physicians (ACEP). (2019). Policy statement: providing telephone advice from the emergency department. Retrieved from https://www.acep.org
American Nurses Association (ANA). (2019). ANA core principles on connected health. Retrieved from https://www.nursingworld.org
Baumeister RF & Tierney J. (2012). Willpower: rediscovering the greatest human strength. New York: Penguin Press.
Benner P. (1984/2013). From novice to expert: excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley.
Bradford A. (2016) Sepsis: causes, symptoms and treatment. Retrieved from http://www.livescience.com
Clawson JJ & Democoeur KB. (2020). Principles of emergency medical dispatch (6th ed.). Salt Lake City: Priority Press.
Covarrubias C. (2020). Health care organization, policy, and financing. Jekel’s epidemiology, biostatistics, preventive medicine, and public health. (5th ed.). Philadelphia: Elsevier.
Dahlgren K, et al. (2017). The use of a Swedish telephone medical advice service by the elderly: a population-based study. Scand J Prim Health Care, 35(1), 98–104. doi:10.1080/02813432.2017
EM Model Review Task Force. (2016). 2016 model of the clinical practice of emergency medicine. Retrieved from https://www.cordem.org
Emergency Nurses Association (ENA). (2019). Position statement: emergency nursing interface with mobile integrated health (MIH) and community paramedicine (CP) programs. Retrieved from https://www.ena.org
Guttman OT, Lazzara EH, Keebler JR, Webster KLW, Gisick LM, Baker A. (2018). Dissecting communication barriers in healthcare: a path to enhancing communication resiliency, reliability, and patient safety. Journal of Patient Safety, Nov. 9. doi:10.1097/PTS.0000000000000541
Haddad A, Doherty R, & Purtilo R. (2019). Health professional and patient interaction. Philadelphia: Elsevier.
Institute of Medicine (IOM), Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. (2011). Clinical practice guidelines we can trust. Washington, DC: National Academies Press.
Institute of Medicine (IOM), Committee on Diagnostic Error in Health Care; Board on Health Care Services. (2015). Balogh EP, Miller BT, Ball JR (Eds.), Improving diagnosis in health care, Washington, DC: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov
Institute of Medicine (IOM). (1999). To err is human: building a safer health system. Washington, DC: Author.
Klein G. (2013). Seeing what others don’t: the remarkable ways we gain insight. Philadelphia: Perseus Book Group.
Klein G. (2003). Intuition at work. New York: Random House.
Klein G, et al. (2010). Rapid decision making on the fire ground: the original study plus a postscript. Journal of Cognitive Engineering and Decision Making, 4, 186–209.
Manetti W. (2018). Sound clinical judgment in nursing: a concept analysis. Nursing Forum, 54(1), 102–10.
Mataxen PA & Webb LD. (2019). Telehealth nursing: more than just a phone call. Nursing, 49(4), 11–13.
Merriam-Webster. (2020). Rule of thumb. Retrieved from https://www.merriam-webster.com
National Patient Safety Foundation (NPSF). (2015). RCA2: improving root cause analyses and actions to prevent harm. Boston: Author.
Paul AM. (2015). Researchers find that frequent tests can boost learning. Scientific American, August 1. Retrieved from https://www.scientificamerican.com/article/researchers-find-that-frequent-tests-can-boost-learning/
Plainlanguage.gov. (2015). Plain language: improving communication from the federal government to the public. Retrieved from http://www.plainlanguage.gov
Plous S. (1993). The psychology of judgment and decision making. New York: McGraw-Hill.
Raheja CG. (2018). Improve patient care and save unnecessary ER visits. Retrieved from https://triagelogic.com
Raheja CG. (2016). Patient symptoms and outcomes: nurse triage saves lives. Retrieved from https://triagelogic.com
Rudowitz M. (2019). The crucial role triage nurses play in educating adults about serious medical symptoms. Retrieved from https://triagelogic.com
Schmitt B. (2018). Pediatric telephone protocols (16th ed., office version). Aurora, CO: American Academy of Pediatrics.
So CF & Chung JWY. (2017). Telehealth for diabetes self-management in primary healthcare. Journal of Telemedicine and Telecare, May 2.
U.S. Department of Health and Human Services (US DHHS). (2015). Health literacy fact sheet: health literacy and health outcomes. Retrieved from https://www.cecentral.com
Visser LS & Montejano AS. (2018). Fast facts for the triage nurse: an orientation and care guide (2nd ed). New York: Springer Publishing.
Wachter R. (2015). The digital doctor: hope, hype and harm at the dawn of medicine’s computer age. New York: McGraw-Hill.
Wheeler SQ. (2017a). Essentials for expert practice: a preceptor workbook. San Anselmo, CA: TeleTriage Systems Publishers.
Wheeler SQ. (2017b). Pediatric telephone triage guidelines infant-child (birth to 6 years). San Anselmo, CA: TeleTriage Systems Publishers.
Wheeler SQ. (2016). Risk management in telephone triage (continuing education course). Retrieved from http://www.teletriage.com
Wheeler SQ. (2013). Telephone triage: theory, practice and protocol development. San Anselmo, CA: TeleTriage Systems Publishers.
Wheeler SQ. (2009). Telephone triage protocols for adult populations. New York: McGraw Hill.
Wheeler SQ, et al. (2015). Safety of clinical and non-clinical decision makers in telephone triage. Journal of Telemedicine & Telecare, 21(6), 305–22.