Telephone Triage and Patient Safety
As the first medical professional liability insurer to establish a patient safety department, The Doctors Company sets the industry standard with innovative tools that can help you reduce risk and keep your patients safe.
Implementing an effective telephone triage system in the office practice can improve physician-patient communication, confidence, service, satisfaction, and care. It can also reduce emergency department visits while ensuring access to the appropriate level of care. Telephone triage, which is just one of the ways that telemedicine is practiced, has its own risks.
Apply lessons learned by The Doctors Company.
- Inform patients in writing about when it is appropriate to seek telephone advice, such as minor headaches, cuts, and bruises.
- Give patients examples of the types of problems that are likely to require an office or emergency room visit.
- Allow only physicians or qualified staff such as RNs, NPs, and PAs to provide telephone advice.
- Outline specific examples in written protocols for office staff, including:
- Questions to ask the caller,
- Recommended responses for minor problems, and
- Which calls to refer immediately to a doctor or schedule for an office appointment.
Implement best practices.
- Document calls and the triage decision in the medical chart, indicating the protocol used and the advice provided. Use the caller’s own words to describe the reason for the call.
- Develop triage algorithms to assist the RN, NP, or PA in appropriate documentation of telephone conversations.
- Develop a written policy defining the role and limitations of non-clinical or unlicensed staff, as well as specific symptoms requiring immediate attention.
- Review all telephone triage decisions for appropriateness of actions taken.
- Review all scheduling encounters for appropriateness and timeliness of appointments.
Recognize top priority, life-threatening calls.
If the patient or a family member calls to discuss the patient’s signs and symptoms but is reluctant to seek emergency medical care:
- Instruct the patient to dial 911 for emergency situations that involve (but are not limited to) allergic reactions, chest pain, eye injuries, burns, or shortness of breath/wheezing.
- Verify with 911 that the patient made contact.
- Keep the patient on the line while another staff member calls 911 if the patient is unable to dial 911.
Remember that telephone triage requires accurate assessment without the benefit of a face-to-face encounter.
If an accurate description of symptoms cannot be obtained, the following strategies with referral triggers and forcing functions1 can assist in appropriate decision making:
- Use appropriate guidelines and algorithms.
- Provide telephone assessments by licensed professionals with appropriate training.
- Define qualifications and training clearly in job descriptions.
- Send the patient to the emergency department, and phone the ED with the patient’s presumptive diagnosis or description of symptoms prior to his or her arrival.
1A forcing function is an aspect of a design that prevents the user from taking an action without consciously considering information relevant to that action. It forces conscious attention upon something (“bringing to consciousness”) and thus deliberately disrupts the efficient or automatic performance of a task.
By Susan Shepard, MSN, RN, Director, Patient Safety Education.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.