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Telephone Triage Systems

All physician office practices have some level of telephone triage. Telephone triage, when done effectively, can improve access to the appropriate level of care, increase practice efficiency, patient satisfaction, and patient/provider communication.

A telephone triage system is not a replacement for medical care. A telephone triage system does not replace a physician's (provider's) physical exam and independent professional judgment. Staff and patients need to be aware of the limitations of telephone communication.

Inform Patients of Your Telephone Triage Practices

Tell patients what your phone advice includes:

  • How calls are managed
  • What is an appropriate triage call
    • Give examples of what telephone advice is acceptable for the office practice and what would require an emergency department visit

Triage Screening Practices: A Scope-based Practice

Triage systems that involve screening of patient symptoms and subsequent clinical advice should utilize registered nurses with the appropriate background, training, and clinical experience. The nurse should utilize written clinical protocols to guide this process.

Triage systems for practices solely staffed by medical assistants should have protocols in place that guide how questions are handled and addressed, both clinical and non-clinical. The role of the medical assistant in the office practice setting has expanded, so established protocols should be specific to this role and the scope of practice of the medical assistant.

Because the physician is responsible for any information staff provide to patients, written protocols for nurses and medical assistants should be reviewed and approved annually by the physicians in the practice. The document should reflect the format of the content used for the questions, which can be delegated to the staff. When clinical decision-making is required in the algorithm, a licensed staff person should be making the determination. For more direct algorithms, the individual who obtains the clinical data during the interview must have a yes/no algorithm and always have the ability to engage the provider.

Improve Telephone Communication

The following recommendations will assist in the development of a structured telephone triage process to improve telephone communication.

  • Establish a written policy that defines the telephone triage process to include the following: sample policy
    • Define Scope: Describe what the triage system will cover.
    • Define Purpose: State the intent of the triage system.
    • Define Personnel: Who will staff the process? Define staff qualifications required and duties to be performed.
    • Define Hours: That triage will be available.
    • Define Program Components: Telephone call management process, written clinical protocols if any, documentation process, and quality review.
  • Provide staff training and education annually, more often if needed.
  • Education should include a competency specific to telephone triage. Standardize documentation through the use of a telephone encounter form. When an EMR is in place, create and utilize a standardized telephone encounter screen.
  • Monitor the program regularly and provide relevant staff feedback and education sample quality review checklist.

Minimize Professional Liability

A telephone consultation poses the same level of professional liability risk as a physician office visit. The duty to provide care is legally established from the moment the patient seeks advice. Minimize professional liability by practicing the following:

  • Utilize written protocols as an adjunct to, not a replacement for, critical thinking and clinical decision-making.
  • Return patient calls in a timely manner according to defined parameters, inform patient when to expect a call back.
  • Require provider review of triage documentation as defined by policy, including time, date of the review, and provider signature. In the EMR, assure the system reflects provider acknowledgment of the triage documentation.
  • Document all telephone communications immediately; utilize standard encounter form or template in the EMR.
  • Assure the patient understands the advice given and document this understanding.
  • Advise the patient when to call back or go to the emergency department, e.g., symptoms are worse.
  • Document an explanation when deviation from written protocols occurs.

Resources

Telephone Nurse Triage Handbook- A Convenient Guide for Providers, TriageLogic Group

Katz, Harvey, MD and Mondor, Maureen, RN, Patient Safety and Telephone Medicine, PIAA, 2007.