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What is Telephone Nurse Triage?
By Sara Courson, BSN
November 2005
Telephone
triage is more than answering health questions.
Telephone triage nurses must be able to assess a client’s health
concerns without the advantage of visual inspection or face-to-face interaction.
Nurses must rely on their communication skills, knowledge of disease
processes, and normal growth and development for all age groups in order to
ascertain an accurate understanding of the client’s symptoms.
Triage nurses must have impeccable listening skills to notice the
non-verbal clues the client is giving regarding pain, anxiety, fear, and level
of comprehension.
There
is a difference between health advice lines and triage lines.
Health advice lines are usually a community-based information service
that offers answers to general healthcare questions.
Triage services are typically offered by healthcare facilities and are
used in association with a physician’s office.
They take calls from patients who are attempting to contact the physician
or other healthcare provider after usual office hours, for specific health
concerns, or urgent medical needs. The
triage nurse must assess the severity of the patient’s symptoms and then guide
the patient to the appropriate level of care.
Triage
nurses do not diagnose clients over the phone.
The function of the telephone triage nurse is to determine the severity
of the caller’s complaint using a series of algorithms developed by a
coordinated effort of physicians and nurses, direct the caller to the
appropriate emergency services if necessary, recommend the suggested medical
follow-up based on their assessments and established triage protocols, and
provide health information. This
process is called the “disposition” in triage settings.
In
addition to addressing specific caller complaints, many tele-nurse programs also
book appointments for the physicians’ offices with which they are associated,
both during and after office hours. Furthermore,
some programs review and triage the lab/x-ray results received in the office and
notify the medical practitioner of critical values.
Making follow-up calls to high-risk patients may also involve allowing
the triage nurse to assess changes of status or to ensure that the patient
sought the appropriate treatment. In
addition, there are interpretation services offered for non-English speaking and
hearing-impaired clients.
Each
triage nurse has a computer that is programmed with triage algorithms or the
algorithms may be in a manual. The
algorithms are programs that provide the nurse with pathways to follow as she or
he investigates the patient’s complaint. Demographic
data is assessed also, such as age, gender, height, weight, and so forth.
The algorithms are designed to assist the nurse in completely and
accurately assessing the client, without jumping to conclusions given certain
symptom sets. Symptoms are assessed
by asking questions starting with the most acute and working down in severity to
the least acute, in order to determine the need for emergency intervention.
Depending on the answers to these questions, the program then guides the
nurse through specific pathways to obtain the needed information and help the
nurse to determine the course of action, based on the various possible causes
for the current problem. Thorough
documentation is part of the process and must be completed just as diligently as
charting on bedside procedures.
Most
computerized systems make use of an electronic chart, which may be an ongoing
record for each patient entered into the system.
When a patient calls, his or her chart is electronically retrieved and
the medical history, diagnoses, and previous records are displayed.
Approaches vary by vendor, but the capabilities are increasing every day.
Some systems have the ability to incorporate x-ray and lab results with
the electronic record as well as notifying the patient’s primary physician,
via email, of the nature of the call and the recommendations given by the nurse
in order to expedite continuity of care and ease of follow-up.
The computerized programs used
within triage centers are purchased from an independent vendor or established by
the management of the center. Protocols
must be carefully developed in order to ensure accurate and timely information,
corresponding with the philosophies of the medical practitioners that are being
supported in the community. Even
programs purchased through a vendor must be tailored to reflect the advice of
the local physician groups. Standing
orders for medications or specific instructions for various patient complaints
can be built into the system according to physician preference.
The protocols are carefully developed from established standards and
documented interventions. Associations
such as the Emergency Nurses Association and American Nurses Association have
recommendations for use of triage and stress the use of researched standards in
order to deliver safe and prudent advice.
Educational
Requirements: Registered
nurses at all educational levels are able to do telephone triage.
Experience is the major requirement, but there are classes available to
enhance telephone triage skills. Seminars
are offered nationally by experts within the triage field as well as online
continuing education courses. Many
of the vendors who provide the computerized programs for facilities also have
educational offerings to help nurses stay current and increase their working
knowledge of the system’s capabilities.
Specialty
Certification: Certification
is not usually required for working as a telephone triage nurse.
However, many employers see this as a reflection of competency and
professionalism that then increases the appeal of a job candidate.
The National Certification Corporation now offers certification in
Telephone Triage. As with most other
certifications, there are certain eligibility requirements, such as current
licensure, 2000 hours of specialty experience, and recent employment in the
specialty. The tests are offered by
pen and paper, or computer.
Entry
Advice:
Nurses who enter the triage field
must have excellent communication skills, critical thinking skills, the ability
to handle stressful situations, the capacity to function independently, have
varied clinical experience, and the ability to document meticulously.
There is no one clinical background that prepares nurses for a position
as a triage nurse.
Most
sources state that a minimum of five years clinical experience is needed as well
as a current staff position. Occasionally,
call centers may require that nurses have specialty certification for the areas
in which they will be working, such as pediatrics, geriatrics, obstetrics, and
so forth.
Not
every nurse will thrive in the telephone triage setting.
Nurses who are used to being on their feet, having face-to-face
interactions with patients and peers, using technical nursing procedures and
skills, as well as those with little or no computer usage, might find it
difficult to adjust to the triage environment.
A typical shift at the call center will involve mostly sitting, looking
at the computer, talking, making independent decisions, and documenting
electronically. This is a prime
example of a non-traditional use of nursing skills.
Don’t be fooled into thinking that triage nursing is an undemanding
job. On the contrary, a shift at the
phone on a triage line can be more demanding than a day running up and down the
medical/surgical floors. The major
difference is that the delivery of top-notch nursing care must come without the
advantage of seeing or touching the patient.
Skills rest on the ability to listen, process information mentally, and
communicate effectively with the client.
Sara
Courson has 15 years experience in Obstetrical
nursing. She wishes to inform and
inspire nurses to learn more about the various employment opportunities within
the nursing profession, in addition to the traditional roles nurses have been
involved in over the years.
Telephone
Triage Vendors: Here is a list of
vendors who have integrated telephone triage protocols into call center
software.
Epic
Systems Corporation
5301
Tokay Blvd
Madison,
WI 53711-1027
608-271-9000
info@epicsystems.com
www.epicsystems.com
Nurse
triage helps users deliver care advice over the telephone.
Access to medical records, practice management tools, and popular
clinical protocols (e.g., Dr. Barton D. Schmitt's
pediatric telephone triage protocols and Dr. David A. Thompson's
adult triage guidelines) guide nurses efficiently through the triage process.
As users assist patients, the system automatically creates the
appropriate documentation, generating context-specific alerts and offering
access to scheduling information along the way.
HealthLine
Systems, Inc.
17085
Camino San Bernardo
San Diego, CA 92127
Richard
D. Stier, Vice President
800-733-8737
RStier@healthlinesystems.com
www.healthlinesystems.com
The
Sharp Focus Personal Health Management System incorporates adult,
pediatric, and women's health symptom-based nurse assessment protocols.
The Cleveland Clinic Foundation
protocols are structured, text-based protocols, founded upon the principles of
emergency nursing medicine, to facilitate the assessment of patient symptoms,
and to determine the appropriate course of care.
The protocols allow RNs to screen for priority and emergent symptoms,
utilizing a nurse's
clinical judgment, as they progress through care choices spanning options from
immediate emergency room referral to home care instruction.
LVM
Systems
4262
E Florian Ave
Mesa,
AZ
85206
480-633-8200
info@lvmsystems.com
www.lvmsystems.com
The
triage module in LVM’s E-Centaurus software uses the protocols authored by
Drs. Barton Schmitt and David Thompson. The
software fully supports triage nurses – making their jobs easier and more
efficient. Advantages include
customization, frequently used protocols, medication/dosage calculator,
quick-entry screens, question or advice-specific comments, on-call schedule
automation and analysis and QA reports
McKesson
CareEnhance
Systems
Phoenix,
AZ 85012
800-345-3342
x1230
www.ask-a-nurse.com
Ask-A-Nurse®
is a licensed program of McKesson Health Solutions.
Healthcare providers can license Ask-A-Nurse and provide nurse call
center services in their community. This
includes telephone triage, nurse advice, and physician and service referrals.
Organizations choose to have exclusive or non-exclusive use of the
Ask-A-Nurse name within their licensed service area.
Telephone
Triage Service Bureaus: There are
several call centers which provide telephone triage on an outsource basis or for
a fee to hospitals, clients, individual practices, and medical answering
services.
CareNet
9725
Datapoint Dr Ste 300A
San
Antonio, TX 78229
800-945-9129
info@callcarenet.com
Fonemed,
LLC.
2975 Broadmoor Valley Rd, Suite 201
Colorado Springs, CO 80906
888-366-3633
info@fonemed.com
www.fonemed.com
IntelliCare,
Inc.
500 Southborough Dr
South Portland, ME 04106
877-579-7857
info@intellicare.com
www.intellicare.com
KP
OnCall, LLC.
dba
OnCall Healthcare Communications
5855
Copley Dr Ste 250
San
Diego, CA
92111
858-974-1000
www.oncallhc.com
McKesson
CareEnhance
Services
Broomfield,
CO 80021
800-829-2550
x6361
Optum
www.optumanswers.com
Team Health
1431 Centerpoint Blvd Ste 110
Knoxville, TN 37932, USA
888-203-1118
www.thmedicalcallcenter.com
"Our services are customizable and are delivered with a timely, cost-effective,
and patient-focused approach, enabling us to offer our clients a 24/7 extension
of their healthcare services."
Tell-A-Nurse
www.medical-triage.com
info@medical-triage.com
The
Beryl Companies
3600 Harwood Road
Bedford, TX 76021
800-833-2000
www.Beryl.Net
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