of Telephone Triage
There are risks associated with telephone
triage, just as with every other area of health care. Quality
health care is always the end product of an involved process. A
breakdown in any step along the way will produce an increased
risk to the quality of the care delivered and the care received
by the patient. The following interventions may be used to avoid
assessment, decision, or advice
ALWAYS follow established protocol.
- Never assume,
never guess, never compromise; always work the call to the utmost
Nurse should ask
open-ended questions whenever possible and offer
suggestions that might spur the caller's memory.
- Ex: What type
of past medical history do you have, such as heart disease, liver
disease, seizures, asthma, immune problems, etc.?
- Ex: What types
of injuries have you been treated for in the past?
Always address each
possible system involved, including the social situation
surrounding the caller.
Perform a focused assessment of the
Restate questions if the caller's
answer was ambiguous.
mistrust of telephone program
Nurse should establish an
excellent rapport with the caller immediately in the
- Remember that the caller is
stressed, may have poor communication skills, or
may be very frightened.
The caller must know that their health
care is of utmost importance to the telephone nurse.
Always ask the caller if they are
comfortable with the topics discussed and the advice
Ask caller to repeat
instruction when given, and suggest they write them down.
Ask for questions.
- This is necessary if future
readers are to understand exactly the dynamics of
To save valuable time, the telephone
triage nurse should ask questions with "yes" or "no" answers as much as possible.