By Ravi K. Raheja, MD
During trying times it isn’t surprising for telehealth triage nurses to see an increase in difficult calls. When we say difficult, we refer to those that are either: about cases of abuse or neglect; from unauthorized callers; about chronic ailments or repeat callers; about complicated medical or psychosocial issues; from callers who are excessively worried, anxious, or angry; and from callers who are hard to understand or communicate with.
Like all areas of effective nurse triage, there are ways to handle each of these calls effectively so that patients receive the proper dispositions for care. Here’s a breakdown of each type, and the best ways for triage nurses to handle them.
1. Abuse and Neglect
When telehealth triage nurses receive calls about these concerns, they must gather as much information as possible, often using open-ended questions, especially when these calls are about children. In the US alone, approximately five children die a day because of abuse and neglect.
Nurses must remain professional and empathetic, as this will improve their chances of obtaining that information and determining if anyone is in immediate danger. If the call is about a child, nurses will also determine whether the patient’s physician should be informed to provide additional instructions, both for the child’s immediate care and for the next steps regarding their situation.
2. Unauthorized Callers
Some individuals call a triage line to ask about a patient whom they are neither directly related to nor have received permission by that patient to receive information about their health. How a triage nurse responds will depend on the specifics of the call.
For instance, friends and relatives who are taking care of a pediatric patient may be treated the same as though they are the patient’s guardians. But if someone calls to ask only for information about that child’s health, that caller must be referred to the patient’s actual parents.
In some cases, it may be a child who phones the triage line directly. If this is the case, the best way to handle this call is to encourage the child to hand the phone over to an adult for further discussion.
3. Chronic Ailments and Repeat Callers
There will be times when callers need extra reassurance about their medical concerns. Others may have medical conditions that are not easy to identify. Each deserves the appropriate level of empathy and attention.
For example, patients who call back about the same concern within twenty-four hours are often known as acute callers. In such cases, it is imperative that nurses make sure to use reflexive listening to talk about those health concerns and encourage the patient to seek the most appropriate level of care—whether that care is at home, from their physician, or at the ER. If no serious issue presents itself based on reported symptoms, the nurse should console the patient and encourage them to make an appointment with their doctor.
4. Medical and Psychosocial Concerns
Calls that fall into this area of healthcare often rely on three solutions.
If they’re found to be minor or acute medical concerns, triage nurses rely on the appropriate protocols. If the caller’s concerns are chronic, nurses must follow specific guidelines from the physician’s practice or the applicable protocols.
In situations where guidelines or protocols are either not available or do not cover the issue at hand, the nurse must contact the physician directly to get further instruction. If that physician is not available, the nurse may determine that the best course of action is to encourage the caller to seek advice and care from the closest ER.
5. Excessively Anxious or Angry Callers
People are at their worst when they’re scared, sick, tired, or hungry, so it’s no surprise when their health influences one or all these factors. That’s why triage nurses must always use compassion to diffuse any heightened tension from an angry caller, gain the caller’s trust and understanding, and encourage the caller to follow their instructions. Effective telehealth triage nurses should:
Listen: They focus on what the caller is saying, don’t talk over the caller, and ask them to clarify when necessary.
Relate. They show empathy to the caller’s situation. A caller wants to feel heard and understood, so nurses can offer condolences about the confusion the caller may be experiencing, the situation the caller is in, or the caller’s feelings about it.
6. Propose an Action Plan
The triage nurse should lay out instructions on what type of care the caller should seek, whether customized instructions from a physician’s practice or based on triage protocols. Nurses should use comforting terminology to remind the caller that they are there to help.
Some examples include:
- “Based on what you describe, I’m going to assist you by following the protocols set by your doctor.”
- “I’m concerned about your symptoms, so please hang up and call 911. I’ll call back in five minutes to make sure you’re okay.”
- “I’ve noted your concerns and symptoms and will have your physician contact you to review them. I’ll ask them to call you at their earliest convenience.”
There will also be times when the patient is either not responsive to the nurse’s guidance or is verbally abusive. Don’t expect triage nurses to tolerate inappropriate behavior directed at them from a patient caller.
In these instances, they should inform the caller that they want to help them, but that if they do not cease the abuse and calm down, the nurse will not be able to assist them any further. If the caller persists after a second warning, the triage nurse should inform them that they are hanging up and that the caller’s physician will contact them.
7. Callers Who Are Difficult to Understand
The holidays also tend to see increases in alcohol and drug use, which can influence how well telehealth nurses may or may not be able to understand patient callers who are under the influence. If those nurses can’t establish a dialogue, their best course of action—like the example above—is to ask their supervisor first, then contact the caller’s physician. If their physician is not available, the nurse should instruct the caller to go to the ER.
This may also be the case if nurses do not understand the patient’s language or if the patient has a speech or hearing impairment.
Telehealth triage nurses will meet a wide range of patient callers, personalities, and symptoms that can influence how well they’re able to arrive at the best dispositions for care. With the right training, triage software, and triage protocols, their services will be even more effective at improving health outcomes.
Ravi K. Raheja, MD is the CTO and Medical Director of the TriageLogic Group. Founded in 2007, TriageLogic is a URAC accredited, physician-led provider of high-quality telehealth services, remote patient monitoring, nurse triage, triage education, and software for telephone medicine. Their comprehensive solutions include integrated mobile access and two-way video capability. The TriageLogic group serves over 9,000 physicians and covers over twenty-five million lives nationwide.