By Ravi K. Raheja, MD
Triaging patients over the phone is challenging because nurses have limited information available to them. Because they are not able to use touch and visual cues, nurses have to use their years of training, education, and instincts to help them make the right decision every time.
This article covers five common challenges and issues faced by triage nurses. Here’s how to avoid some of the most common of these issues and how to ensure positive triage outcomes.
- Avoid Stereotypes: As a triage nurse, be careful to be objective no matter what the circumstances. It can be easy to mistake a caller’s sex or age by listening to his or her voice. To avoid stereotyping the caller, always confirm the age, gender, and medical history before triaging a patient.
- Listen First: It is easy to jump straight into triaging the first symptom mentioned by the patient. Instead listen carefully to the caller’s history and symptoms, then explore all possibilities. For example, abdominal pain in an older female may signal a urinary tract infection, while pregnancy may need to be considered in a younger female. Asking for a brief history and exploring the callers’ concerns in more detail will prevent overlooking a serious symptom and triaging to the wrong disposition.
- Assess the Situation: Remember to use your own professional judgment to assess the situation. It is important to listen to the patient to understand his or her concerns and get a good history. However, patients sometimes have their own diagnosis and accepting the caller’s diagnoses can lead to a bad outcome. For example, a parent may call and say her child has chicken pox. It is the nurses’ role to understand that the caller is concerned about chicken pox. However the nurse cannot assume the parent is correct. The nurse must do a full assessment of the child’s airway, breathing, and circulation, as well as assess the rash and any other symptoms to make the correct triage decision.
- Address the Callers’ Emotional State: Listen to the caller’s concern, voice, and anxiety levels. While the triage nurse is the trained professional, callers who are anxious have to be taken seriously and get an extra-thorough assessment for two reasons: first to ensure there is nothing really serious going on, and second to reassure the caller that you are taking them seriously and they will be okay.
- Use Nurse Triage Protocols Properly: Triage protocols are carefully and thoroughly designed, but they can still be misused. Nurses can omit using a protocol, use the wrong protocol, or use a protocol improperly during triage. For instance, many new nurses tend to over-use fever protocols. When misuse occurs, it puts the patient at risk. It is critical for triage organizations to provide detailed and comprehensive continuing nurse triage education and good quality assurance programs to ensure high-quality patient care.
Further, nurses need to be trained to use their professional knowledge in addition to protocols. Critical thinking skills are essential for any triage nurse to adequately and safely make assessments and decisions. Triage nurses must have balance between good judgment and proper protocol practice.
Ravi K. Raheja, MD, is the medical director and COO of the TriageLogic Group. Founded in 2005, TriageLogic is a URAC-accredited, physician-led provider of telephone nurse triage services, triage education, and software for telephone medicine. The TriageLogic Group serves over 5,000 physicians and covers over 10 million lives nationwide. Learn more at www.triagelogic.com.
[From AnswerStat – December 2015/January 2016]