This case was developed by Dr. Harvey Katz, from Harvard Medical School.  Dr. Katz has written extensively on the subject of telephone triage.  Some of his work is included in the references.

Your task is to work through the following case, answering the questions that follow each portion of the scenario.  You can use a blank sheet of paper or the attached file to write out your answers.  You will get more out of the exercise if you actually write out your answers.

Part One (Friday PM in the Pediatric Department)
You are MG, a pediatric provider, recently out of training.  You feel fortunate to have landed a job with the Hill Valley Medical Group (HVMG), the fastest growing and most highly regarded multispecialty group practice in town.

Your first two months have been great.  Your panel is beginning to grow.  The staff of 8 pediatric colleagues, 2 nurse practitioners, 3 RNs, and one PA have been welcoming and supportive.  Orientation has gone smoothly.  It is late Friday afternoon and you are preparing for your first solo weekend on call when the department chief, Dr. Ring, comes by.  He appears agitated.

Dr. Ring:  Hi. You won't believe what just happened -- some guy came into the department and slipped me a summons.  I have to appear for a deposition in two weeks!

MG:  Why?

Dr. Ring:  A patient who claims that her kid should have been seen in the office when she called and spoke to our nurse is suing our group.  Actually, she was seen by Dr. Casey (one of your colleagues) two days before the phone call and diagnosed with the "flu."  It was almost two years ago, when we were in the middle of an influenza epidemic.

MG:  How old was the child?

Dr. Ring:  Six months old.  Our triage nurse gave her fever advice--when I reviewed the case, it seemed appropriate at the time.  A day later, the kid started to seize.  The ambulance took her to the ER.  She looked really toxic - the LP was positive - she had pneumococcal meningitis.  We started antibiotics right away.  She ended up being hospitalized for about three weeks.

MG:  How did she do?

Dr. Ring:  It's a tragic case, really.  She survived, but is now severely retarded and totally deaf.  The parents are boiling mad and switched their care to another medical group.  The mother has an uncle who is a lawyer who urged her to sue.  Our nurse is devastated - actually quit a few months after the episode.  Her deposition is scheduled for next month and she is really stressed out.  Between you and me, documentation was a problem.  It's so poor, our lawyers think we may not have a case - in addition to the horror the jury will feel when they see the child.  You know, res ipsa loquitor.  In any event, I now have to spend the week preparing to face their lawyers - not a pleasant prospect.  Have you ever been deposed before?

MG:  No, thankfully.  What do you think will happen?

Dr. Ring:  Good question.  The plaintiff's team has brought in a few telephone triage experts.  They're gathering a lot of internal information about our triage system.  I'm really worried -- the whole telephone system around here is a major headache.  Patients complain left and right.  Nothing changes.  I'm afraid that this case is just the tip of the iceberg.

Write out the answers to the following questions on your sheet.  Then go onto the next page.
1)  What do you think about the quality of the documentation?

2)  What will the lawyers want to know about HVMG's telephone triage system?

3)  If the plaintiff's lawyer asks you to describe the key elements of a quality telephone medicine system, what would you say?

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