Tricks of Telephone Triage

Quality telephone triage is essential for all pediatric practices.  The documentation of the phone call noted on the previous page is not all that atypical of that seen in many practices.  As you thought about some of the areas of deficiency, you may have come up with some of the following issues.  These are some of the areas that may be queried during a deposition:

In addition to these issues, Katz has identified the following items as the key elements of a quality telephone management system:
  1. Specialized triage training
  2. Designation of responsibilities
  3. Appropriate protocols
  4. All phone calls must be documented
  5. There should be a process to ensure adequate supervision, review, and evaluation of the triage system.

Part 2 (Sunday evening sign-off in the urgent care department)

MG:  Hi, Dr. Casey.  This is MG with the weekend report.  I think you're on call tomorrow, and I wanted to tell you about the admissions -- and a baby of yours that was a near disaster.

Dr. Casey:  Yeah, I take over in the morning.  How was your first weekend on call?

MG:  It was crazy.  Seven newborns, four hospitalizations, and the usual ER business.  We got over one hundred phone calls between Saturday and Sunday.  Unbelievable.  I'm beat.

Dr. Casey:  What about that baby of mine?

MG:  Thanks for reminding me.  On Sunday morning, I stopped by the triage area after rounding on the floor and just happened to overhear this conversation.  Our triage nurse Rogers was going through breastfeeding instructions usually given by the lactation specialist.  She put the patient on hold and told me about the case.  She was worried -- thank goodness I was there.

I took the call and learned that she had called last night.  The Mom was worried about the baby, but was reassured that it was just a feeding problem.  She had misgivings about not being seen, and almost frantic, and a bit angry, when I spoke to her.

The baby was a week old, discharged after 36 hours.  Second kid.  Mom's name is Mrs. Hsu.  Do you remember her?  Feeding was not going well and she called last night to get some advice.  At 8 AM, when I spoke to her, she had called again to say her child's suck was weaker, and the baby was more lethargic.  Nurse Rogers and I agreed that she should be seen immediately and told her to go to the nearest hospital, just a few minutes from her home.

Dr. Casey:  Thanks for the update.  Speaking of phones, I've heard that our new CEO is putting together a committee to take a hard look at the way the phone system works (or doesn't work) around here.  Patients are constantly complaining about how our staff answer the phone, and how difficult it is to get to speak to a human voice, let alone their clinician.  Say, if you're interested, speak to Dr. Ring.  I think he could use volunteers on what may be an interesting project.  It's also a good way for you to get more involved in the group's business activities.

Write out the answers to the following questions on your sheet.  Then go onto the next page.
1)  What are the essential data to collect from the first call from Mrs. Hsu?

2)  What are the ways that you can connect with Mrs. Hsu when you begin speaking with her, particularly given the anger in her voice?

3)  Write out a sample triage note based on your call with Mrs. Hsu.

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Last updated:  March 6, 2000