Thursday, October 4, 2012

Real Telephone Triage

There are so many telephone triage companies now that it would be impossible to name them all, and I am definitely not here to say there is any one program that is better than another. However, has telephone triage gotten so complex that many have lost focus on what it really is?
I have seen complex programs, and have spoken with many experienced telephone triage nurses that tell me they feel like robots reading from computer screens. Systems have gotten so complex that they are not given the ability to actually use what they were trained to do, and that is be independent critical thinkers and use the nursing judgment skills they were trained with. Many of these nurses are now expected to be secretaries among other duties and track waiting times in urgent cares for instance. Is that really providing patient focused care?
What is wrong with being able to follow a protocol for questions to ask, to get the information needed to make a sound judgement of if the patient needs immediate treatment, or can it wait until the office opens? And, if there is not a protocol that fits, to be able to use nursing judgment to give sound advice? I know that I have spoken with patients who are grateful to be able to get appropriate advice from someone who can think independently from a computer screen, and I know the patients can tell when that advice is being read to them vs actually coming from a voice of experience and reassurance. Offices have verbalized that they appreciate personalized attention given to their patients from experienced telephone triage nurses.
Alot of money can be spent in some elaborate systems, and they sure look attractive, but I am proud to say that we ARE what telephone triage nursing is...Quality telephone advice given following standardized protocols, by caring, experienced triage nurses who go the extra mile to educate, advocate and direct the caller to the most appropriate next step of care. All completed without the complexities of navigating among many screens for one symptom.
Our nurses care about their callers, and many will tell you they will take patient focused care and the freedom to be a real nurse any day!!
It would be interesting to see how many other triage nurses feel the same. 

7 comments:

  1. I absolutely couldn't agree with you more! I am a telephone triage consultant, and one of the most disturbing elements of telephone triage in many settings is the nurses' "robotic" use of the decision support tools. It isn't uncommon for the nurse/patient encounter to be ALL ABOUT the protocol, rather than the patient! I agree with you, Helen and Joann, that the telephone triage encounter is professional nursing which requires complex critical thinking and superior patient focus in order to provide safe, individualized care! While decision support tools are commonly used in telephone triage, it makes much more sense to use them as a check-list to assure nothing important has been overlooked than to use them (inappropriately) as an interviewing guide. This is a "theme-song" for my consulting business and publications, but you two couldn't have said it any better, clearer, or in a more compelling fashion. Thanks for bringing this dysfunctional and unsafe practice of overreliance on the protocols into focus!

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    1. Thank you Carol. It is an honor that you are reading this blog. I have learned alot from you, and am reading your new book. I have found it very informative and a delight to read! Kudos to you and Liz Greenberg for writing a much needed and awaited resource.

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    2. How does one go about getting ?educated with telephone triage? I'd love to work from home as I'm getting older. I want to stay in nursing. I've had Emergency room experience and I presently work a rural ICU. I have been looking for input and ways to get experience so I can do this. Any ideas where I can get assistance with this endeavor?

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    3. hoping-
      I did attend one of Carol Rutenberg's conferences. It was fantastic. http://www.telephone-triage.com/index.php?option=com_content&task=view&id=43&Itemid=34
      If you really want to get into triage nursing, I would hope you could find a call center that provides great training along with a great decision support tool. I currently teach nurses about Telehealth Nursing as well as Triage Nursing and it has been such a great experience. Good luck!

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  2. Nice blog about the construction plan and the points which are described are also interesting to read. voip phone system

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  3. Great details here, better yet to discover out your blog which is fantastic. Nicely done!!! CNA Practice Test

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  4. Even with recent advances, technology has outpaced professional standards; I believe that we are still in "early days" in telephone triage. A recent review I performed with Liz Greenberg and Laura Mahlmeister found that safety has not improved markedly since the adaptation of computerized decision support systems (CDSS). http://teletriage.com/telephone-triage-articles-books/safety-clinical-non-clinical-decision-makers-telephone-triage/

    If nurses are not trained to perform thorough assessments of the problem and patient before selecting the guideline, they are missing a critical step in the nursing process. If they prematurely select and then overrely on the CDSS, the software program essentially function more like decision-making rather than a decision support tool. For example, one nurse complained that she "feels like her brain is in a vise" because she is required to ask the mandatory list of questions. On the other hand, a parent of a sick child complained that she wished the nurses "would just let me tell my story", and that she had to answer "endless lists of questions".

    We need better systems, including qualified staff, reliable and user friendly CDSS and EMR, comprehensive and standardized training programs and practice standards to support nurses in their work. I have addressed several of these topics in recent blogs: http://teletriage.com/category/blog/

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