Friday, March 27, 2015

Telephone Triage Is Not Just a Job Anyone Can Do............

It is very difficult to explain the training that should be provided for telephone triage to someone who has no idea the complexity of the skill. Yet, we see front line people in offices and answering service personnel making triage decisions everyday, and the scary thing is, they do not realize they are making medical decisions without a license. Don't get me wrong, ancillary personnel are very important in the day to day operations of businesses, but you never want to put your business at risk by not having properly trained personnel in key areas.
Anyone on the front lines of answering telephone calls should be very careful in their selection of answers when patients ask questions or with giving information such as urgent care availability. A good example of this would be if the patient calls and states they have a nosebleed and they are taking anticoagulants. If the receptionist says "You can go to the walk in at XYZ location, but I will put your call in to the nurse". That is giving medical advice. The patient could interpret that as they should go to the walk in to be seen, and not wait for the call. You might say, "Ok, so?" Here is the worst case scenario. The patient goes to the walk in. His nose is bleeding profusely. A quick INR fingerstick at the office shows it is 5.4. The office calls for an  ambulance and he is sent to the ED. He ends up having Vitamin K and blood transfusions due to the amount of blood loss from the delay in treatment. He goes from there into CHF because of fluid overload from the transfusions, and .....well, you get the picture? And with any luck, some good malpractice attorney somewhere does not pick up on it.
Here is another scenario. The receptionist at the office has been there for 15 years and knows the ins and outs of everything about the office. She takes a call from a 45 year old female patient with what she thinks is a left shoulder strain. The receptionist, not being medically trained, and not knowing other questions to ask, says "Ok, I will let the nurse know, and she will call you back before lunch". The patient does not make it until lunch. Her husband found her slumped over in the bathroom one hour after the call in cardiac arrest.
Telephone triage is a highly skilled specialty that requires a licensed nurse, preferably an RN, as LPNs must be under the direct supervision of the RN. Even still, the nurse in that position must have received individualized further training on the skills required to perform the job safely. It should not be taken for granted that anyone can answer calls from sick patients. There should be specific protocols in place for non trained personnel on how calls should be handled. It is just not worth the risk not to.