Practically any call can turn out to be high-risk, but there are some that triage nurses should be especially attuned to. The typical ones that most think of are breathing issues, chest pain, abdominal pain, trauma, suicide and overdose calls. However, there are other red flag calls to be concerned about.
If the caller is calling again for a 2nd and 3rd time during a shift, there is something they are very concerned about. This is the time that the triage nurse needs to hone in his/her assessment questions, and make sure there is not something there they are missing. This would be good time to ask, "So, what is it that concerns you that made you call tonight?" This is a perfect question to ask if the symptoms are not new, or you are having difficulty discerning why they are calling to begin with, and even more so, that they are concerned enough to keep calling back. Triage nurses should be really listening for any subtle changes, and if it is concerning enough, send them on to the ED. It is best sometimes for someone to actually lay eyes on the patient to really determine what is going on. This is especially true if the caller is a poor historian, and even the best assessment questions does not get the answers you are seeking, or if there is a language barrier.
Newborn calls is another group to be especially attentive to. We have all dealt with nervous new parents who are concerned that their baby is crying. However, newborns can get sick very quickly, and we, as triage nurses, need to have assessment skills to be able to determine if that cry is normal or if there is something more serious going on. Newborn parents need extra time and attention, and alot of education!
Medication calls could potentially be high risk calls as well. If the parent is requesting to know the dosage of acetaminophen or ibuprofen, we should be finding out why. Is it a fever of 105? A patient calls for an albuterol inhaler refill. How often are they using it? What are the symptoms now? Any respiratory distress? These calls should always be thoroughly assessed to make sure that the patient does not need a higher level of care, and that medication is appropriate. We should never take it for granted that the caller is capable of discerning this on their own.
Telephone triage is about constantly assessing, planning, and thinking about the what-ifs. It takes keen listening and thinking skills to get the patient through to the next level safely.