Any time that a triage nurse speaks to a patient caller about their symptoms, they need to include callback instructions. These are meant to guide the patient on what to do in case those symptoms worsen. It is imperative that the nurse provides enough information to the patient so that they can identify when that change has been significant enough to warrant a callback.
Case Study: Infant’s Dry Cough
To explain this process in more detail, let’s consider a case study involving a nine-week-old infant who has developed a dry cough overnight. So far, the cough hasn’t interfered with activities like breastfeeding or sleeping, and the mother explains on her call to nurse triage that another child of hers is already experiencing a cold. She says that she hasn’t seen any initial signs of distress from her baby and the triage nurse hears a quiet cough with no abnormal breathing sounds.
The Triage Protocol
After getting a brief medical history for the patient, the triage nurse uses the mother’s feedback in conjunction with Schmitt-Thompson protocols to arrive at a disposition for care: in this case, having the infant seen by their primary care physician within 24 hours. This information is documented in the patient’s file and then added to the electronic medical records for continuity of care.
Callback Instructions
Before wrapping up their call, the triage nurse provides callback information to the mother in case her infant’s symptoms become more severe. Those changes include:
- A fever over 104 degrees rectally
- Difficulty breathing
- Wheezing
- A worsening cough
To help the mother know what to look for, the triage nurse also explains the signs of respiratory distress in infants, including retractions (when the ribs become visible when the child sucks in with each breath), nasal flaring, and an increased respiratory rate.
During the Callback
Six hours following their initial conversation, the mother calls back to the triage line with a concern about her baby’s labored breathing. She tells the triage nurse she’s speaking with now that she can see her child’s ribs when they breathe and that she was instructed to call back if this happened. When the triage nurse asks what symptoms have changed since earlier in the day, the mother explains her infant’s breathing is more labored, and their cough sounds worse. The nurse can also hear grunting from the child during each breath. This information generates a new protocol, which advises the mother to call 911.
After seeking care, a pediatrician initially diagnosed the infant with Croup and a negative RSV test. Three weeks later, they were diagnosed with RSV and treated.
In Review
Appropriate callback instructions are crucial when addressing the symptoms of patient callers — even more so when the patient cannot speak for themselves. Parents are understandably worried and nervous when they call. Nurses can go a long way to relieving that concern and empowering those parent callers by staying calm, reiterating the symptoms to watch for, explaining the circumstances under which to call back, and what to tell the triage line if and when they do.
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About TriageLogic
TriageLogic is a URAC-accredited, physician-led provider of top-quality nurse telehealth technology, remote patient monitoring, and medical call center solutions. Founded in 2007, the TriageLogic Group now serves more than 9,000 physicians and covers over 25 million lives nationwide.
