How a Telehealth Triage Nurse Determines if a Child’s Cough Is a Concern

A child’s cough can be a point of concern, especially to new parents. This was the case even before the COVID-19 pandemic, when this symptom accounted for the second highest number of triage calls. Now, it’s even more important that telehealth triage nurses are available to address this concern and confirm whether it’s severe enough for parents to take their children to the ER. Here’s how nurses can make that determination while also reassuring parent callers.

Follow the 10 Critical Steps

We teach how triage nurses should answer every patient call with a 10-step process, which you can read more about here. These critical steps include the use of empathetic language so that callers remain calm, and are more receptive to the information that nurses provide. Plus, it allows those nurses to ask open-ended questions to learn more about each patient’s symptoms, especially when those patients are children.

Those questions can include whether the patient is experiencing any breathing, swallowing, or speech difficulties; chest pain; a bluish face or tongue; discolored sputum; or a fever. Nurses should also inquire about any pertinent past medical history.

For any of these calls, a full respiratory assessment is necessary to address changes in skin color, possible retractions along the ribcage and stomach, speed of respiration, and any audible noises (wheezing, grunting) that seem abnormal. If possible, the nurse should listen to the child speak (recite their ABCs) as well as breathe. This is used to estimate the child’s level of respiratory distress on a scale of mild to severe, where:

• Mild reflects rapid respiratory rates, mild stridor, or wheezing.
• Moderate refers to labored breathing, some retractions, nasal flaring, stridor, or wheezing.
• Severe indicates a marked respiratory effort, struggled breathing, retractions, or cyanosis.

The triage nurse should be aware that fevers can minimally affect the respiratory rate. They should also make sure to ask the caller whether their child has experienced changes in activity level or appearance, or if they have had any sick contacts.

Select the Right Protocol

A caller’s answers will be documented in the patient’s file within nurse triage software before being used to select the appropriate Schmitt-Thompson protocol. Based on the information that’s supplied, a triage nurse may select either the “cold” or “cough” protocol, then follow additional prompts from that protocol to confirm the severity of the patient’s symptoms.

Ultimately, this will provide the triage nurse with a disposition for care, whether that care can be administered at home, by a PCP, or in the ER. The nurse must also make sure that the caller understands these instructions and what has been discussed (prompting the caller to write the information down), and that they have callback advice in the event that their child’s symptoms worsen.

Additional Notes for Callers

Triage nurses would do well to remind callers that coughs are almost always viral in origin, so antibiotics won’t help. Coughs are productive even when they’re severe because they’re freeing the patient’s lungs of damaged cells. In spite of being very unpleasant, they’re also quite normal, and can often take three (3) weeks or longer to subside following an infection. Nurses must keep these factors in mind when discerning the severity of a child’s cough and determining whether the parent can rely on home care to manage their child’s symptoms.

Materials for Your Nurse Triage

Does your nurse triage need updated Schmitt-Thompson protocols, our 10-step process for how to answer triage calls, or additional nurse learning center materials to further address a child’s cough and more? Or perhaps you’d like to discuss outsourcing nurse triage service to handle patient phone calls?

We’d be happy to help! Give us a call today to discuss a customized solution to best fit your needs.