Two nurses review triage protocols on a desktop computer.

More Than Just Protocols: Critical Thinking in Nurse Triage Is Essential

While Schmitt-Thompson triage protocols are highly effective for evaluating patients’ symptoms, critical thinking in nurse triage is a vital skill providers must use when determining the appropriate dispositions for care. That’s the takeover from a recent newsletter released by Schmitt-Thompson, which you can read in full here. Below, we review several ways that nurses can practice critical thinking skills.

Using Protocols as a Guideline

Schmitt-Thompson protocols establish a guideline of yes/no questions that nurses follow when evaluating the severity of each patient’s symptoms. This keeps nurses from inadvertently forming their own diagnoses and being held liable in the event of poor health outcomes. 

However, protocols are only as accurate as the feedback that patients provide, whether over the phone or through virtual  visits. As Schmitt-Thompson notes, this puts the onus on nurses to verify that they have factual and sufficient information to lead to the right protocols. Schmitt-Thompson recommends gathering at least five to six objective facts per case by asking patients open-ended questions and always verifying if there’s anything else they forgot to mention. 

Validating Symptoms

There will be times where the information that a patient provides doesn’t necessarily make sense with the symptoms they report or the circumstances surrounding them. Nurses are encouraged to use active and reflective listening skills to understand patients’ points of view, and prompt them to clarify or reiterate their symptoms as necessary. If available, nurses may also request that patients submit photos or videos to explain what they’re experiencing.

Establishing a Telephone Triage Process

Schmitt-Thompson notes that nurses are less likely to miss key patient data if they have an established process to obtain it. Part of this relates to protocol use, as they recommend that nurses apply search terms and “See More Appropriate Protocol” prompts when choosing the right protocols. Then it’s a matter of following those protocols and “ask[ing] the triage questions in sequential order before reaching a disposition decision.” Most importantly, nurses shouldn’t give care advice before an assessment of all symptoms has been completed.

There are additional steps that we teach our triage nurses to follow during these patient interactions — 10 in total — that are outlined in this video.

Ultimately, if registered nurses can use this approach to gather and validate the information that they need, all that remains is putting the facts together to form the “big picture.” Here, Schmitt-Thompson has one final piece of advice: as nurses do so, they must also use their critical thinking process to sift out irrelevant data that has no bearing on each patient’s health, while avoiding particular levels of bias that could influence the dispositions that they select.

Avoiding Bias

Schmitt-Thompson highlights four key types of bias that triage nurses may experience. These include:

  • Wellness Bias, which is the belief that younger patients are inherently healthier than older ones.
  • Patient Just Seen Bias, where a nurse assumes a patient who has had a recent doctor’s visit is healthier than one who hasn’t.
  • Illness Bias, where a nurse chooses a disposition based on their own health experience or that of other patients, rather than focusing on the specifics of their current patient.
  • Protocol Shopping, where a nurse decides early on what disposition they think the patient will need, then looks for a protocol that will justify it.

Critical Thinking in Nurse Triage Can Save Lives

There are times when a nurse may need to override a protocol because their critical thinking and knowledge of a patient’s symptoms help them identify a more appropriate solution. It’s important that these instances are fully documented for patient continuity of care, nurse liability, and the liability of the practice they represent. 

Using intuitive nurse triage software like myTriageChecklist can provide the customization and documentation necessary to make these phone and telehealth interactions more effective. It includes the most recent versions of Schmitt-Thompson protocols, and allows nurses to share their patient interactions and dispositions directly with referred providers.

We’ve seen firsthand how maintaining this kind of service — training on our 10-step process, our software, Schmitt-Thompson protocols, and critical thinking in nurse triage for assessing patients and solving problems  — can help patients better understand the severity of their symptoms and the level of care they should seek. In many cases, this has meant advising patients to go to the emergency department when they weren’t planning to, arguably saving their lives.

Would You Like Nurse Triage Assistance?

If your team would like assistance improving its training and staffing for triage nurses, TriageLogic is ready to help! Contact us with any questions you may have when it comes to Schmitt-Thompson protocols, nurse triage software, or nurse triage support from our medical call center of registered nurses

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 22,000 physicians and covers over 42 million lives nationwide.

Download E-Book “Revolutionizing Care – Technology and Telehealth Nurses in Remote Patient Care”

Download E-Book “A Provider’s Guide To Remote Patient Monitoring”

Download E-Book “Telehealth Trends During COVID-19”

DOWNLOAD E-BOOK “Telephone Nurse Triage Handbook”