With the holiday months upon us, it isn’t surprising for telehealth triage nurses to see an increase in difficult calls. When we say difficult, we refer to those that are either: about cases of abuse or neglect; from unauthorized callers; about chronic ailments or repeat callers; about complicated medical or psychosocial issues; from callers who are excessively worried, anxious, or angry; and from callers who are hard to understand or communicate with. Like all areas of effective nurse triage, there are ways to handle each of these calls effectively so that patients are given the proper dispositions for care. Here’s a breakdown of each type, and the best ways for triage nurses to handle them.
Abuse and Neglect
When telehealth triage nurses receive calls about these concerns, they must gather as much information as possible, often through the use of open-ended questions, especially when these calls are about children. In the US alone, approximately five (5) children die a day because of abuse and neglect. Nurses must remain professional and empathetic, as this will improve their chances of obtaining that information and determining if anyone is in immediate danger. If the call is about a child, nurses will also determine whether the patient’s physician should be informed in order to provide additional instructions, both for the child’s immediate care and for the next steps regarding their situation.
It’s not uncommon for individuals to call a triage line to ask about a patient whom they are neither directly related to nor have been given permission by that patient to receive information about their health. How a triage nurse responds will depend on the specifics of the call.
For instance, friends and relatives who are taking care of a pediatric patient may be treated the same as though they are the patient’s guardians. But if someone calls to ask only for information about that child’s health, that caller must be referred to the patient’s actual parents.
In some cases, it may be a child who phones the triage line directly. Generally speaking, if this is the case, the best way to handle this call is to encourage the child to hand the phone over to an adult for further discussion.
Chronic Ailments and Repeat Callers
There will be times when callers need extra reassurance about their medical concerns. Others may have medical conditions that are not easy to identify. Each deserves the appropriate level of empathy and attention.
For example, patients who call back about the same concern within 24 hours are often known as acute callers. In such cases, it is imperative that nurses make sure to use reflexive listening to talk about those health concerns and encourage the patient to seek the most appropriate level of care — whether that care is at home, from their physician, or at the ER. If no serious issue presents itself based on reported symptoms, the nurse should console the patient and encourage them to make an appointment with their doctor.
Medical and Psychosocial Concerns
Calls that fall into this area of healthcare often rely on three solutions.
If they’re found to be minor or acute medical concerns, triage nurses rely on the appropriate Schmitt-Thompson protocols.
If the caller’s concerns are chronic, nurses must follow specific guidelines from the physician’s practice, or the applicable protocols.
In situations where guidelines or protocols are either not available or do not cover the issue at hand, the nurse must contact the physician directly to get further instruction. If that physician is not available, the nurse may determine that the best course of action is to encourage the caller to seek advice and care from the closest ER.
Excessively Anxious or Angry Callers
People are at their worst when they’re scared, sick, tired, or hungry, so it’s no surprise when their health influences one or all of these factors. That’s why triage nurses must always use compassion in order to diffuse any heightened tension from an angry caller, gain the caller’s trust and understanding, and encourage the caller to follow their instructions. Effective telehealth triage nurses do this by:
Listening. They focus on what the caller is saying, don’t talk over said caller, and ask them to clarify when necessary.
Relating. They show empathy to the caller’s situation. A caller wants to feel heard and understood, so nurses can offer condolences about the confusion the caller may be experiencing, the situation the caller is in, or the caller’s feelings about it.
Proposing an action plan. The triage nurse should lay out instructions on what type of care the caller should seek, whether those instructions are customized from a physician’s practice or based on triage protocols. Nurses should use comforting terminology to remind the caller that they are there to help. Some examples include:
“Based on what you describe, I’m going to assist you by following the protocols set by your doctor.”
“I’m concerned about your symptoms, so please hang up and call 911. I’ll call back in five minutes to make sure you’re okay.”
“I’ve notated your concerns and symptoms, and will have your physician contact you to review them. I’ll ask them to call you at their earliest convenience.”
There will also be times when the patient is either not responsive to the nurse’s guidance, or is verbally abusive. Triage nurses are not expected to tolerate inappropriate behavior directed at them from a patient caller. In these instances, they should inform the caller that they want to help them, but that if they do not cease the abuse and calm down, the nurse will not be able to assist them any further. If the caller persists after a second warning, the triage nurse should inform them that they are hanging up and that the caller’s physician will contact them.
Callers Who Are Difficult to Understand
The holidays also tend to see increases in alcohol and drug use, which can influence how well telehealth nurses may or may not be able to understand patient callers who are under the influence. If those nurses aren’t able to establish a dialogue, their best course of action — similar to the example above — is to ask their supervisor first, then contact the caller’s physician. If their physician is not available, the nurse should instruct the caller to go to the ER.
This may also be the case if nurses do not understand the patient’s language, or if the patient has a speech or hearing impairment.
Telehealth triage nurses will meet a wide range of patient callers, personalities, and symptoms that can influence how well they’re able to arrive at the best dispositions for care. With the right training, triage software, and triage protocols, their services will be all the more effective at improving health outcomes. That’s why our nurse triage call center has been so successful acting as the extension for hospitals, medical practices, and doctors’ offices nationwide. If you’d like to provide the same care for your patients, contact us to learn more.
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.