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Tips for Successful Patient Triage
By Ravi Raheja, MD
Triaging patients over the phone is challenging because nurses have limited information available to them. Because they are not able to use touch and visual cues, nurses have to use their years of training, education and instincts to help them make the right decision every time.
This article covers 5 common challenges and issues faced by triage nurses. Read on to learn how to avoid some of the most common of these issues and how to ensure positive triage outcomes.
1. Stereotypes: As a triage nurse, be careful to be objective no matter the circumstances. It can be easy to mistake a caller’s sex or age by listening to the voice. To avoid stereotyping the caller, always confirm the age, gender and medical history before triaging a patient.
2. Listen to the Entire History Before Triaging: It is easy to jump straight into triaging the first symptom mentioned by the patient. To avoid this, listen carefully to the caller’s history and symptoms and explore all possibilities. For example, abdominal pain in an older female may signal a urinary tract infection, while you may need to consider a pregnancy in a younger female. Asking a brief history and exploring the callers concerns in more detail will prevent overlooking a serious symptom and triaging to the wrong disposition
3. Remember to Use Your Own Professional Judgment to Assess the Situation: It is important to listen to the patient to understand her concerns and get a good history. However patients sometimes have their own diagnosis and accepting the caller’s diagnoses can lead to a bad outcome. For example a parent may call and say her child has chicken pox. It is the nurses’ role to understand that the caller is concerned about chicken pox. However the nurse cannot assume the parents are correct. The nurse must do a full assessment of the child’s airway, breathing and circulation as well as assess the rash and any other symptoms to make the correct triage decision.
4. Listen to the caller’s concern, voice and anxiety levels: While the triage nurse is the trained professional, the callers who are anxious have to be taken seriously and get an extra thorough assessment for two reasons – to ensure that there is nothing really serious going on and to reassure the caller that you are taking them seriously and that they will be okay.
5. Use the Nurse Triage Protocols properly: Triage protocols are carefully and thoroughly designed, but they can still be misused. Nurses can for example, omit using a protocol, use the wrong protocol, or use a protocol improperly during triage. For example, we often see fever protocols being overused by new nurses. When any of these occur, it puts the patient at risk.
It is critical for triage organizations to provide detailed and comprehensive continued nurse triage education along with good quality assurance programs to ensure high quality patient care. Further, nurses need to be trained to use their professional knowledge in addition to protocols. Critical thinking skills are essential for any triage nurse to adequately and safely make assessments and decisions. Triage nurses must have balance between judgment and protocol practice.
To Summarize, there are 5 common challenges to avoid:
- Listen to the Entire History Before Triaging
- Remember to Use Your Own Professional Judgment to Assess the Situation
- Listen to the caller’s concern
- Use the Nurse Triage Protocols properly:
What other challenges have you seen in your nurse tele-health center?
What to read next: Free Telephone Nurse Triage Handbook