Why Charting by Exception Is Acceptable When Triaging Patients
Dr. Barton Schmitt and David Thompson’s Opinion on Charting by Exception
Documenting the Positive Triage Question : When a Triage Nurse documents a call from the patient, the triage protocols allow her to document the “yes” statement by the patient, but leave out the “no” statements. This is called charting by exception. Some physicians question the necessity of charting the negative triage questions. Sometimes a concern is raised that only the “yes” statement is documented, but all the preceding “no” statements (pertinent negatives) are not charted.
As per the authors of the protocols, “Documenting by pertinent positives is safe and permissible because the nurse is following and adhering to a protocol. The protocol is key. Without it, the nurse would need to record pertinent negatives as well. Charting by exception has become the standard of care in medical call centers and offices. It keeps call processing and documentation simple and brief.“
At TriageLogic, we use the gold standard Barton/Schmitt protocols and chart by exception based on their recommendation for safe triage care. Charting by exception is a shorthand method for documenting normal findings. Every nurse is trained to ask every question within the protocol and only click on the “yes” answer. By doing so, the nurse is indicating that all standards and protocols have been followed. Documentation includes the main symptom or chief complaint of the patient and any pertinent negatives. This also decreases the amount of charting time.
In most call centers documentation is supplemented by voice recordings which provide more information about the encounter. The voice recording combined with charting by exception is not only safe and acceptable, but it is a more efficient way for the Triage Nurse to get her patient to the right level of care.
Note : For those organizations that prefer to continue documenting every negative response, our platform can be configured to accommodate that workflow.