Telephone triage and treatment protocol

Article Information Volume: 24 issue: 4, page s : Karina L. Abstract Abstract. Keywords telephone triage , advice , pediatric oncology. Correction Erratum. Sign Out. Email required Password required Remember me Forgotten your password? Need to activate? Institutional Access does not have access to this content.

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Betty L. Chang and more Western Journal of Nursing Research. Suzanne Pursley-Crotteau and more Use of Protocols and Guidelines by Telephone Nurses. Ann M. Mayo and more Clinical Nursing Research. Crossref Cherie Rushton and more British Journal of Nursing Apr A psychosocial oncology program: perceptions of the telephone-triage a Crossref France Desrochers and more Supportive Care in Cancer Feb Crossref Paula M. Sanborn Jan Cookies Notification This site uses cookies.

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By continuing to browse the site you are agreeing to our use of cookies. Find out more. Tips on citation download. Anastasia, P. Outpatient chemotherapy: Telephone triage for symptom management. Oncology Nursing Forum, 24 1, Suppl. Google Scholar Medline. Baker, R. After-hours telephone triage and advice in private and nonprivate pediatric populations. Archives of Pediatric Adolescent Medicine, , - Blythin, P. Triage documentation. Nursing , 3 32 , 32 - Briggs, J.

Telephone triage protocols for nurses 2 nd ed. Philadelphia : Lippincott-Raven. Google Scholar. Cady, R.

• Paramedics working in the er;
• Learn more about Telephone Triage?
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Pitfalls in telephone triage. Telephone triage: Avoiding the pitfalls. Canadian Nurses Association. Telehealth: Great potential or risky terrain? Canadian Nurses Protective Society. Telephone advice. Coleman, A. Where do I stand? Legal implications of telephone triage. Journal of Clinical Nursing, 6, - Cooley, M. Finally, caregivers with limited medical knowledge and experience may use the telephone for simple reassurance and positive reinforcement.

A second significant difference between calls from caregivers of private and nonprivate practice patients in the present study was related to the seriousness of the complaint. This was suggested by the finding that a higher percentage of calls regarding nonprivate practice patients resulted in a referral to the office for an ill visit during regular office hours. This was in contrast to the higher percentage of calls regarding private practice patients who were referred to an ED or urgent care facility, suggesting more serious illness.

Reasons for this are likely related to the same factors that prompt a higher use of telephone medicine in general as previously discussed. The present study also showed differences between private and nonprivate populations in the age of the patient, which has been previously reported. Reasons for this are less clear, although may be related to the same factors as those regarding the increased number of calls and calls for less serious illness previously discussed. It is likely that all these factors would be even more pertinent in the younger age range due to perceptions of increased vulnerability of infants and toddlers.

It is also possible that the 2 populations of patients are in fact different, with a tendency for private practice patients to be somewhat older. This is not likely based on the limited demographics we have available on the 2 populations. Alternatively, the mean age of the nonprivate practice patient population could be younger because of older, nonprivate patients losing contact with their primary care provider. Compliance with recommendations for referral and follow-up care was lower than expected in both groups and not significantly different between the 2 groups.

Several reasons for poor compliance are possible. The apparent degree of illness in children tends to change rapidly, both in response to medications, particularly antipyretics, and to other circumstances such as time of day, mood, and temperament.

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Children can appear very ill to a parent in the evening at the time of the call, yet be remarkably recovered by the following morning when the office visit is to occur. Parents may sometimes exaggerate the child's degree of illness prompting an ED referral, perhaps owing to overinterpretation of symptoms and signs eg, vulnerable child or expecting a prescription to be called to a pharmacy without a physician evaluation.

The high costs of medical care, both emergency and primary, and prescription medications are often seen as prohibitive when no third-party coverage exists. Even with third-party coverage, there are often costs related to health care visits that are not covered by third-party payers, such as missed work, transportation, and sibling child care. A final possible explanation for the poor compliance with referrals is that caregivers sought care at health care sites other than the site to which they were referred such as local urgent care facilities or other hospital EDs.

This explanation is unlikely for several reasons.

First, Cincinnati has only 1 children's hospital, and it receives the vast majority of pediatric referrals from the metropolitan area. Second, in the geographic area of the practices in the study, there are limited alternative sites available urgent care facilities ; the primary urgent care facility in the geographic area is a satellite of the Children's Hospital the records of this satellite were reviewed to document compliance with referrals.

Third, of the small number of alternative urgent care facilities in the geographic area, all have excellent systems of feedback to the primary care source copies of patient encounters are sent to the primary care source. The records from the primary care source were reviewed to capture this information. The use of nursing staff using published medical protocols to provide after-hours medical triage and advice is effective and provides high satisfaction to caregivers and physicians.

There may be a tendency for higher use of such a service by young, isolated, inexperienced caregivers with limited medical and parenting skills. This should prompt the primary care physician to include education about telephone medicine and use of ED and urgent care facilities as part of the routine health maintenance visits. Increasing compliance with referrals requires a proactive approach and the establishment of trust among the caregiver, physician, and nurse, which should be developed during repeated visits for routine health maintenance supervision.

Reprints: Raymond C.

Editor's Note: The finding that about half of both groups did not comply with the directions to take the child to the emergency department is surprising and very worrisome. It would be interesting to know what happened to these children—and to those who did make it to the emergency department.

DeAngelis, MD. Arch Pediatr Adolesc Med. All Rights Reserved.