Guidelines for Telephone Triage

Carolyn Buppert, JD, CRNP


Dermatology Nursing. 2009;21(1):40-41. 

In This Article

Accommodating Patients

That said, practices who take the advice will need a way to accommodate, in a timely way, patient requests to be seen as soon as possible. I have experienced frustration with a dermatology office’s approach to telephone triage both as a patient and as a primary care clinician. Several years ago, I called a dermatologist’s office as a patient with a worrisome lesion. There was no triage. I was offered an appointment 8 weeks in the future. I asked "What if it is cancerous? I’m worried about the delay in diagnosis." The staffer replied, "See a primary care provider and if he is worried, he can call us and we will fit you in sooner." I took the appointment and employed some self-care. The lesion disappeared just 2 days before my appointment with the dermatologist. There was nothing to examine. I called to cancel, and the staffer gave me a hard time about the late cancellation. I explained that I had called 8 weeks earlier, and had a lesion for 8 weeks, and couldn’t help that it cleared up just before my appointment. Both I and the dermatologist would have been better off fitting me in sooner. The lesion was back in a few weeks.

A year or so later, as a primary care provider, I called a dermatologist’s office for an appointment for a patient who had a suspicious lesion and who was sitting there with me. I described the lesion. Again, there was no comment and no triage. I was offered an appointment 8 weeks in the future. "I’m not comfortable with that time frame," I said, and described a worst-case scenario, and the potential liability for delay in diagnosis if this lesion was malignant. I was then offered an appointment 10 days in the future.

Practices may be uncomfortable with leaving appointment slots open for walk-ins with suspicious lesions, but given that a cancerous lesion shouldn’t be left to fester for 2 months, there must be a way to offer patients a quick-look visit, as a compromise between risky telephone triage and nothing. Some practices are resolving the problem by hiring nurse practitioners or physician assistants, who can perform histories, examinations, and biopsies, and whose work is reimbursed by third-party payers.