12 Guidelines for Safe Care
If there is no way a practice can give patients timely appointments, then it makes sense to focus on offering safe telephone triage, to determine which patients need to be seen sooner, rather than later. If your office is going to undertake telephone triage, here are some guidelines:
Take seriously the responsibilities inherent in taking telephone calls. When you accept a call, you are liable for any advice given, as well as advice called for (based on the patient complaint) but not provided.
Know the "red flag" complaints. For example, if a patient describes a mole as irregularly shaped, that should raise a red flag of warning that this patient needs prompt evaluation, face-to-face.
Get enough information to give informed advice.
Give advice based on the worst-case scenario. Staffers who are performing triage should be trained about the worst case scenarios in dermatology. (Worst-case scenarios in dermatology may be the topic for a future column.)
If the call is about a previous problem or unresolved problem, revisit the problem until it is resolved. Get the patient in for an examination rather than keep telling him/her to call back in a few days.
Document history taken and advice given by telephone.
Adopt practice systems and policies for addressing telephone calls, including who may give advice to a patient, what credentials or training the advice-giver must complete, protocols for specific complaints, and who can vary from the protocol. Review and update the policies and protocols every year. Circulate the policies and protocols and have staff sign and date, acknowledging that they have reviewed them.
Include, in a triage form to be reviewed by the dermatologist and filed in the patient record:
Name, date, time of call
Call handled by [insert name]
Patient telephone number
Chief complaint and history of present illness
Disposition, including advice given
Prescriptions called in, if any, and time called in
Triage should be performed by the most educated and experienced people at the practice rather than the least experienced.
Set conditions for telephone advice, including:
a. That the caller is registered with the practice.
b. That the chart is available to the clinician giving the advice.
If you violate b, treat the patient like a new patient (redo the history). Do not violate a.
Do not give advice without the opportunity for followup.
Beware when the caller is not the patient. There may be confidentiality issues and/or translation issues, both of which increase the risk level of the triage.
The issues discussed in this column are not meant to be considered legal advice. For personal advice, readers are urged to contact a qualified health care attorney.
Dermatology Nursing. 2009;21(1):40-41. © 2009 Jannetti Publications, Inc.
Cite this: Guidelines for Telephone Triage - Medscape - Jan 01, 2009.