Risk Tip: Reducing Risks in Telephone Triage

Provided by The Doctors Company

The phone is a key area of responsibility for front-line staff, and it is critical for physicians to make certain that protocols for this important point of contact with patients are set, reviewed and followed. Otherwise, the practice is at risk.

While at one time it was merely a scheduling tool, phone interactions have become an integral part of practice. Phone triage is a critical tool in managing care delivery. It is frequently the first interaction with a patient and the care team, and can help determine the patient experience. Office staff picking up the phone can rank the caller’s health problems according to urgency, potentially educate and advise clients, as well as making safe, effective and appropriate dispositions. All of this, however, is done without the benefit of seeing the caller who is speaking and has risks. Without proper training and management, telephone triage can result in improper diagnosis and management, as well as legal liability.

Consider the following recommendations regarding the telephone triage system in your practice to reduce potential risk:

• Outline in written protocols the questions to ask the caller, the recommended responses for minor problems, and which calls should be referred immediately to a doctor or scheduled for an office appointment.
• Recognize top priority calls and instruct the patient to dial 911 for emergency situations that involve, but are not limited to, allergic reactions, chest pain, eye injuries, burns or shortness of breath/wheezing.
• Only physicians or qualified staff such as RNs, NPs and PAs provide telephone triage.
• Document all calls and the triage decision in the medical chart, indicating the protocol used and the advice provided. As much as possible, use the caller’s own words to describe the reason for the call. Many practices use specific forms - either paper forms or notes in the electronic records - to memorialize telephone calls. These forms then become part of the patient record and are available for other members of the health care team to review.
• Review all telephone triage decisions for appropriateness of actions taken.

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