American Nurse Journal (ANJ)Telephone Triage Nursing: When Patients Call

The role of telephone triage nursing in telehealth: implications for patient care and healthcare resource optimization.

Telephone triage nursing is a critical component of telehealth, providing registered nurses with the opportunity to utilize their clinical skills to assess patient needs remotely. This practice plays a vital role in determining the appropriate level of care for patients, reducing unnecessary emergency department visits, and offering timely advice and education. The process involves a structured approach using established protocols and requires strong communication and critical thinking skills. This article explores the role, training, and processes involved in telephone triage nursing, emphasizing practical implications for clinical practice.

Key Points:

• Role and Scope
  • Telephone triage is a unique aspect of telehealth nursing, allowing RNs to assess and manage patient care remotely.
  • Nurses in this role can work in various settings, including healthcare provider offices, outpatient care centers, telephone triage centers, poison control centers, crisis hotlines, managed care organizations, or health insurance companies.
  • They provide guidance on whether a patient needs emergency care, can wait for an appointment, or can manage their symptoms at home.
• Critical Skills and Processes
  • Telephone triage nurses rely heavily on critical thinking, clinical judgment, and communication skills, as they cannot use their senses of sight, smell, or touch.
  • They use published protocols, guidelines, and algorithms to manage calls, including Schmitt’s Pediatric Telephone Protocols, Thompson’s Adult Telephone Protocols, and Bunik’s Breastfeeding Telephone Triage and Advice.
  • The process includes an introduction, confirmation of demographics, brief medical history, chief complaint, assessment and guideline selection, triage, transition, advice and education, and closing.
• Training and Preparation
  • Training for telephone triage nursing can take several weeks to months, depending on prior experience.
  • New nurses undergo training that includes reviewing organizational policies, role-playing, mock calls, and observing live calls triaged by experienced nurses.
  • Continuous evaluation and quality assurance are essential to maintaining effective and safe telephone triage practices.
• Assessment and Decision-Making
  • The assessment process involves interviewing, data collection, and prioritizing care needs based on the patient’s responses and any audible indicators.
  • Nurses must develop an effective plan of care based on the assessment and use decision support tools to guide their recommendations.
  • The encounter concludes with ensuring the patient understands and agrees with the plan, including when to seek further care or follow-up.
• Qualities and Competencies
  • Telephone triage nurses need several years of clinical experience, excellent communication skills, and the ability to provide empathetic and objective advice.
  • They should be proficient with technology used in telehealth, including digital protocol telephones, video conferencing, and computer software.
• Safety and Efficacy
  • Studies have shown that telephone triage nursing, when using computerized decision support systems, maintains a high level of quality and safety.
  • Research indicates no significant difference in outcomes between telephone triage nursing and traditional care, confirming its safety and efficacy.

“Telephone triage nursing is more than just a phone call. It’s an art that combines the science of nursing, clinical knowledge, critical thinking, and digital technology.”
– Christina M. Rausch, MSN, RN, CPN; Quality and Nurse Educator at University Hospitals-Rainbow Advice Center in Cleveland, Ohio

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