Audio Only Services: Tips for Triage Nurses

Practical tips for triage nurses, including documentation do’s and don'ts, and how to handle busy seasons.

Be Prepared

Think about each shift in advance – will it be busy or not? What's going around the pediatric office these days? What's the media been pitching lately in terms of health topics? Review your guidelines for "winter" illnesses and read up on topics like RSV and influenza.

Other tips to get ready include taking the time to tidy up the workstation; stocking up on essential forms or office supplies; and updating reference materials.

Documentation

Do not delay documentation. The main way to avoid this pitfall and stressor is to "document-as-you-go." This is where multi-tasking comes into play. Try to fill in some of the patient demographics while you are waiting for the phone to ring. Focus on documenting the positive symptoms and only record the negative symptoms when ruling out something serious. After hanging up the phone, finish documentation with care advice and recommendations for follow-up.

When multiple callbacks have to be made, remember that not everything is an emergency.

Tricks of the Trade

The following is a list of little tricks that telephone nurses have found to be helpful. These little things can really add up as timesavers.

• Headsets are a must! A headset keeps both hands free for documentation and/or getting reference material. For those who do not like headsets, consider a shoulder rest to free up the hands.
• Get the caller to focus on the immediate complaint. If having difficulty identifying the true reason for the call, ask "What is the one thing or symptom that made you call for advice right now?"
• If there are several difficulty breathing calls at the same time, handle one at a time by ensuring that it is not a 911 event, then provide a quick treatment recommendation (ie. start a neb for asthma; provide warm mist for croup), inform the caller/s that there are multiple emergencies and instruct them to start the treatment advice and await a call-back in 10-15 minutes. Go on to the next call, give the same type of quick advice and then make follow-up calls to evaluate the therapies and complete the assessment, disposition, and care advice.
• Use a four-tier IN/OUT box for: 1) Unanswered calls; 2) Completed calls to be faxed or filed; 3) Calls that need follow-up; and 4) Calls that need physician intervention.
• Keep a few good references close by: a telephone triage guideline book, a medication handbook, a medical dictionary, and a basic pediatric textbook.
• Be organized. Don't let messes pile up. Telephone triage has been compared to air traffic control: ask yourself "where is the best place to treat this patient — home, office, clinic, ED, ambulance?"
• Use a sports-type water bottle to prevent spills on the keyboard or papers.
• Remember to get up, stretch, get a drink, or go to the bathroom.

Note: The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. This content is for informational purposes only. It is not intended to constitute financial or legal advice. A financial advisor or attorney should be consulted if financial or legal advice is desired.

Additional AAP Telephone Care Resources

• Pediatric Telephone Protocols, 17th Edition
  A go-to resource for telephone care triage, which covers a broad spectrum of caller concerns.
• Pediatric Nurse Telephone Triage
  A decision-support tool that is a companion to Pediatric Telephone Protocols, and helps office staff deliver superior telephone advice.
• Breastfeeding Telephone Triage and Advice
  Resource to help nurses, lactation professionals, and other medical staff confidently advise breastfeeding mothers by phone.