Jennifer Larson, NurseZone feature
Townsend, RN, knows exactly what to do if you get bitten by a turtle.
a charge nurse with the Call a Nurse program at Methodist Children’s Hospital
of South Texas in San Antonio, picked up the phone one evening to hear a worried
mother on the other end of the line. A small turtle had bitten the woman’s
3-year-old son on the hand and broken the skin. The mom was worried that her son
might contract a disease from the bite.
was used to fielding calls about dog and cat bites, but a turtle bite was a new
case for her. She consulted her call center’s computer program guidelines, but
it only had information on animal bites in general.
to look it up in one of our reference books, but we still used one of our bites
protocols,” she said, adding that she recommended the woman take her son to
the local emergency room, since animal bites can get infected easily.
bites, jellyfish stings, fevers, colds, earaches and upset stomachs: they’re
all part of a day’s work for Townsend, who works the night shift for
Methodist’s pediatric telephone triage and health information phone line.
Townsend handles pediatric calls, other health systems’ nurses answer calls
about adult health concerns. Some actually schedule appointments for callers,
and others provide health information. No matter the job, they all have one
thing in common: they provide special health care service over the phone.
people lump any phone-related services into the broad category of telephone
triage, telephone triage is actually a specific service that encompasses a wide
array of nursing skills.
Wheeler, president of TeleTriage Systems and author of Telephone Triage:
Theory, Practice and Protocol Development, writes, “Triage means a sorting
out. Telephone triage involves ranking clients’ health problems according to
their urgency, educating and advising clients, and making safe, effective, and
appropriate dispositions—all by telephone.”
triage can include symptom assessment, counseling, crisis intervention,
information brokering, disease management and referrals for appropriate
treatment, according to Wheeler.
field telephone calls often report respiratory ailments are common complaints
from callers, as are sore throats and colds. Other common calls from adult
patients include urinary tract infections and chest pains, said Ginger Gebhardt,
RN, a telephone triage nurse with the Mayo Clinic-Scottsdale in the Phoenix,
many but not all nurses who perform telephone triage services use computerized
programs that lead the nurses through a series of standardized protocols for a
variety of health care problems that they might be asked to address over the
Children’s Hospital uses a computer program called Centaurus. The program has
guidelines for each nurse to follow.
them some questions, and that’s how we do our assessments,” Townsend said.
“Based on what kinds of symptoms the patient is having, we determine if they
need to go to the ER right away or if it’s something they can treat at
home care tends to account for about half the calls received by Call a Nurse
nurses. In March, 47 percent of the calls received were routine home care, while
about 23 percent of the calls resulted in a recommendation for the caller to
follow up with a physician.
existing computer protocols for common pediatric ailments like croup, but at
some times, the nurses have needed to be creative.
example, Call a Nurse often gets calls about jellyfish stings because the
calling area includes the coastal town of Corpus Christi. But until recently,
there wasn’t a prescribed protocol for jellyfish stings.
service’s medical director gave the nurses some general guidelines, and they
worked to put together a protocol in a format compatible with the Centaurus
program, Townsend said. Eventually, it became a standardized protocol.
Clinic-Scottsdale operates a telephone triage service, but the service has not
yet moved to a computerized protocol system, said Gebhardt, who has been working
there for about 13 months.
service has three to five nurses taking calls from 8 a.m. to 5 p.m. on weekdays.
The nurses refer to the book Telephone Triage by Julie K. Briggs as one
guideline and use some existing handwritten protocols.
use each other as backup sources,” Gebhardt said. “If we have any other
problems, we go to the physicians directly.”
nurses at the Mayo Clinic-Scottsdale do have a computerized system of patient
information, so they can pull up a patient’s electronic chart while he’s on
the phone. They can add clinical notes to the electronic chart, which they often
e-mail to the patient’s physician.
talk to people and decide whether to offer home treatment advice over the phone
or schedule the caller for an appointment at the clinic. Like other telephone
triage nurses, they often refer callers to urgent care centers or the emergency
room in certain situations.
Gebhardt said, the nurses do have the ability to call in standing prescription
orders, such as Diflucan for a patient with a recurring yeast infection, or
order simple lab work or X-rays for a patient who is scheduling an appointment.
phone call taken by a nurse is a triage call. Sometimes nurses dispense health
care information or make outgoing calls to check up on patients who were
recently discharged after surgery.
Willie, RN, is the manager of the Dial A Nurse service operated by St.
Vincent’s Hospital in Birmingham, Alabama. The primary function of Dial a
Nurse, which operates on weekdays, is to provide health information, Willie
other phone services, Dial A Nurse logs phone calls on a computer system.
field 100-200 calls in an average day, for a total of 2500-3000 per month. But
there are days when the nurses are constantly fielding inbound calls while
trying to make outbound calls, too.
are “feast of famine” in terms of call volumes, but usually “our nurses
are hugely busy,” Willie said. “You just can’t predict what’s going to
20-40 calls each day are made to patients who were discharged after outpatient
surgery, and nurses make a few more follow-up calls to patients who suffer from
congestive heart failure. A handful of calls are crisis calls, requiring the
exquisite care and attention from the nurse who answers such a call.
are probably the most tense ones because you don’t know what you’re up
against,” Willie said. “You don’t want to get off the line with them. You
want to stay on.”
instances, the nurses will try to keep the callers on the line until emergency
medical services can reach the caller.
It can be
hectic, but the nurses who work as telephone triage nurses often say they love
their work for the challenges it presents. Unlike many situations in which
nurses work with patients, these nurses can’t actually see their patients.
the variety, the unknown,” Willie said. “It’s always exciting. It’s
always challenging, and you stay busy. People do not realize how much work goes
on in this tiny little office.”
like solving a problem without seeing all the puzzle pieces,” added Gebhardt.
“I enjoy the challenge of trying to find out what’s wrong and trying to get
somebody the correct help that they need.”
April 26, 2002. © 2002. NurseZone.com. All Rights