ER triage over phone

Thunderwolf, MSN, RN · Oct 28, 2005

I agree...

student4ever · Oct 28, 2005

I agree in part. In my ER, we don't give out advice over the phone... and nurses sitting at triage cannot advise treatment plans either. However, if the condition seems very emergent (possible head bleed, high feever w/ headache, etc.) we will say that it would be a good idea to be checked out, and we would be glad to see them. We cannot advise people, because they must make their own medical decisions, otherwise it's a liability. If we tell you it's not serious, you can stay home, you record the conversation, die, and then family sues, the nurse is then liable.

Trauma Columnist · Oct 28, 2005

I work in large ER and we used to (over 5 years ago) give advice over the phone. However, our hospital now has a telephone triage line that takes 30,000 calls/month and they record everything, get info from callers, etc. The only thing I ever say on the phone nowadays is that if you feel you need to be seen now, we will be glad to see you. That is all we (as employees) are allowed to say.

webbiedebbie · Oct 28, 2005

I recently started working in telephone triage. I believe this is where healthcare is headed. Most insurance companies offer this service and I think it is very beneficial. We are extensively trained to handle all calls. Specifically, based upon the information we receive, we can direct the patient to the safest point.

You can check your insurance benefits to see if this service is offered, and if it is, have the peace of mind of knowing you can have your needs met.

missnurse01, MSN, RN · Oct 28, 2005

same here-we can only say that they can wait to see their doc or come in and we will see u. we do have an 800 number to refer them too, but they also seem to have their hands tied too as we get the faxed info that the 800 number gets and everything says, go to the er. we are a smaller hosp and would love to be able to help people over the phone or in triage, but money and legal prob is always the final say! my good friend who does charge on the w/e got written up for telling a girl who had no complaints in triage that she would save money to just go to walmart to get a pregnancy test. she flat out said that was all she wanted and denied all other symptoms, my little hosp just looked at it as money out the door...although i don't know if they could have gotten any money from her anyway. the whole thing is a mess and i agree that it contributes to the overcrowding issue. wish people would at least try to call their primary docs before they come in if poss...uck.

**canoehead, BSN, RN** · Oct 28, 2005

It's a very poor idea to tell someone they can wait to be seen, just because they may be leaving out the most important symptom. For example, someone calls with a rash, but doesn't realize they have a fever too, or hasn't noticed that it is spreading...

I always make no bones about it if I feel they should be seen immediately. I tell them "you should come in right now." But as far as nonurgent complaints I will only say that if they need to be seen we are happy to have them come anytime.

flashpoint · Oct 28, 2005

We aren't allowed to give advice over the phone either. But...if someone calls and has an obvious emergency, I will tell them that it sounds like they need to be seen...if the emergency is life threatening, I will tell them to hang up the phone and call 911. I would much rather stick my neck out and tell them they need to be seen (even if it turns out that they could have waited) than not. If it is something that doesn't sound like an emergency...I'll give the speech about how we cannot give advice over the phone but that they are certainly welcome to come in...

Noryn · Oct 28, 2005

When I worked in an ER we were not allowed to give advice either. We did sometimes tell them they should come in if it sounded like an emergency but with the legal situation the way it is now, it really does put you at risk. My personal family doctor now is unable to treat patients over the phone during the hours she is closed because of her malpractice insurance.

Another issue I ran into as well is that if you tell someone to come in and it isnt considered an emergency or appropriate then their insurance may not pay for it and they are on the phone with your nurse manager immediately. So it is a double edged sword.

Working in an ER, I have to say that there is no substitute for a physical assessment. I have worked telephone triage and one major limit is that you are assessing someone through another person's eyes. That person may have a variety of factors that can interfere such as developmental delays or even personal experiences. It was often that patients would come into the triage room and underestimate and overestimate their injuries. Especially "little old ladies" who complained of slight indigestion--based on appearance too you didnt even have to wait for a 12 lead to know they were having a cardiac event.

PamUK · Oct 28, 2005

As you can tell, I live in the UK & we have a national system called NHS Direct. It is a telephone help-line which anyone can call for medical advice. Manned by Registerd Nurses, they have strict protocols to adhere too and I believe that the computer software prompts them to probe a bit deeper & ask pertinent questions. The range of calls they get is enormous, from heart attack to child-birth to the common cold.

I dont think there have been any serious errors (it would have been in the national papers otherwise). Doctors were generally aginast it at first, because it was manned by nurses and they must have thought we are a bunch of eejits! But I think that they realise the benefits now

KatieBell · Oct 28, 2005

ER triage over the phone is a "no-no" in my book. I've never been allowed to do it either. It is too difficult to tell what is going on. There is just too much potential for a big problem. In addition, because of EMTALA laws we can not tell anyone their problem is not serious enough to be seen in the ED. Anyone who feels they might have an emergency has the right to be seen and given all needed screening exams...

Telephone triage is totally different, as they have a big fat book of protocols and policies to cover any condition and the nurses are trained in t. triage. Sitting in the ED we do not have that...and as we all know people give us incorrect information all the time, much better to be able to look at you. Noryn has a good point about over and underestimating- many times I've heard "He's covered in blood" only to find 2 spots of blood on the guys shirt from a nose bleed. both are problems, but there are different approaches to them...

neneRN, BSN, RN · Oct 28, 2005

I get these calls in the ER all day long; we are not allowed to give medical advice. I always tell them that I cannot give them advice, but we will be more than happy to evaluate them. If they press for further info, I tell them that the causes for ANY complaint can range from something very minor to something life threatening and tell them again if they are concerned or unsure whether to come in, we will be happy to see them.