|
FREQUENTLY ASKED QUESTIONS ABOUT WHEELER PROTOCOLS
Sheila Wheeler provides answers to common questions about Telephone Triage Protocols, the philosophy of the developers, the protocol track record and the rationale for the unique design.
What is the background of the developer?
Sheila Wheeler has practiced in and pioneered the field of telephone triage since 1982. Her expertise derives from her vision of the field, experience as a telephone triage practitioner, author of a training manual and protocols, product developer/researcher and conference developer/founder. In 1993, Wheeler authored the best-selling text - "Telephone Triage: Theory Practice and Protocol Development" - the first training manual and audiotape for novice practitioners. It was the first text to describe how to write protocols and remains a classic and is used by over 60,000 nurses currently.
In 1994, Ms. Wheeler served as Editor-in-Chief for development of "Telephone Triage Protocols for Adult and School Age Populations" (Delmar), the first comprehensive, age-based, updated and customizable paper-based (and later electronic) telephone triage protocols.
In 1994, Ms. Wheeler founded the first the annual national conference - "Telephone Triage: Essentials for Expert Practice", now in its ninth year and attended by over 6,000 nurses, nurse managers and industry experts. For seven years, Ms. Wheeler served annually as chairperson and guest speaker.
How were the protocols developed?
The protocols were developed over a two year period by a task force of 20 expert level nurses and two physician reviewers under the direction of Sheila Wheeler, the Task Force Leader. The task force was trained for eight hours in protocol development, then broke into three specific groups: Pediatrics, Adult and Women's Health. Each group worked collaboratively under the direction of Wheeler and created approximately 10-20 drafts of each protocol. These, in turn were proofed and rekeyed by editorial assistants and reviewed by Wheeler for consistency and accuracy. Finally, each protocol was reviewed by physicians, revised and approved.
What is the background of the contributing authors?
The bios of the physician reviewers as well as the nurse contributing authors are located in the appendix of the protocol manuals. Medical reviewers for the project include Robert Pantell, M.D., Chief of General Pediatrics at the University of California, San Francisco, Edwin C. Pigman, M.D., Medical Director of World Access, Richmond, Virginia and Russ Kino, M.D.,Medical Director of ER on Call, St. Joseph's Medical Center, Santa Monica, CA.
The nurses and nurse practitioners were selected for their expertise in Adult and Geriatric Medicine, Pediatrics, Women's Health, or were expert practitioners working at Santa Clara Valley Medical Center. The protocols represent the assembled expertise of the task force members, most of whom had 20 or more years of experience.
What references were used as resources for the protocols?
In developing the design the task force referred to other protocols and standard references currently on the market. They synthesized and distilled information from over 200 of the latest classic and "gold standard" medical and nursing texts, listed in the reference sections.
What makes the protocols unique?
The protocols have many unique features. They are the only paper protocols that are age-adjusted, updated annually, comprehensive, user friendly, and customizable. Age-based protocols are integrated into a single volume with separate sections for Women's Health and select Infant-child protocols. Thus, the volume addresses presentations, diagnoses, dispositions and treatments that are unique to all age groups.
Annual updates help to insure a longer "shelf life" and current information. Selected protocols are reviewed and revised annually. Because the protocols cover approximately 1500 possible diagnoses and over 500 informational topics, these volumes are one of the most comprehensive products on the market. Even though they are information-packed, the overall design is structured to facilitate the interaction, making the protocols quick and easy to use. These protocols are written at the fifth to eighth grade reading level for the widest client application.
Can the protocols be customized?
Yes, the three ring binder makes these protocols highly customizable. For example, to create a Women's Health version, simply remove any protocols that don't apply (i.e., penile problems, heat, cold exposure, burns and bites) from the three ring binder. You may then add specific protocols of your facility or modify the remaining ones. I suggest typewriting preferences on a colored sheet, placing it behind the corresponding tab, with the directive that the user always refer to "the blue (pink, yellow) sheet".
Do the protocols cover Women's Health?
If you review the enclosed Table of Contents carefully, you will see that Women's Health primary care for both adults and adolescents is addressed throughly. Core Women's Health Protocols address common symptoms and informational questions such as: Abuse: Sexual and Physical/Elder; Breast Problems, Breast feeding Problems, Emotional Problems, Post Partum Problems and Concerns (Discomforts), Pregnancy Problems and Concerns (Discomforts), Urinary Problems, Vaginal Problems and Bleeding, and Women's Health Issues: Birth Control and Menopause Concerns and Frequently Asked Questions.
How are the protocols organized?
You will notice that the protocols are organized alphabetically and by site (i.e., abdomen, back, chest, ear, neck, urinary, etc). This unique feature enables nurses to quickly locate the correct protocols, using the patient's own words for where the problem seems to originate. While appearing simplistic, this streamlines the "search" process by using lay terms beginning with location, followed by symptoms. For example, whether a patient presents with a foreign body in the eye, trauma to eye, contact lens problems, pain in the eye, visual problems, red eye, sudden loss of vision, or discharge from the eye, the nurse will always start with the Eye Problem protocol, thereby eliminating time consuming and frustrating searching for the "correct" protocol. Patients can usually tell the nurse where the problem is located. Location of symptoms provides the best starting point for pattern matching and further questioning.
Some protocols are not site based, like dizziness, fever, fainting, burns, bites, vomiting, nausea, etc. They are listed alphabetically.
Are the protocols algorithmic format?
The protocol design is a hybrid of algorithm or decision tree and pattern matching approaches. While some maintain that strict algorithms are the more scientific approach to medical decision making, to date, there are no outcome studies that demonstrate that algorithms or decision trees produce superior results. However, one important study done by Vimla Patel (1995) has found that telephone triage nurses use context, or pattern recognition to make medical decisions. Pattern recognition approaches mimic how the human brain naturally solves problems. Thus, we have based this design on a combination of semi-algorithmic and pattern recognition models.
How do the protocols work?
The protocol format is unique and incorporates several decision-making strategies: 1. "case based" or "classic picture; 2. "red flags"; 3. "rules of thumb"; and 4. allowance for intuition. Research demonstrates that experts use each of these strategies to make decisions under conditions of uncertainty or urgency, in combination or separately, as the situation requires.
The decision making approach is predicated upon the following
premise: that adequate data must be collected initially, before
choosing a protocol. Adequate data collection supports the
pattern recognition model. The complementary documentation form
supports pattern recognition through facilitating thorough data
gathering using key "trigger questions". These questions are
based around the concept of "critical indicators" and designed
to quickly elicit standard data, as the situation requires:
- "global" (broad categories of high risk problems and patients);
- symptom history;
- patient history; or
- baseline state of health.
Pattern recognition strategies mimic natural ways in which the brain solves problems. Decision support systems that support pattern recognition helps reduce the "wrong train syndrome"and redundancy while facilitating safe, effective and efficient problem dispositions. Red flags identify groups of high risk patients and problems. Rules of thumb are incorporated as quick ways to make decisions (i.e., "kids get sicker quicker").
What is the best way to use the protocols?
The nurse should start by asking open-ended questions and using the documentation form to collect as much standardized information as possible. The documentation form has key "trigger" words to facilitate collection of standardized data. After the nurse has gathered sufficient data, s/he consults the protocols. The protocols serve as a repository for "classic pictures" or patterns of common emergent to non-acute conditions that the nurse may encounter by phone. The nurse matches the pattern that s/he has elicited from the patient with the patterns listed in the protocol, perhaps asking a few more detailed questions from the protocol. If a match is found, then the nurse follows the directives regarding the disposition. Thus, the protocol manual serves as a sort of "Merck Manual" for pattern matching or decision making.
Is training for these protocols available?
Yes, protocol competency training is available and recommended. On-site training of groups is provided by Sheila Wheeler. Training is also available by Home Study. The Protocol Competency Course is available for 5 contact hours. This course is available at individual and group rates.
Are these protocols useful in all settings?
These protocols are suitable for call centers, internet based services, HMO, group practice, student health, school nurse, office, county hospitals or community clinics, ED, public health or home health settings.
Can the content be licensed to create customized electronic versions or for resale?
Yes, TeleTriage Systems licenses the protocol content to companies wishing to develop or enhance existing electronic protocols. The content may be licensed for the following uses: CD, internet-based call centers, or electronic protocols of any type. TeleTriage Systems will license the content to be customized and modified in any manner. Consultation to assist in the interpretation of the content into an electronic format is available. Please contact Sheila Wheeler at 415.453.8382 to discuss prospective licensing arrangements.
Who were the medical reviewers for the Protocols?
The three physicians listed above served as medical reviewers for the protocols.
|
