SYSTEM-BASED

The system seamlessly integrates training text/audiotape, on site and self study programs, protocol competency exam, specialized training programs, standards, paper and electronic protocols/form and QA tools.

 ANNUAL UPDATES

The only paper protocols with annual updates - 75 pages of new or revised protocol content.  Last updates for Adult/School Age version was 2003.  Last update for Infant/Child version was 1998.

USERS GUIDE

DESIGN

The unique design is a synthesis of both algorithm and case-based reasoning which mimics the brain's natural problem solving by utilizing a symptom recognition/matching strategy. This "real world" approach to decisionmaking has been identified and validated by Vimla Patel in her research of telephone triage nurses practicing in the ER setting.

FORM

The integrated form facilitates thorough documentation and risk management by facilitating elicitation of key information.  This reduces common pitfalls: inadequate data collection, jumping to conclusions, and use of wrong protocol.

MASTER TEMPLATE

A "fall back" protocol that supports nurses with generic descriptions of common emergent, urgent, acute and non-acute problems, in cases where existing protocols may not apply.

Comprehensive

The most comprehensive (500 + pages) paper resource for identifying, interpreting and classifying symptoms. Each of the fifty-protocol address approximately 1,500 possible conditions and diagnoses. Since initial publication, no user has identified weaknesses, missing protocols or major errors. The product has required minor updates and adjustments only.

Users Guide

The only protocol manual with 80+ page User¹s Guide.

Master Template

A "fall back" protocol that supports nurses with generic descriptions of common emergent, urgent, acute and non-acute problems, in cases where existing protocols may not apply.

Protocol Standards

Farnsworth and Mariani (1996) researchers in medical decision making, have described desirable qualities for Practice Guidelines. They drew upon criteria developed by IOM (Institute of Medicine) and AHCPR (Agency for Health Care Policy Research).

CQI

In regard to development criteria, IOM recommends the development processes include representatives of key affected groups and have scheduled review. The base protocols were developed by a multi-specialty task force of 20 expert level nurses, nurse practitioners, and physicians under the direction of Sheila Wheeler, expert in telephone triage and protocol design. The protocols have been updated annually since 1994. They are reviewed and revised annually by selected experts in collaboration with Wheeler. Continuous Quality Improvement feedback has been solicited by end users since the first publication of the protocols in 1995.

Provision of Assumptions, Analytic Methods, and Rationale in Protocol Development.

IOM further stresses there be documentation sets forth the assumptions, analytic methods, rationales used in protocol development. Assumptions, methods and rationales are proprietary information, but may be discussed with prospective clients provided a Non-Disclosure Agreement has been signed.

While these standards apply to all telephone triage protocols, many cannot meet them. These protocols meet and exceed the following criteria: 

• Validity - if followed, it will lead to expected outcomes
• Reliability/reproducibility - given the same data, another  set of nurses would produce the same results
• Clinical applicability - explicitly states the populations  to which they apply
• Flexibility - identifies exceptions to their  recommendations
• Clarity - unambiguous language, precisely defined terms,  easy to follow mode of presentation?

1) Validity and Reliability/reproducibility

If followed, it will lead to expected outcomes: The protocols will only work in the areas of validity and reliability, if qualified nurses, well suited to the work of telephone triage, with sufficient training and good judgement are operating them. If this standard were maintained, then given the same data, another set of nurses would produce the same results.

2) Clinical applicability

Explicitly states the populations to which they apply. These protocols primarily apply to male and female adults (Age 18+) and school age (Age 6-18) children of all risk levels, socioeconomic status and literacy levels. Specific protocols apply to Infant Child age groups (Birth to Six years). The protocol address commonly presented symptoms for approximately 1,000 conditions

3) Flexibility

Identifies exceptions to their recommendations. There are rules or provisions for situations, which do not fall into typical presentation: 

• When no protocol seems to apply
• When dealing with high-risk patients, atypical symptoms  or situations
• When in doubt as to what to do
• When the nurse wishes to upgrade or downgrade.

4) Clarity

Unambiguous language, precisely defined terms, easy to follow mode of presentation? The authors of the protocols made every attempt to achieve the goal of clarity. We used 5th the eight grade level so the protocol information could be read directly to the caller, rather than having to either "retranslate" it from college to 8th grade level. In this edition, we simplified the format to streamline the process and direct the eye through he protocol. Abbreviations are included.