Which is more important - the nurse or the protocols?
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 | Excellent protocols are essential but no protocol can cover every situation. Therefore, the key to a high quality, effective telephone triage program is adequate numbers of well trained, experienced nurses. The best candidates should have at least 5-10 years of nursing experience, excellent interpersonal and communication skills, and the ability to make good decisions under conditions of uncertainty and urgency. These nurses should have formal training in telephone triage skills and proper use of the protocols. On-the-job training is not adequate.
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What is telephone triage?
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| Telephone triage is the safe, effective appropriate disposition of health-related problems by nurses by phone. Telephone triage may include symptom assessment, counseling, home treatment advice, referral, information brokering, disease management and crisis intervention. RNs with specialized training and experience in decision-making employ decision support tools (protocols or guidelines) and the nursing process (assess, diagnose, treat and evaluate). Telephone triage has been compared to the work of air traffic controllers, anesthesiologists and emergency medical dispatchers in that it involves making sound decisions under conditions of uncertainty and urgency.
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Why is training in telephone triage so essential?
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| All training should be designed to facilitate the transfer of previous knowledge and skills from known areas of expertise to new areas. Further, training can reduce some of the uncertainty and enhance decisionmaking. Thus, it builds confidence while providing a feedback loop for participants to answer questions. Training offers a low stress opportunity to "try out" the new product - further enhancing staff buy-in. Finally, it helps to assure that the protocols will be used correctly and consistently, a practice that enhances risk management.
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| What are the best training techniques for telephone triage?
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| Since people learn in different ways, an all-inclusive approach is best: reading, lecture, discussion, analysis and critique of audiotaped case studies, and role-play, using prepared scripts. Simulations and role-playing synthesize previous experience and provide the opportunity of practicing telephone triage in low-risk situations. Participants alternately take the role of patient and nurse: "patients" calling in from another room and "nurses" using protocols and documentation forms to simulate the real-life experience.
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