Standards-Based Telephone Triage (AAACN, 2018)

• Safe:  TeleTriage Systems has a spotless safety record since publication (1995). There are no malpractice cases related to the use of TeleTriage Systems’ guidelines.

• Multi-Purpose/Multi-Setting: Applicable to a range of clinical settings: Home Telehealth Visits to Face-to-Face Encounters, Emergency Department, Urgent care, and Ambulatory Settings (Office, Clinic, Surgicenter  and Student Health Settings).  

• Five-Level Triage:  A unified method for assigning triage that is innovative and exclusively unique to this system (AAACN Telehealth Standard 2, 3). Includes defined clinical prioritization nomenclature:  acuity classifications, descriptions, time frames and sites for follow up. 

• Uniquely Patient Centric & Age-Specific.  Explicitly state the population to which they apply (IOM). Content is customized to three unique age groups: Infant-Child (Birth to 6 Years), School Age (Age 6-18 Years)and Adult (Age 18 +years )  (AAACN Telehealth Standard 1)

• 5-8th grade literacy level  Assessment questions and home treatment Instructions facilitate communication and call brevity. Developed to serve all literacy levels, (AAACN Telehealth Standard 1, 5, 6)

• All economic levels:  Originally developed for a large facility serving low-income, high risk, multi-cultural populations. Advice for home treatment and first aid features low-cost, treatments commonly available in the home, plus recommendations for free self-help and support groups.

• ACCESS — Round -the -Clock Design supports 24/7/365 patient access policy — not just office hours.  (AAACN Telehealth Standard 1)

  • Adapted from American Academy of Ambulatory Nurses Telehealth Standards, 2015

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Standards-Based Five-Level Telephone Triage (Manchester Triage Group, 2015)

In 2015, the Manchester Triage Group set forth requirements for on-site triage. MTG Triage requirements also apply to remote triage systems. Teletriage Systems guidelines meet MTG triage requirements.

1. Nomenclature:  Basic terminology and descriptions. 

2. Definitions of terminology. Clearly defined classification levels

3. Robust Triage methodology.  5-Level Triage with clear instructions on when, where and why patients are to be further evaluated as appropriate

4.  Acuity classification. Based on Five-Level Triage (Emergency Severity Index or ESI) i.e. Life threatening, Emergent, Urgent, Acute, Non-acute.

5. Clinical Training Program. Robust clinical training program

6. Audit (QA, QI).  QA Audit

• Adapted from Manchester Triage Group, 2015

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 Standards-Based Criteria for Guidelines (Institute of Medicine (IOM), 2011)

Like other Telephone Triage Protocols and Guidelines, teleTriage Systems Paper-based Guidelines have yet to be Evidence-BAsed. However, the Guidelines Achievable meet the IOM Criteria for Clinical Guidelines in the first five of six categories below. Clinical Computerized Decision Support Systems (CCDSS) should also adhere to the same criteria especially in the era of AI-Augmented Clinical Computerized Decision Support in healthcare.

•  Explicit:  clearly state the populations to which they apply

• Clarity: a user-friendly presentation, written in unambiguous language, using precisely defined terms

• Transparent: Users can clearly understand how they work

• User’s Guide:  Since 1993, the only paper-based guidelines with a Users’ Guide — 30 page with full operating instructions, describing assumptions and exceptions to recommendations.

• Reliable: designed to result in safe, timely outcomes. 5-Level Triage

• Reproducible Outcomes (EBM-verified): different groups of clinicians are likely to choose the same safe dispositions

• Adapted from Clinical Practice Guidelines We Can Trust, IOM, 2011