Telehealth Nursing

Protocol & Guideline Description

Remote medical diagnosis and estimating symptom/patient acuity are not synonymous. 

• ON Site Diagnosis:  requires physical examination and testing to identify the cause of an illness by  

• ON Site Triage: requires preliminary assessment of symptomatic patients to determine the urgency of their need for treatment and the timing and nature of treatment required. requires the  sorting of patients — in person.

REMOTE NURSE TRIAGE requires clinicians to assess and sort symptomatic patients according to their combined symptom and patient acuity to determine the need for additional on-site evaluation, testing or treatment. Telehealth nursing requires clinically-informed estimates and decisions about when, where, why and whether symptomatic patients require additional on-site evaluation and treatment.

• Updated Remote Nurse Triage References: Remote Nurse Triage 5-Level Flow Chart, Triage QA Audit, Clinical Training & Safety Research
  
  Checklists – Five standardized screening checklists help to rule out -- and to rule in -- key symptoms to estimate symptom urgency and reduce mistriage (Gawande, 2009; Wachter 2015)

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  5 –Level Triage Dispositions – insure patient informed consent and continuity, directing patients to where, when, why and whether they should be further evaluated on site. This approach consistently apprises callers of their estimated acuity in terms they understand, and fulfills clinicians’ “Duty to Warn” (Tennenhouse, 1993). Five clearly defined, standardized dispositions — with firm but flexible time frames, access sites and urgency rationale —promote consistent outcomes and support patient compliance..

  
  All Hours/All Access Sites  ispositions apply 24/7/365; they are not limited to office- or after- hours. Access sites are flexible for all hour options.  Expanded Office, Clinic and Urgent Care Clinic Hours are beginning to proliferate, enhancing patient access and helping to reduce Emergency Department overcrowding.

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  Standards-Based System to reduce common errors: inadequate data collection, miscommunications, cognitive bias and inadequate informed consent and continuity (IOM, 2011, Donabedian, 2003, Patel, 1996, AAACN, 2012)

•  A Universal Guideline Adapts ACEP symptom acuity categories. Meets Manchester Triage Group triage criteria. The Universal Guideline design has potential to support clinical triage as:

  • 1. a template is a structure for designing a full set of guidelines

  • 2 a contingency or “fall back” guide for cases where no specific guideline applies

  • 3. a preemptive guideline, or “go to” guide before selecting a more specific guideline

  • 4. a training tool for newly hired nurses (as an introduction to a new remote nurse triage system, a review of practice and commonly presented symptoms (IOM, Joint Commission, 2011)
    
    The Universal Guideline serves both as an “Uber Triage Check List” as well as a Guideline Template for 45 + Site-Based Chief Complaints. The unique remote triage design is transparent, explainable and consistent. The clinical approach supports pattern recognition, patient context and heuristics that nurses typically use (Lephrohon, Patel, 1995), 

• As an integrated system, the guideline design, clinical approach and clinical training increase clinical opportunities to make safe decisions by:

  •  adapting the nursing process to apply to remote nurse triage

  • describing broad patterns to identify high-risk symptoms, plus broad patterns of emergent to non-acute conditions

  •  listing broad categories of high-risk patients — Patient Contextual Patterns

  •  integrating built-in safety prompts and standards intended to reduce recurrent error

  • requiring training for remote clinical decision making.

• Essential, Unique Features:

• Evidence-Informed  Standards are derived from Manchester Triage Group, Emergency Medicine, American College of Emergency Physicians, Institute of Medicine, Joint Commission, AAACN, etc.

• Comprehensive – Address the most common presenting symptoms, from rare, but predictable emergent to common non-acute symptoms –1,500 medical conditions addressed in 45 symptom-based guidelines
  Risk Management Used in several thousand sites since 1995 with no report of errors, omissions or malpractice.
  User's Guide describes how to operate this reference (30 pages)

• All Ages (Since 1995) Infant-Child (Birth - Six Years), School Age (6 -18 Years), Adult (18+ Years)
  Cost effective Paper-based guidelines are economical; electronic algorithms can be extremely costly

• TeleTriage Systems welcomes EBM research on safety and reliability of the Universal Guideline