By Raj Shah
Telephone triage is a crucial component in providing high-quality healthcare to patients. However, giving medical advice over the phone is legally considered medical practice and creates liability exposure because advice is given without the advantage of seeing patients in person. To avoid issues, licensed and unlicensed professionals should be thoroughly trained to use standard protocols for answering patient calls and to know when they can address an issue or must delegate it to someone else.
What is Telephone Triage?
Telephone triage is the process of evaluating a patient’s call to a physician’s office to determine the urgency of their medical issue, type of provider who needs to respond and next steps for the patient. The person triaging must evaluate and record the patient’s symptoms while also checking medical history and current medications to direct the patient to the appropriate level of care.
While telephone triage has many benefits, including improving the quality of service and optimizing results, it also comes with risks, such as failure to treat or delayed treatment. Effective communication between a physician and a patient is crucial for maintaining a positive experience for the patient and for reducing liability exposure for the doctor.
Understanding Who Can Answer Calls
Because telephone triage requires an accurate evaluation of the patient’s needs without an in-person visit, only licensed professionals with the necessary training should provide it. The licensed professional answering the phone determines whether the caller’s situation is urgent and whether it is a medical question that requires a physician or other employee of greater expertise to answer it.
An unlicensed professional may answer a call and address nonclinical or non-urgent questions, but they must transfer it to a licensed professional if the patient seeks medical advice or the matter is urgent.
The American Nurses Association suggests that only registered nurses should provide telephone triage, but in some states licensed practical nurses and medical assistants who have received telephone triage training can answer patients’ calls to assess urgency.
Developing Guidelines for Unlicensed Professionals
Unlicensed professionals should not provide medical advice over the phone. Those who take initial calls should follow written triage protocols that include examples of questions to ask the caller and suggested responses for nonclinical or non-urgent situations.
Such protocols also should include an overview of the types of calls that require an office visit, a direct transfer to the physician for a more thorough evaluation, or a call to 911 for emergencies. Office staff must be given clear instructions and training on situations that necessitate dialing 911.
Following triage procedures and passing along calls to licensed practitioners when necessary is critical for patient care. The supervising physician is responsible for all medical advice provided over the phone regardless of who gives it, and unlicensed staff who fail to follow scope-of-practice requirements can endanger patient safety and create a common malpractice liability issue.
Creating Protocols for Licensed Professionals
Telephone triage procedures help licensed staff determine when and where patients should receive treatment, encourage standardized and superior care and reduce risk. Protocols should outline a course of action for recommendations, documenting telephone interaction and making follow-up calls to patients. Employees should be thoroughly trained on how to use the protocols. And all protocols, whether for licensed or unlicensed professionals, need to be evaluated regularly and changed as needed.
It’s important to note that telephone triage and advice calls do not aim to produce official medical diagnoses, which should be made known to all staff and patients who call in.
All calls in which medical advice is given over the phone by a licensed professional should be thoroughly documented. Even when a call seems unimportant or is quick, an adverse outcome can result if the patient does not follow advice. If telephone triage and advice calls are undocumented and questions arise, it becomes the patient’s word against that of the medical professional.
Documentation should occur promptly to ensure accurate and detailed information. It should include date, time, patient’s name, caller name (if different from patient) and relationship to patient, complaints, how the injury (if any) occurred and advice given. Also, information used to eliminate certain issues, such as whether a patient has a fever, also should be documented, as should reasons for any deviation from protocols.
When to Require Appointments
If a patient contacts the practice again with unresolved issues from an initial call, it’s best to require an appointment. Before ending any call, always confirm the caller’s comfort level with the information given and his/her understanding of the recommended course of action. Finally, be sure to give patients guidelines on when to call back or seek emergency care if symptoms worsen.
As with all medical care, patient safety is the priority. Standardized telephone triage protocols such as those outlined above, followed appropriately by licensed and trained professionals, help medical practices provide safe and consistent advice over the phone.
Disclaimer: The information provided in this article does not constitute legal, medical or any other professional advice. No attorney-client relationship is created and you should not act or refrain from acting on the basis of any content included in this article without seeking legal or other professional advice.
Raj Shah is an attorney with MagMutual Risk Management.