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    Telephone triage can jeopardize patient safety, lead to litigation

    Staff must document all calls where medical advice, information is given to patient


    Physician oversight imperative

    Physician oversight of how telephone triage is handled is imperative. Protocols and algorithms should be reviewed and tested on a regular basis. Some recommend that physicians call in from time to time, pretending to be a patient, to assure that calls with clinical concerns are properly routed to licensed personnel (bit.ly/Triagewhitepaper).

    Staff need to document all calls where medical advice or information is given to a patient. This should at minimum include the time and date, patient’s name, relationship of caller to patient, the complaint/concern/question, and the advice given, according to an article from the Doctors Company (bit.ly/Triagetips). Handwritten documentation should also include the signature of the person taking the call.

    Teach staff to document critical negative information, in addition to the positive findings reported, that might be learned from the communication, such as: The child did not have a fever, the patient’s belly is not stiff, or the patient did not lose consciousness (bit.ly/Triagetips).

    Read: How patient obesity can impact malpractice litigation

    Based on your medical specialty, outline types of calls that either need immediate attention by a provider or an urgent office visit so there is less room for a high-risk and acute medical condition to be missed (bit.ly/Triagetips).

    Communication failures are found in many malpractice suits. The use of variously skilled office staff to triage patient phone calls is an area ripe for communication pitfalls. Office policies and procedures need to be adhered to and should be tested periodically to ensure compliance. Further, all staff, regardless of clinical acumen, are part of the patient care team. Empowering them as such can have many positive effects, one of which is improved patient safety, according to an Aug. 14, 2013 Healthcare Finance article (bit.ly/Empoweringstaff). Take the time to review how your office handles telephone triage and put systems in place to mitigate risks for litigation.

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    Brianne Goodwin, JD, RN
    Ms. Goodwin is manager of clinical risk and patient safety at Cambridge Health Alliance, Cambridge, MA.

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    • [email protected]
      I believe that one critical component of the process has not bee stressed in this article. While it is proper to document the positives and the negatives, there must be a way to let the physician know that there was a communication from the patient. If the physician has no reason to open the record of a patient, he may not see the note until the extreme situations described have already occurred. With a paper chart, a note on the front with a request to review the record is an easy way to have it reviewed. With EMR, a log should be kept so that the physician can review the notes and make a decision about how to proceed. If this were part of the protocol, these 2 poor outcomes might never have happened.