Triage is conducted by asking a series of questions, and the best interactions get to the heart of a patient’s problems quickly and confidently. Excellent telephone triage is not just about asking the right questions but asking them in the right order to properly assess a patient’s situation. While triage is not about arriving at a diagnosis, asking the right triage questions can help patients get the care they need in a timeframe right for them.
Telephone triage has proved to be a life-saving process, especially for remote areas where some would delay care, not wanting to make the lengthy trip without necessity, until it is too late. That being said, the process is not without its difficulties. Telephone triage nurses do not have the luxury of observing the patient in person, and things like a patient’s inability to accurately describe symptoms, a caller’s emotional state, and even language barriers can make accurate assessment challenging.
This is why, though telephone triage has been described as “patient assessment wearing a blindfold,” asking the right triage questions can make the difference between correct care and a misstep. Succinct and efficient triage questions allow medical staff to interpret symptoms to determine the severity of a patient’s condition and recommend the correct course for care.
Protocols are in place in any triage setting to ensure things are done properly. Following these protocols and asking questions in the correct order helps to ensure that all patients receive standardized care and that room for error is minimized. In this way, the telephone triage process is streamlined and can be performed as quickly and efficiently as is reasonable.
Initial triage questions are designed to ascertain symptoms and their severity. Once a temporary diagnosis for assessment purposes only is found, the Schmitt-Thompson protocols are in place to help triage nurses and callers know how they should proceed.
There are many kinds of questions that make up a telephone triage encounter. Some add to the efficiency of a call, and some do not. Triage nurses should be mindful of these unhelpful question types so they can avoid them.
Closed questions have either a yes or no answer: for example, “Are you bleeding?” The answers to closed questions are usually the most accurate because they do not leave much room for confusion or interpretation.
Open-ended questions can be helpful for allowing a patient to speak to the things he or she finds important. They usually begin with “who”, “what”, “when”, “where”, “why”, “how”, or “tell me about,” with the expectation of a response that is more than three words.
Probing questions help triage nurses to gain more information about the responses given to previous questions, whether closed or open-ended. “Where are you bleeding,” “when did the headache first manifest,” and “can you tell me more about the fall” are all examples of probing questions.
Closed compound questions follow the same structure of individual closed questions but ask multiple questions with the expectation of one response. For example, a triage nurse may ask, “Do you have shortness of breath, headache, or dizziness?” Whether the patient says “yes” or “no,” the information conveyed will still remain unclear. Has the patient experienced all three, some of the symptoms, or none of them? For this reason, compound questions are not efficient in a triage setting and should be avoided. Ask each question individually.
Leading questions impose the asker’s bias on the person being asked. There is a fine line between probing questions and leading questions. While probing questions allow a patient to expand on a question previously asked, leading questions sway a patient in one direction. For example, the leading question, “But you’re not worried about that, are you?” could be rephrased as “How does that make you feel?” to better understand a patient’s real concerns.
You can spot a leading question if it does one of four things:
Negative questions are a type of leading question that almost always result in confusion. Because of the way negative questions are phrased, whether callers answer “yes” or “no,” the actual answer to the question is unclear. Avoid phrasing questions in a negative tense: “You’re not dizzy, are you?” Communication is much clearer if you use a closed question—”Are you dizzy?”—succeeded by some follow-up questions.
Good technique on a triage telephone call includes more than just which triage questions are asked. It also involves being friendly and courteous, knowledgeable and professional, understanding and honest. Triage nurses should respond with confidence and with compassion, using positive phrasing and tones.
Triage nurses should identify themselves early and address the caller by his or her name to humanize the interaction. Help patients have a sense of control by giving reasons when questions are asked: “Does your son have a fever? That will help me determine the best way to help him.”