The risk of miscommunication between patients and triage nurses presents a challenge in any clinical setting. When that triage is conducted over the phone, the risk increases as any medium that is not face-to-face presents new challenges. When utilizing a telephone triage service, it is critical to follow prescribed standard operating procedures to avoid legal issues, perhaps even more critical than in a face-to-face triage setting.
The Proper Personnel
The question of who can perform telephone triage must be considered carefully in order to prevent legal issues later on. When a patient calls a triage line, an operator on the other end greets that patient, takes down notes on the reason for the call and patient-specific information, and then assesses which patients in the clinical facility’s queue require more urgent attention. The nurse then calls those patients back to verify the information they provided and direct them to the best care.
Because triage over the phone requires timely but accurate medical assessment of a patient’s condition without the diagnostic value of face-to-face evaluation, it is vital that only licensed professional staff with appropriate training conduct triage over the phone. A cheerful and reassuring disposition is valuable to set callers’ minds at ease, but the priority is qualified medical diagnostic experience.
That being said, triage nurses do not make diagnoses and should not claim to if they wish to avoid legal issues. Triage personnel gather relevant information, assess the immediacy of care needed, and relay that information to the appropriate medical staff. Diagnoses and prescribed care are offered after designated medical examination.
To prevent legal issues down the line, not to mention just as good business practice, all triage documentation should be thorough. Triage staff should be trained on and instructed to use proper medical terminology as well as universal shorthand. This facilitates cohesion in communication between triage board and attending medical staff and helps make sure the patient receives the proper care. Personal abbreviations in triage documentation are not acceptable.
Once they are set down in ink, so to speak, notes in a patient’s chart should not be edited. Preserving notes as they were originally taken helps avoid the impression of changes in data or obfuscation of information. Make sure that all paper trails meet standard procedures and are easy to follow. If a member of triage staff is concerned that recorded notes are unclear, the risk manager on staff is the person to consult.
Communication Is Key
Because a member of triage staff does not make diagnoses or prescribe specific medical help, it is critical that triage personnel maintain sufficient contact with participating medical staff. If a patient is told to wait to go into the hospital, that information, in addition to being well-documented, should be relayed to the relevant clinical facility.
Avoiding Claims of Negligence
No triage system is perfect. Disgruntled or properly upset patients will arise, and some might be so dissatisfied with care as to seek legal action against their attending triage personnel. To avoid being guilty of negligence, triage staff should remember those precautions already discussed as well as their duty to their patients.
A Duty to the Patient
The moment a member of telephone triage personnel answers a call and begins conversation with a patient, duty to that patient is established. Duty of care assumes that a physician will protect the patient from unnecessary risk of harm as possible. Legally, a breach in that duty arises when triage personnel either neglect a step in their triage (classified as “omission”), or they perform some action which they should not (“commission”). As far as can be done, claiming breach in duty judges staff against a reasonable standard, i.e. comparing their actions to the steps reasonable personnel would have taken in the same situation.
Proximate cause when discussing the legal issues of telephone triage indicates that a patient sustained damage or injury directly because of the actions of a triage operator. If a link can be established between what the triage nurse either did or did not do and a patient’s negative outcome or injury, there are grounds for legal action against that operator and potentially their place of employment.
If proximate cause can be established, “damages” in the form of compensation may be awarded. If irrevocable harm can be traced to a member of triage personnel’s action or inaction, that person or their place of employment may very well be required to pay out damages to the injured party. Other damage outside of the legal sense may also incur, such as injury to the reputation of that operator or the termination of their employment.
Avoid Telephone Triage Legal Issues
At CareXM, our staff are qualified and experienced telephone triage operators. They are thorough in their examinations and in their documentation. We serve incoming patients as well as the clinical facilities in our sphere to ensure that no legal issues arise as we help you give the best care to your patients.