I am Marcy lying and I'm the triage logic nurse educator telephone triage nurses use protocols when assessing their patients this helps ensure that the information they are providing is standardized and that patients are receiving the most appropriate care this short video gives you an introduction to what protocols are and how they are used by the nurse during this video course we will explore a brief history of telephone triage how it works what protocols are and how they are used to determine a safe and appropriate level of care for each caller let's start by answering a few questions to see your current understanding of nursery eyes write down your answers to the following questions and at the end of this video look at the questions again and compare your answers to your newly learned knowledge so what exactly does the word triage mean the term triage comes from the French verb tree air meaning to separate sift or select in times when supplies or other resources were insufficient such as wartime determining which patients required immediate attention or medication in which patients could wait was common practice triage was also used in determining the order and priority of emergency treatment the order and priority of emergency transport or the transport destination for that patient you the term triage is thought to have originated around the 1800s and was further used during World War one by doctors treating the wounded soldiers those responsible for the removal of the wounded from the battlefield are their care afterwards would divide the victims into three categories those who are likely to live regardless of what care they received those who are likely to die regardless of what care they received and those for whom immediate care might make a positive difference in their outcome a similar model is still used today when rescue personnel are responding to disasters such as volcanic eruptions mass shootings earthquakes and rail accidents or when emergency room census is extremely high you let's go over some other ways that triage is used today it is also used in non disaster incidences it is used in physician offices to determine which patients need immediate care nurses working in hospitals use a triage system to organize their patient load and triage is also used in nurse call centers to assess their collars and determine safe levels of care let's go back forty plus years to learn the roots of telephone triage since the 1960's nurses have been using the telephone as a convenient tool for managing patient care however it wasn't until the mid-1980s that computerized guidelines in documentation tools became available it was during these beers that there was a drastic increase in the number of nurse triage call centers around the country nurse triage despite being a relatively new field in nursing has evolved dramatically just like every other aspect of Medicine over the last ten years as Internet use has become more widespread and nurses were able to access computer systems remotely we began seeing triage nurses move from call centres to working from home there were several challenges to overcome in order to safely move agents to a home setting these included how to maintain HIPAA compliance how to supervise a staff that all worked from home and assuring quality control including the recording of all calls with the advancement of Technology many of these hurdles have been overcome today the advanced nurse triage platforms are completely web-based they are scalable to accommodate the needs of the smallest physician practice to the largest hospitals and have several advanced features including integrated call recordings and the ability to transmit each encounter directly to the practices via fax are directly to the patient's electronic medical records so what exactly are protocols and how do they work protocols are specialized algorithms that are used to evaluate the seriousness of a callers condition based on their present complaint and their answers to a series of questions starting with the highest acuity 902 those symptoms that can safely be managed at home because of the variety of Ages and multitude of reasons the patient is calling the triage protocols have to be extremely comprehensive and need to give targeted advice based on the symptoms and disposition of the caller protocols like the nurses stethoscope are just one of many tools used by the triage nurse to assess her patient the nurse must also rely on her past nursing experience her judgment and her critical thinking skills this advice is targeted and specific based on the patient's symptoms and the disposition that was chosen protocols can also allow the nurse to recommend home remedies make an appointment are referred to a specialist or an urgent care facility as appropriate the most important thing that protocols do when used correctly is ensure that consistent and accurate advice is given to all patients that are calling about their health concerns or symptoms there are different types of protocols used by nurses and other health care professionals today some protocols are used for workers compensation clients others are streamed line to adults or pediatric patients and yet others are used for psychiatric patients or ob/gyn most protocols used today are symptom-based meaning that the patient will call with a symptom such as vomiting or a headache and the nurse will use the corresponding protocol to assess the severity of the patient's symptoms we will focus on the Schmitt Thompson protocols because they are the most widely used in modern call centres in electronic format let's start with a brief introduction to the doctors dr. Barton Schmidt is professor of pediatrics at the University of Colorado School of Medicine he has written more than 100 articles for fellow pediatricians as well as the book pediatric telephone protocols and the computer software program called the pediatric advisor which is used in over 450 hospitals nationwide dr. Schmidt has received numerous awards for his work including the American Academy of Pediatrics Education Award in 2004 dr. David Thompson is board-certified in emergency medicine and internal medicine with over 25 years of experience he's the author of three integrated sets of clinical content for using software in numerous medical articles he lectures in areas of telephone triage professional coding quality improvement and patient satisfaction you an important aspect of the Schmidt Thompson telephone protocols are that they are an example of symptom based protocols the goal of these protocols is not to diagnose the patient as that would be outside the scope of Nursing instead their purpose is to assess the patient's symptoms and direct them to the right level of care required based on the severity of their current symptoms these protocols are comprehensive in the sense that no matter what specialty our primary care doctor the patient sees when used correctly by the triage nurse these protocols cover over ninety-nine percent of all symptoms so they are thorough enough that the triage nurse will almost always have a guideline that will apply to her patients situation Schmidt Thompson protocols are thoroughly reviewed by a panel consisting of nurses medical directors primary care providers specialists and emergency room physicians and are updated as the latest evidence-based research becomes available and since ninety percent of nurse triage centers used the same standard guidelines they have the experience and feedback to continue to make these standard of care in the nursing triage industry so far we've talked about the historical background about how nurse triage has evolved and about what protocols are and who designs them but how does a typical nurse triage call center actually work nurse triage as profession has evolved dramatically over the last 10 years prior to the widespread use of the internet nurses worked mainly in large call centres and most patient encounters were faxed to them from outside sources such as answering services the nurses would use the information faxed to create a patient record then call the patient back perform a triage and then fax the form back to the physician office this process could be very slow and tedious at times if staff called in sick or could not make it to work due to inclement weather conditions then it might take hours to find a replacement nurse which further slow down the triage process the development of better software and communication systems has allowed telephone triage nurses and managers to work remotely from home these advances offer several advantages we'll go over a few of them here firstly patient encounters are entered directly into the software which means the nurse has quicker access to the information the new software is a more secure method for transmitting personal health information than the fax machine other advantages include a quicker callback time leading to increased patient satisfaction and the ability for call centers to manage a higher call volume more efficiently by having nurses that can logon immediately with no commute time nurses also have more satisfaction they can work from home saving themselves the time and expense of commuting nurse triage is much more efficient today thanks to the advanced technology let's walk through the steps of a typical triage call first the patient makes the initial call to either their physicians office or calls the designated triage line number an answering service enters information directly into the triage software where a nurse can claim the call in with the click of a button cause the patient back directly once the nurse gets the patient information they talk with the caller review their medical history and their current symptoms taking all of this into consideration the nurse will select the most appropriate protocol based on the caller's most urgent symptom the protocol then leads the nurse through standardized questions which guide the caller to the most appropriate level of care based on the severity of their current symptoms the dispositions can range from calling 911 to the emergency room visiting their doctor within 24 hours down to giving home care advice to keep the patient at home safely you once the patient and the nurse agree on a plan of action the nurse will encourage the caller to call back for any other concerns as you will close her encounter the note is electronically faxed to the physician office or in more advanced offices the encounter is received via File Transfer Protocol are sent directly to the physician offices EMR where it becomes part of the patient's permanent medical record there are many features of advanced nurse triage software and systems some of which include the ability to secure tax the doctor when the nurse has to reach him the development of smartphone apps for patients to request a callback directly from their phone direct integration with electronical medical records is available with most advanced nurse software systems and the ability to view a brief medical history from the patient's medical chart within the software is also available sometimes the software has the ability for the nurse to make a patient appointment in the electronical medical record if they need to be seen the next day this is a convenience for the patient as it saves them time and give some peace of mind that they already have an appointment scheduled nurse triage call centers can also work to prevent hospital readmissions they can do follow-up calls after patients are discharged from the hospital or after surgery they can manage chronic diseases such as diabetes asthma and heart disease and they can perform surveys or other functions that can be done over the telephone nurse triage is seen in many different aspects of medicine today it is used by hospital systems to increase referrals to their facilities and increase the community's awareness of events offered by the hospital insurance companies including managed care and many Medicaid organizations utilize nurse triage to assist their members in saving costs by making sure the patients are seeking care at the appropriate levels physician offices rely on nurses to triage their patients after hours health plans physicians and other health care providers involved in the telephone triage system report a variety of benefits from using nurse triage including economic savings saving costs by getting the patient to the right level of care at the right time patients having timely access to medical information and referrals leads to increased patient satisfaction and let's not forget nurse triage also provides the physician with needed relief in peace of mind when there office is closed in this video course you have learned that while triage systems have been around for many years it is only in the last 30 or so years that telephone triage has evolved dramatically from a system of mostly manual forms and nurses or other medical personnel winging it when giving advice to patients to a system that uses highly specialized technology to assure that all patients are triaged using standardized algorithms and give inaccurate dispositions and care advice we went over how using protocols gives the nurses standardized and uniformed approach to assessing her patient and went over the basic steps of nurse takes to triage your patient congratulations on finishing this video course on protocols what they are and how they are used let's take a look at the pretest questions how did you do did any of your answers change based on the information you learned don't forget to come back soon for the next video course where we will explore more on protocols and how to be sure you are choosing the right one don't forget to come back soon for the next video course where we will explore more on protocols and how to be sure you are choosing the right one for your patients symptoms