A telephone triage nurse works at a medical answering service.

Medical Answering Services and Telephone Triage

Doctors in the United States first began to use answering services in the 1920s so they would be made aware of patient emergencies. At that time, operators were basic message-takers and would pass along patient messages and contact information to the doctor.

Today’s medical answering services provide a much wider range of services to lighten the administrative workloads of medical offices, and not only assist doctors, but also surgeons, hospice and home health, dentists and orthodontists, and even large healthcare systems. Medical organizations that use an answering service can experience increased appointment setting rates, better patient-doctor communication, improved patient satisfaction, and provide their patients with reliable access to care 24 hours a day, 7 days a week.

Some medical answering services can even provide telephone triage if they employ licensed professional staff members who are trained to give an accurate assessment of a patient caller’s concerns.

Telephone Triage

The use of triage originated during World War I to avoid focusing resources on victims with fatal injuries. Sometime in the early 1970s, health maintenance organizations (HMOs) instituted telephone advice services which led to hospital emergency departments establishing 24-hour telephone advice program. Telephone triage is now a sophisticated practice usually performed by nurses and other highly trained medical personnel.

A few definitions may be helpful before reading more about telephone triage. Telehealth, telemedicine, and telephone triage may all sound similar, but each are very different. Telehealth is focused on the actual delivery of care (both preventative and curative), and telemedicine involves the diagnosis of a patient’s health compliant and recommended treatment by a physician via any form of telecommunication. Telephone triage is the assessment of a patient’s symptoms and the urgency needed to quickly get that patient connected with the correct doctor or department. 

Telephone Triage Communication Model

Effective communication is critical in telephone triage. Typical models of communication include three parts:

Data collection: The answering service agent gathers data from the patient caller about the problem and asks open-ended questions to encourage more information about the symptoms.

Confirmation: The agent repeats the information using some medical terminology but in a way that the patient can understand. The patient confirms and redefines the symptoms if necessary.

Disposition: The agent may give advice about treating symptoms, but the main outcome is to quickly connect the patient caller with an appropriate doctor, clinic, or hospital department. 

To assist operators with remembering which questions to ask during the assessment, it is common for them to use a mnemonic device called OLD CART:

    • O (onset of symptoms): When did the symptom(s) first occur? Has it happened before?
    • L (location): Where on the body is the symptom occurring?
    • D (duration): How long has the symptom(s) been present and is it constant or does it come and go?
    • C (characteristics): Describe what the symptom(s) feels like.
    • A (associated factors): Are there any other signs and symptoms that occur?
    • R (relieving factors): Does anything make it feel better or reduce the severity?
    • T (treatments tried): What has been tried to relieve the symptom? Has anything worked?

Advantages and Disadvantages of Telephone Triage

There have been many studies published about telephone triage and how they help reduce a healthcare organization’s costs while helping patients experience better health and greater satisfaction. BMC Health Services Research conducted a review of existing body of research about telephone triage and advice services (TTAS) and found that, “TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care... Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care.”

The primary disadvantage of telephone triage is liability. Lawsuits can be filed if a patient call was mishandled. For example, if a negative health outcome can be attributed to a miscommunication, or because a patient was on hold for long time, or due to a lack of information about the patient.

If the situation is serious enough and becomes a legal issue, the courts may even hold a doctor responsible if they find the person assisting the patient via telephone triage lacked skill or training. In the unfortunate event of a serious medical problem or death because of mistakes made by a triage service, anyone connected with the case (e.g., nurses, physicians, other medical personnel, the healthcare organization, the patient’s health plan) could be sued.

Importance of Call Center Software Effective Telephone Triage

Medical answering services who also offer telephone triage systems can safeguard against liabilities for themselves and their medical clients by using a robust call center software suite. All-inclusive, highly interoperable healthcare software can integrate with electronic medical record (EMR) systems and use artificial intelligence (AI) to help ensure operators are talking to the correct patient; customized scripting ensures operators are asking and giving correct information; and they also offer critical call priority and improved call routing.

[Related: Integration Engines Improve Interoperability]

Effective contact center software also provides a customizable reporting function to keep track of metric that: enhance accountability with call logging and video screen capture, connect remote agents, and manage on-call scheduling. Because calls, messages, screen capture images, and more can be recorded, tracked, time-stamped, and stored, data from call centers can also help protect themselves, hospitals, and patients in litigious situations.

Medical answering services can also take advantage of running their call center software in a virtual server environment or in the cloud. This enables their staff to work from home by turning any personal computer into a professional agent workstation. All of the tools used by an agent in a medical answering service call center are accessible to the virtual agent.

Secure Messaging and Telephone Triage

A secure mobile messaging app can help keep both medical answering service providers and their healthcare clients HIPAA-compliant in the event an agent needs to contact on-call medical personnel about a patient caller.

If an agent determines a patient’s doctor needs to be notified immediately about a critical situation, a secure messaging app that’s integrated with the agent’s call center software and on-call software can quickly contact the correct physician. End-to-end encryption ensures all communications are secure and protected.

Persistent alert settings can be set so important messages won’t be missed, and full reporting functions available via the app keeps track of messaging histories including if a message was received, opened, and replied to.

[Related: Encrypted BYOD Messaging as a Pager Replacement]

With today’s technological advances and secure HIPAA-compliant communication options, medical answering services can provide outstanding telephone triage services that results in better patient care while protecting against liability issues.