A Brief Guide to Structuring a Paediatric Telephone Triage Call

Introduction

Telephone triage is an essential skill for healthcare professionals, providing an efficient way to assess and prioritize patient needs remotely. In paediatrics, this task can be particularly challenging due to the wide range of potential issues and the inherent difficulty of assessing symptoms over the phone. This paper presents a structured approach to conducting a paediatric telephone triage call, aiming to guide healthcare professionals in delivering safe and effective care.

Step 1: Initial Contact

The triage call begins with the healthcare professional introducing themselves, stating their role, and explaining the purpose of the call. It’s crucial to obtain the child’s name, age, and a brief description of the presenting problem. This initial step sets the tone for the rest of the call, helping establish rapport with the caller and ensuring they feel heard and understood.

Step 2: Detailed Assessment

The next step involves asking open-ended questions to get a detailed history of the present illness. This includes the onset, duration, and progression of symptoms, any associated symptoms, and any actions taken so far. For infants and non-verbal children, it’s important to ask about changes in feeding, sleeping, and behaviour patterns. This comprehensive assessment allows for a better understanding of the child’s condition.

Step 3: Red Flag Symptoms

The healthcare professional should inquire about “red flag” symptoms that might indicate a serious condition. These include but are not limited to high fever, severe pain, difficulty breathing, altered mental status, and signs of dehydration. If any red flag symptoms are present, the call should be escalated appropriately, ensuring the child receives the necessary care promptly.

Step 4: Medical History

A thorough understanding of the child’s past medical history is crucial. This includes any chronic conditions, previous hospitalizations, and current medications. It’s also important to ask about any known allergies. This information can provide valuable context and help guide decision-making.

Step 5: Decision Making

Based on the information gathered, the healthcare professional must decide on the next steps. This could range from home care advice, scheduling an in-person appointment, or immediate referral to emergency care. It’s essential to trust clinical judgement and, if in doubt, err on the side of caution.

Step 6: Clear Instructions

The healthcare professional should give clear and concise instructions. If advising home care, they should explain what to do, what to watch for, and when to seek further medical attention. If referring for further care, they should explain the reasons and the urgency, ensuring the caller understands the next steps.

Step 7: Documentation

Every call should be documented thoroughly, including the symptoms reported, the advice given, and any decisions made. Good documentation is essential for legal reasons and for continuity of care, ensuring that any healthcare professional who subsequently treats the child has access to all the necessary information.

Conclusion

Telephone triage is a complex task that requires good communication skills, clinical knowledge, and sound judgement. By following a structured approach, healthcare professionals can ensure they provide safe and effective care to their paediatric patients. This guide serves as a general framework, but the specifics may vary depending on the organization’s protocols, the nature of the call, and the child’s condition. Always follow training and clinical judgement. If in doubt, seek advice from a senior colleague.

By adhering to this structured approach, healthcare professionals can navigate the complexities of paediatric telephone triage, ensuring that every child receives the appropriate care they need in a timely manner.

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References:

1. Hertz, A.R., 2022. Pediatric Nurse Telephone Triage: A Companion To Pediatric Telephone Protocols. American Academy of Pediatrics, Elk Grove Village, IL. 
2. Schmitt, B.D., 2021. Pediatric Telephone Protocols, 17th Edition. American Academy of Pediatrics, Elk Grove Village, IL.