ACEN - the Australian College Of Emergency Nursing provides trauma and paediatric training courses for nurses

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Position statements Clinical Practice - Telephone Advice

Purpose

Historically, emergency nurses have provided telephone advice in response to client demand.1 In recent years telephone triage (not to be confused with telephone advice) has evolved as a discrete service providing health care information and resources to the community.

Telephone triage is the process of assessing a client’s health needs from a telephone interview while identifying and informing the client of the most appropriate health care resources to meet those needs.2,3,4.

In Australia, the telephone is the most readily available source of health care information for many households, especially in rural and remote areas.5, 6. Calls to the local emergency department for advice is a frequent occurrence, especially after hours and in rural areas, which indicates a demand for a service that meets these needs. 7. While there are some telephone triage centres emerging, there is not a national uniform approach. 6. Currently, there are no national standardised protocols or mandatory training for the emergency nurses who receive calls for advice.5.

Appropriate training and guidelines for nurses who are required to give telephone advice is essential to ensure optimal care.8,9. This includes ensuring the client understands the importance of compliance with the advice given and providing adequate follow up.8,9. Appropriate documentation is crucial to decrease the risk of legal liability.1-11. Without adequate guidelines and training, telephone advice by emergency nurses can be a time-consuming task that is potentially hazardous.7.

An increased awareness of the legal ramifications of giving ad-hoc telephone advice has seen hospital policies implemented that dictate that the only acceptable advice that nurses may give callers is to attend the emergency department.2,5. The increased workload generated by this blanket referral of all callers to the emergency department has lead to the establishment of dedicated telephone triage services in several countries, as a strategy to reduce the strain on emergency departments that are already overcrowded.1,3,6,10. This situation has made telephone advice a controversial topic with one end of the spectrum advocating that no telephone advice be given due to the inherent risks, while the practicality of the situation is that people still call emergency departments for advice.7,11.

TNCC (Provider) Course Content

  • Government should provide increased access to appropriate health care advice for all Australians by instituting a free nationally funded telephone triage service. Appropriately educated and experienced emergency nurses should staff this service and there should be public education to promote its use.
  • If emergency department nurses receive calls for advice, they should not give an opinion on diagnosis but should refer to appropriate emergency department, general practitioner or telephone triage call centre.
  • An experienced emergency nurse, who can give appropriate instructions in life threatening situations, should be designated to take all emergency department calls for advice. Protocols and guidelines should be readily available in the department for this situation.
  • All calls for telephone advice should be documented.

Position Guidelines

Employer Responsibilities
Employers are responsible to:

  • Promote the necessity of education programs for the establishment and maintenance of telephone advice skills.
  • Ensure that they review their policies and procedures to provide guidelines for telephone advice by nurses.

Employee Responsibilities
Employees are responsible to:

  • Attend training session/s offered.
  • Maintain competency throughout employment period.
  • Document and report all cases of telephone advice.
  • Work with employer to develop strategies and protocols to best enable practicable implementation of policies and procedures.

Joint Responsibilities

  • All parties should support and conduct relevant research at the local and national level that will continue to inform and enhance telephone triage practice.
  • To be collaborative in all matters related to the management of telephone triage services.

References

  1. Rutenberg,C. (2000). What do we really know about telephone triage? Journal of Emergency Nursing, 26 (1), 76-78.
  2. Fifield, M. (1996). Telephone triage: protocols for an unacknowledged practice. Australian Journal of Advanced Nursing, 13 (2), 5-9.
  3. Crouch, R. & Dale, J. (1998). Telephone triage identifying the demand (part 1). Nursing Standard, 12, (34), 33-38.
  4. ENA Emergency Nurses association position statement - telephone advice. www.ena.org/about/position/telephoneadvice.asp (accessed 20/03/03)
  5. Lyneham, J. & Nancarrow, M. (1997) The nature and content of telephone calls received in rural and metropolitan emergency departments. Australian Emergency Nursing Journal, 1, (2), 64-68.
  6. Wilson, A. & Turner, V. (2002). NHS Direct audited: telephone triage in Western Australia is cheaper than NHS Direct. British Medical Journal, 325 (7356), 165.
  7. Edmonds, E. (1997). Telephone triage: 5 years’ experience. Accident and Emergency Nursing, 5, 8-13.
  8. Gobis, L. (1997) Legally speaking: reducing the risks of phone triage. RN, 60 (4), 61-63.
  9. Cady, R. (1999) Telephone triage avoiding the pitfalls. MCN, The American Journal of maternal/Child Nursing. 24(4), 209.
  10. Zimmermann, P. (1999) Telephone triage. Journal of Emergency Nursing 25 (4), 311.
  11. Coleman, A. (1997). Where do I stand? Legal implications of telephone triage. Journal of Clinical Nursing, 6, (3), 227-231.