TRIAGE LOGIC TRAINING 2013

 We have all dealt with them. The caller with the short fuse that is uncooperative from the greeting; the one that will not let you get a word in edgewise and becomes defensive when you try to steer the conversation back to their reason for calling; the one that has been reading on the internet and KNOWS exactly what is wrong!

 You know who they are- they are the parent/patient that is tired, stressed out, anxious and worried about their health or a sick child

 These callers are not targeting you specifically, you just happen to be in the line of fire. Being sick or having a sick child (either acute, chronic or both) is stressful, tiring and nerve wracking. By the time the person has called the nurse line, many are near the end of their ropes. They may have talked to neighbors, grandparents and read on the internet about their symptoms- all of their efforts have not worked and now they are calling YOU!

 A) You can fire back! “Doesn’t that caller know its been a long day for you also?” Maybe you are tired, stressed out and in need of a well deserved vacation. “DON’T THEY APPRECIATE ANYTHING YOU ARE DOING FOR THEM?!?!” OR  B) You can cut them some slack. Take a deep breath (silently, of course!), let them vent for a minute then ask “You sound worried, what can I do to help you tonight”.

 If your caller is difficult to talk with and is calling about a sick child, they may be angry, demanding, extremely worried, confused or overwhelmed by other emotions  Attempt to triage the patient with the appropriate symptom guideline before using the Difficult Caller Guideline.

 Angry or rude caller  Caller demands to speak with physician  Overly worried caller What protocol would you use?

 Description: Parent is angry, hostile, rude or verbally abusive.  Verbal response: Many of these parents need 2 to 3 minutes to vent to a sympathetic listener about whatever has upset them, after which time they become more reasonable. Make helpful comments such as "Tell me about it”, “That would be upsetting to anyone”, or “Was there anything else?“  Do not criticize the parent`s comments or offer any excuses for what took place. If appropriate, apologize.  Disposition: Home Care for most. If the parent continues to be angry after 5 minutes of counseling, transfer the call to the physician.

 Description: A parent demands to speak with the child`s PCP even though you could probably help them.  Disposition: Try to help caller solve their problem; try to clarify what they are calling about, e.g., “Do you have a specific question I could try to help you with? We use guidelines and standard advice that has been approved by your doctor."  If unsuccessful, offer to page the MD on call. Tell the caller: “I will page your physician for you, please callback if you have not heard from him/her in 30 minutes”.  If the caller becomes more demanding, don`t argue with him. Let the physician inform the parent that the call easily could have been handled by a trained triage nurse or waited until morning (ie non-urgent requests).

 Description: A caller that is unduly worried or anxious about their condition and cannot be reassured with telephone advice. The triage nurse is certain the child is fine. Disposition: Offer to have them seen within 24 hours by the primary care physician. If that is not sufficient, page the on-call physician for assistance. If the patient calls back with additional concerns soon after the initial call has ended, it can be assumed that they probably need to be seen sooner.

 Do not use slang or poor language. Never use swear words.  If there is a problem, be concerned, empathetic, and apologetic (even if it is not your error)  Do not give the impression you are rushed or uninterested  Never engage in an argument with the caller. Source: Dialogue January/February 2011 (these tips were compiled from a hodgepodge of websites, including Ezine, OfficeSkills and Buzzle)

 Practice good listening skills  Always use a pleasant, congenial and friendly tone.  Never interrupt the person while he/she is talking to you (although there may be a few exceptions to this…)  When hanging up the phone, make sure the caller or person who called hangs up first Source: Dialogue January/February 2011 (these tips were compiled from a hodgepodge of websites, including Ezine, OfficeSkills and Buzzle)

 Do not take the anger personally. Many parents who are angry are often frustrated, fearful and concerned. Let the caller express their issue without interrupting. Do not argue.  Note all important details of the caller’s issue/concern. Repeat the facts to the caller to verify accuracy.

 Listen closely and acknowledge how the person is feeling, e.g., “I can imagine how frustrating this has been for you.”  Identify the expectation of the caller. What do they want? In what time frame? Do they expect a response from a specific department or individual?

 Offer suggestions. Let them know what you can do and what you need from them. Move to a positive solution. “I will notify your physician and have him call you as soon as possible.” “I will notify your physician that you will be calling the office in the morning.”

 Document the callers behavior using objective statements and use direct quotes as much as possible. Avoid using labels such as “nasty” or “angry.” You may document that their tone of voice is stern or that they are speaking loudly, swearing, etc. Try to describe the callers behavior accurately.

 Documentation of the callers behavior should be done in the notes section of the call form, not in the assessment. Remember, the assessment is used for subjective information from the parent concerning the child’s symptoms, not objective observations by the nurse.