Simplifying Nurse Telephone Triage

April 28, 2022
Simplifying Nurse Telephone Triage

Let’s say you have a headache when you wake up, and your back aches … you can’t quite bend down and reach your slippers on the floor. You sit back up, and you feel a bit lightheaded. Is that just you getting old? Something wrong with your back? Or perhaps something more serious?

Instead of frantically Googling the symptoms and being told that you have cancer on every single page that you encountered, you decided a better course of action would be to call a clinic and talk to a professional first. A nurse picks up the phone, asks you about your symptoms, and tells you what you should do next.

After the reassurance that everything is fine—you just need to take a day off—you can now sit back, make a cup of tea, call in sick from work and start a new Netflix show.

You just had your encounter with telephone nurse triage.

A Brief Introduction to Telephone Triage

You might find yourself wondering—how does the person on the other side of the phone determine what’s happening? The questions they ask? And the advice they give you?

Am I really fine?

All the things mentioned above are governed by strict nurse triage protocols to ensure that the right answers are given and that care should be given accordingly based on a standardized and objective analysis of your symptoms.

In fact, it’s an important yet overlooked aspect of the medical system that continues to save lives every year and ease pressure on the already-overwhelmed healthcare system around the world.

Image by Proxet, What Nurses Told Patients to Do
What Nurses Told Patients to Do

The chart above shows the courses of action taken after calling a triage nurse, according to a survey conducted by TriageLogic. Imagine how much unnecessary pressure will be directed to emergency departments if not for the use of phone triages before calling 911.

"With increases in annual visits to U.S. emergency departments, declines in capacity have led to unprecedented levels of crowding and consequential delays in care."— Scott Levin, Ph.D., associate professor of emergency medicine at the Johns Hopkins University School of Medicine.

History of Triage

Triage, as a term, originates from the French word Trier—and yes, it’s pronounced like a French word as well. Now, repeat after us … tree·aazh.

Triage is a process that separates and prioritizes patients based on their level of needs and urgency. The term is thought to be originated in the 19th century, but it saw its most prominent use during the First World War when field nurses and doctors were overwhelmed with thousands upon thousands of casualties during one of the deadliest conflicts in history.

In order to better utilize the already-strained resources, the wounded were categorized into three main categories—those likely to live regardless, those who were likely to perish regardless, and those who could be saved given the appropriate action.

Similar systems and protocols are still being used today in mass casualty events.

Telephone Triage

Fast forward a few decades, in the 1960s, telephone triage was used to determine the level of patient urgency, but it wasn’t until the 1980s that computer standardized guidelines and documentation are established. It was also around the time when triage call centers began to appear all around the US. From then on, nurses have a better idea of how to interact with patients and categorize them accordingly based on their symptoms while referring to an established protocol.

As the technology develops, however, nurses are no longer bound to call centers—they can also carry out their duty while working from home. Yet certain challenges remain, such as Health Insurance Portability and Accountability Act (HIPAA) compliance—namely the processing of sensitive personal data—supervision, and quality control … similar to challenges faced by other fields.

Modern Telephone Nurse Triage

These days, a lot of the telephone triage systems are web-based, allowing for more flexibility and better integration with existing electronic medical systems, such as electronic medical records (EMRs). Gone were the days of sifting through archives just to find a specific record, as everything about a patient—their past medical history, underlying conditions, allergies … all are within reach through a few clicks in the system.

There are also numerous companies that provide software development services working on automated online triage systems.

Other benefits of modern triage systems include the ability to scale the triage system, directly transfer the patient's information to the clinic’s internal system, and automatic call recordings for future reference, among many others.

"The use of AI in medical care is gaining traction in recent years. And triage is one area showing significant untapped potential."

George Serebrennikov, COO at Proxet (ex - Rails Reactor) – a custom software development services company.

Triage Market Forecast

According to an article by Forbes, the US medical system already faced a shortage of supplies and funding prior to the pandemic, and the COVID-19 crisis only deepened the issue.

However, as technologies mature over the recent years, it is believed that triage systems, a field that can ease the load of the overloaded medical care system, will see significant growth around the world. According to research conducted by Persistence Market Research, it is believed that the global triage system market will grow at a compound annual growth rate (CAGR) of 21 percent, and grow 7.6 times its current market value by 2031, with the market with the most potential being East Asia.

Now that you have a general understanding of what triage systems are and their role in medical care, let’s take a closer look at triage protocols for nurses and ways that can be implemented to simplify them for better accuracy and efficiency.

Triage Algorithms and Triage Nurse Protocol

What exactly are phone triage protocols? Well, as the name suggests, these are telephone triage protocols for nurses to help them identify the symptoms, ask follow-up questions, and determine the best course of action. You can see them as nurse triage guidelines.

In other words, triage nursing protocols are structured algorithms that are designed to help evaluate the caller’s condition and determine the severity of their condition based on their complaints and the answers given to the questions. See them as checklists that help identify the caller’s condition and to act accordingly.

Let’s look at a potential call and understand how the triage nursing protocols work.

Basic Example

Let’s say our protagonist today is a man called Tommy, aged 25. He woke up with a headache and stomachache and decided to call a phone triage center for help.

  1. Tommy places a phone call
  2. The answering service picks up the call and enters the information
  3. The triage nurse picks up the call
  4. Tommy tells the nurse about the symptoms—his headache and stomachache
  5. The nurse asks Tommy follow-up questions—does he have a stiff neck? Was he vomiting as well? 
  6. The nurse chooses an appropriate protocol based on the symptoms described by Tommy
  7. Based on the protocols, the nurse suggests the best course of action for Tommy—should he see a general practitioner? Or should he see a specialist?
Image by Proxet, How does nurse triage work today
How does nurse triage work today

One of the most popular nursing protocols examples would be the Schmitt-Thompson Protocols, which can be seen as checklists for both pediatric and adult patients by breaking down their symptoms. Other telephone triage nurse protocols also exist for other scenarios and conditions such as obstetrics and gynecology. There are also emergency room nursing protocols and emergency department triage protocols, but these are beyond the scope of this article.

Schmitt-Thompson Protocols

A symptom-based protocol developed by Dr. Bart Schmitt and Dr. David Thompson, the Schmitt-Thompson Protocols are among the most popular nursing phone triage protocols used in the market today. In fact, more than
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of triage nurses in the US use the Schmitt-Thompson Protocols.

As a symptom-based protocol, its goal is not to diagnose the patients as that would be the doctor’s job. Instead, the main goal for symptom-based protocols such as Schmitt-Thompson Protocols is to direct them to the appropriate level of care. Once the triage nurses identify the level of severity, the patients can then be categorized into nine different levels:

  • Call 911 now — life-threatening conditions
  • Go to the Emergency Room (ER) now — urgent symptoms requiring ER assistance
  • Go to the ER or your primary care provider (PCP) now — symptoms that can be evaluated or managed in a physician’s office, potentially redirected to ER
  • Go to your PCP’s office now — symptoms that can be evaluated by a PCP, preferably within two hours
  • Be seen today in your PCP’s office — urgent symptoms and patients who request to be seen today
  • Be seen today or tomorrow in your PCP’s office — non-urgent symptoms
  • Be seen within three days in your PCP’s office — persistent symptoms with no deterioration
  • Be seen within two weeks in your PCP’s office — non-worsening chronic or recurrent symptoms
  • Home or self-care — mild symptoms that can be managed at home

The process doesn’t end there, however, as the information will then be transferred to the hospital or clinic or simply stored within the system for future reference. The triage would also encourage the patient to call back should there be an acute change of symptoms after the call was made.

Protocol Automation Methods and Ready to Use Tools

Good triage nursing protocols depend on accuracy and standardization, which is where automation comes into play. While telephone triage still relies on certified nurses to make an informed decision, it can help ensure the quality of care by standardizing the use of protocols.

However, as technology advances and with the growing popularity of smartphones, a lot of the triage systems are moving towards a web-based model, sometimes powered by AI to aid its analysis.


One such example would be ExpertRN, used by Mayo Clinic in delivering clinical decision support for primary care patients.

"We found that we had very well-intentioned nurses who might start out by utilizing a textbook or a guide with decision-making help in it [...] But once the nurse started to feel comfortable that they understood the guidelines, they sort of put the book away and started to assess patients by memory.  And being human, of course, they might forget a step or get confused about something, which could be an issue for the patient."

Debra Cox, Mayo Clinic Nurse Administrator.

With that in mind, ExpertRN incorporates the guidelines into the algorithms where nurses will be able to use a guided decision tree based on the symptoms the patient presents, making sure that no important symptoms are overlooked.

The results are promising as well, with significant improvement in the documentation since the system’s introduction.

Other Technologies in the Market

An advantage of AI in triage systems is its ability to identify underlying symptoms and their seriousness based on historical data, which can in turn, lead to more accurate predictions.

Babylon triage and diagnostic system, a triage system that utilizes a Bayesian Network to discover the conditional dependencies between different symptoms, has been showing great success in triaging patients while showing decent accuracy.

MayaMD is another triage system powered by AI that utilizes Bayesian Networks and pattern recognition, including changing geographical data. It also showed promising results—according to research, it performed better than individual clinicians in certain scenarios.

Image by Proxet, Case percentage of Individual Physicians vs. MayaMD coming to same triage decision as Physician Consensus Triage
Case percentage of Individual Physicians vs. MayaMD coming to same triage decision as Physician Consensus Triage

Custom Proxet Nurse Telephone Triage System

However, telephone-based triage systems still have their place in the modern world—despite the advantages that websites and applications offer, there’s still the straight simplicity of phone-based triage systems.

So what about the best of both worlds?

It is also possible to utilize AI in phone triage protocols to aid the process while retaining the advantages of phone-based systems—human interaction. Proxet, with years of experience in developing AI solutions for medical institutions, can create custom nurse telephone triage system that harnesses the power of AI and integrate it with existing triage call centers.

With the use of historical data and reports, nurses can rely on an easy-to-use protocol—powered by AI with reliable medical data—to save time in triaging each patient while ensuring accurate performance. Are you interested in a smart triage solution? Contact us today!.

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