Project

5-Level TELEPHONE TRIAGE

Goal: The author seeks partners for a comparison of electronic prototype integrating a "Universal Guideline" with EHR. The 5-level Universal guideline incorporates fail-safes and user error feedback. It is available for research to compare algorithmic approaches with pattern recognition approaches in telephone triage in order to estimate symptom urgency. Measures may include: reliability, validity and transparency in terms of dispositions (safe, quality outcomes).

Date: 31 December 2020

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Project log

Sheila Quilter Wheeler
added an update
Based on experience as an expert witness on malpractice cases, and 35+ years expertise, she has developed an electronic prototype -- a "universal guideline" and EHR -- with a unique user interface. It incorporates 5-level Outcomes tracking, QA/QI features-- built-in fail safes and user feedback, designed to reduce common practice errors. The design is grounded on models of safety and quality expert opinion (Donabedian, Gawande, Wachter, Clawson,) standards (AHRQ, ACEP) and organizations IOM, Joint Commission.
 
Sheila Quilter Wheeler
added an update
“We don’t look for patterns of our recurrent mistakes or devise and refine potential
solutions for them. But we could, and that is the ultimate point”. --Gawande, 2010
Despite the introduction of software telephone triage technologies -- intended to reduce error -- recent research suggests that decisions are still not safe (Wheeler et al.). Risk is likely related to
lack of: 1. clear triage categories and/or 2. outcome (final diagnosis) of their clinical
decisions. Both failures appear to have changed little since the 1970’s. However, two
error reduction strategies are emerging: 1. Defined Outcomes or triage consensus, and 2.
Outcome feedback or Planned Call Recovery. Current technology can facilitate both
safety features.
 
Sheila Quilter Wheeler
added a project goal
The author seeks partners for a comparison of electronic prototype integrating a "Universal Guideline" with EHR. The 5-level Universal guideline incorporates fail-safes and user error feedback. It is available for research to compare algorithmic approaches with pattern recognition approaches in telephone triage in order to estimate symptom urgency. Measures may include: reliability, validity and transparency in terms of dispositions (safe, quality outcomes).
 
Sheila Quilter Wheeler
added 2 research items
Age-based, comprehensive, user-friendly and practical telephone triage guidelines. Standards-Based Features include: • 5-Tier Triage System Approach to Urgency Estimation (ENA, ACEP, Manchester Triage Group) • Standardized Dispositions that apply 24/7/365 • Multi-Purpose Master Guideline, which may serve as a training tool, or pre-emptive or contingency guideline (IOM) • Patient-specific language (IOM) 5th-8th gr literacy level instructions • Standards-based content & design to avoid common root causes of error (AAACN, Joint Commission, IOM) • Includes Practice Standards, Preceptor Training Program & 30-page User’s Guide (IOM) User Friendly Content is organized and formatted for ease of use and for face-to-face triage – in ED, clinic, office, Student Health center. A Complete Telephone Triage System that “makes it easy to do the right thing” (IOM) The Guideline Manual contains three system components: guidelines, documentation form and practice standards. The fourth component – the preceptor workbook – is a clinical training program. With adequate numbers of qualified staff, these five components form a complete system. Reasonable, prudent practice of telephone triage cannot guarantee that error will not occur. If malpractice does occur, an expert witness may request all of the five components listed above as evidence of a system. Each component adds a separate “layer of protection”, serving to reduce risk.
Age-based, comprehensive, user-friendly and practical telephone triage guidelines. Standards-Based Features include: • 5-Tier Triage System Approach to Urgency Estimation (ENA, ACEP, Manchester Triage Group) • Standardized Dispositions that apply 24/7/365 • Multi-Purpose Master Guideline, which may serve as a training tool, or pre-emptive or contingency guideline (IOM) • Patient-specific language (IOM) 5th-8th gr literacy level instructions • Standards-based content & design to avoid common root causes of error (AAACN, Joint Commission, IOM) • Includes Practice Standards, Preceptor Training Program & 30-page User’s Guide (IOM) User Friendly Content is organized and formatted for ease of use and for face-to-face triage – in ED, clinic, office, Student Health center. A Complete Telephone Triage System that “makes it easy to do the right thing” (IOM) The Guideline Manual contains three system components: guidelines, documentation form and practice standards. The fourth component – the preceptor workbook – is a clinical training program. With adequate numbers of qualified staff, these five components form a complete system. Reasonable, prudent practice of telephone triage cannot guarantee that error will not occur. If malpractice does occur, an expert witness may request all of the five components listed above as evidence of a system. Each component adds a separate “layer of protection”, serving to reduce risk.