telephony
becoming frazzled and frustrated. We decided to have telephone consultation training to enable us to offer telephone appointments to improve patient access. This included training for our receptionists on how to sensitively enquire about symptoms or need with patients who were requesting a face-to-face appointment and how to ask the right questions to ascertain how best they can help. Our GPs also received training on how to perform telephone triage and advise patients over the telephone. One year later, our new access system is working well. Our patients are more understanding of why we need to ask for brief details of their symptoms when they call and all our GPs can confidently offer consultations and triage over the telephone.” Educating worried parents through
triage is another wonderful tool of effective communication, says Pygall. “If you have a concerned parent with a poorly child who has a temperature and is vomiting, a good triage call can firstly eliminate any serious problems, check that there are no red flags indicating risk factors and ensure that everything is done safely. From this you can go on to empower the parent by detailing steps and factors to look out for. This is a key part of triage – you are not just telling the carer how to manage the condition, you are actually telling them how to ensure the child stays safe by detailing the next course of action and a timeframe if there are any changes. The next time the child is poorly, the carer may follow the steps given by you and realise if it does not work, they will need to make contact. There are many opportunities to empower and educate patients within telephone healthcare,” she adds.
When responses go wrong, this can result in the loss of a patient’s life. The trauma of listening to someone dying on the telephone is one Pygall will never forget. A better response from the clinician may have saved that person’s life. “I’ve heard calls where the patient, partner or parent is describing how unwell they are feeling and either the GP or nurse has not realised what they have said. The worst ones are when you hear an extremely worried parent talking about their child and you know that is the last telephone call they will make about that child. It is really traumatic when you think, ‘why did you not pick up on this,’ or ‘why did you not ask those questions’ and they have simply missed something critical during the call.”
30 february 2013
I’ve heard calls where the patient, partner or parent is describing how unwell they are feeling and either the GP or nurse has not realised what they have said
TIPS FOR HANDLING TELEPHONE CONSULTATIONS
1. Access training – Even if your organisation will not pay for training, consider paying for it yourself because ultimately we are all responsible for our own professional development. If you are doing triage on a regular basis, and you have not accessed training, do so first and foremost.
2. Find time – One of the biggest risks is when we fit triage calls in between everything else as this puts pressure on you and your caller. Under time constraints you may ask fewer questions and not gather enough information. You could carry out a mistriage or not get all the information you need and go on to make the wrong outcome.
3. Work to a model or structure – When I listen to consultations of people who have not been trained or who are not using some form of protocol or decision support system, their triages and interactions can become quite chaotic at times. The best form of structure is protocol-led.
4. Voice record your calls – It is so easy to do and it is very useful when it comes to recollection of the call, complaints, but mainly for clinical supervision and reflective practice. If there has been an incident or a grievance made, nine times out of ten, the voice recording actually supports the clinician. This is largely because when things go wrong, callers can interpret the call differently.
5. Documenting triage calls – Look at how you record your telephone interactions as this is also something that can be done poorly. You can either develop a telephone consultation form or agree as a practice on what you feel is the minimum standards for documenting telephone interaction.
management
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52