Telephone Communication and Triage

Every encounter with a patient influences their perception of the quality of care they receive. It is extremely important that patient communication via telephone be regarded as equally important as face-to-face communication. The telephone has become the “front-door” for the patient and a target for liability issues. Telephone conversations are unreliable by their very nature, and an incomplete evaluation with the rendering of medical advice can make a physician liable for a patient that was never seen. In a study by Harvey Katz, MD in 2007, faulty triage of calls and errors in the documentation of calls were cited in allegations of failed diagnosis.

The most dangerous first step in the breakdown of patient-physician communication is pushing the hold button. This step, before determining the reason for the call, leads to patient frustration, anger and increased liability, or loss of the patient from the practice.

1. The following are suggested to improve telephone etiquette:
   1. Answer phone calls promptly
   2. Speak slowly
   3. Give the patient your full attention
   4. If the problem is not resolved, inform the patient that information will be given to nurse/physician and a return call will follow. We recommend that you have a tracking mechanism to assure follow-up occurred
   5. Document the call
   6. Hang up gently
   7. Never give advice beyond your competence level/training
2. The following recommendations for telephone triage are suggested to improve the quality of care and reduce liability:
   1. Have procedures and guidelines for staff who field telephone calls
   2. Develop message pads for documentation
   3. Train telephone triage nurse or staff
      1. Develop office guidelines, such as encouraging patients to come in, especially after multiple calls to the office or unresolved complaints of the same problem
   4. Establish an office policy for when calls will be returned (i.e., end of the day, during the day)
      1. Inform the patient
      2. Follow up to assure calls are returned
   5. Beware of leaving messages on answering machines or voicemail. The fact that the patient came to the office is confidential
      1. Give no specifics, request recipient contact the office
   6. If the patient/family are not satisfied with information, schedule the patient for a visit
   7. If you use a phone tree, have an option to speak with the staff
3. After Hours Calls
   1. Evaluate the answering service
      1. Call your own service
         1. Are they efficient, courteous, accurate?
         2. Are they putting you on HOLD?
   2. Add after hour documentation
      1. Document all patient contact in the medical record, date and sign the entry
4. Process Improvement
   1. Annually evaluate your office processes. Consider using the Telephone Utilization form and Office Telephone Assessment form to assess telephone activity