One of the biggest challenges in telephone triage is learning to think in terms of clinical presentations and urgency levels, rather than immediately looking for a diagnosis.
When assessing the patient, avoid jumping to conclusions or trying to identify the diagnosis too early. Instead, keep asking yourself one key question:
“Is this urgent?”
Your assessment of the clinical presentation is based on the information provided by the patient or caller. As you listen, additional questions will naturally arise. Ask open questions whenever possible and avoid leading the caller towards a particular answer.
By consistently exploring the patient’s clinical presentation, you reduce the risk of diagnostic bias or tunnel vision. Maintaining an open and curious attitude is essential. Many questions about the clinical presentation will overlap with your ABCDE assessment, but they focus on understanding the patient’s situation rather than confirming a diagnosis.
A helpful approach is to explore the patient’s story by asking questions about Who, What, Where, Why, How, When, and Which.
Who?
- Who are you speaking to?
- Is the patient able to come to the phone?
- Who is describing the patient’s condition?
- Who else is present with the patient?
What?
- What has happened?
- What is the main complaint?
- What is the patient still able to do independently?
- What can the patient no longer do independently? Did this change occur suddenly?
- What prompted the call today?
- What else can you hear in the background besides the caller’s voice?
Where?
- Where is the patient at the moment?
- Where did the symptoms first start? (For example, with abdominal pain, has it been in the same location from the beginning?)
- Where did the incident occur? (In the case of trauma.)
Why?
- Why is the patient seeking medical advice now? (Avoid making assumptions or passing judgement.)
- Why was the patient’s own GP not contacted first? (Ask without making assumptions or passing judgement.)
How?
- How did the symptoms start, or how did the incident happen?
- How have the symptoms progressed?
- How is the patient doing right now? Specifically ask whether the symptoms have changed, worsened, or improved.
- How does the patient sound?
- How are family members or bystanders responding to the situation?
When?
- When did the symptoms begin?
- When was the last time the patient experienced similar symptoms? (For example, in patients with urinary tract infections, consider recent antibiotic use.)
Which?
- Which symptoms is the patient experiencing?
- Which parts of the body are affected? (For example, with neurological symptoms, determine whether the symptoms are affecting one side of the body.)
Good Communication During Triage
Ask one question at a time. Listen carefully to the answers and record the most important information immediately, at least in brief notes.
Avoid making assumptions. If you do not understand an answer, or if the patient does not answer your question, always ask for clarification.
Adapt your language to the patient’s situation. Consider whether there may be a language barrier, a mild intellectual disability, anxiety, stress, or agitation that could affect communication.
Finally, always explain why you are asking so many questions. Patients are more likely to cooperate when they understand that your questions help determine the urgency of their situation and ensure they receive the most appropriate care.
