Telephone Triage

I recently had someone ask about the appropriateness of providing medical advice over the phone. To answer, let's begin with the definition of medical advice. Is it responding to a question about a current or past health situation?

Does the response include instructions? Is relaying test results to a patient considered medical advice? Who is providing the advice?

As you can see, this is an area where the answer can vary based on the circumstances. Staff members who provide medical advice or instructions to patients without a written and approved protocol may be viewed as practicing without a license. Therefore, a good practice is to have a written policy as a protection for you, your staff and your patients.

Your policy should identify what information the dentist will allow the staff to tell patients. It is important that the policy distinguishes who can—in accordance with their professional licenses—provide information. Additionally, it should address which questions should be directed to others. It is also important to distinguish between urgent and nonurgent calls and how they are handled.

The first step in assessing whether your practice needs a policy is to ask the following questions:

  • Do you currently have a policy with procedures related to handling telephone calls to the office?
  • Does this policy address who (by role, not name) is responsible for triaging calls?
    • Is this policy approved and periodically reviewed by the dentist?
    • Are the procedures approved and periodically reviewed by the dentist and staff?
    • Is documentation maintained of both of these reviews?
  • Does/do the individual(s) in this role have specific training, experience and competence in the telephone assessment techniques? Can they:
    • Positively identify the patient prior to discussing any medical or personal issues?
    • Identify specific symptoms or concerns and their duration?
    • Inquire as to interventions taken?
    • Assess the situation as to the next step (make an appointment or go to the ER)?
    • Verify understanding?
    • Give call back instructions?
    • Document the conversation?
      • Patient name
      • Age and gender
      • Person calling and his or her relationship to the patient
      • Date and time of call/time of call back if not immediately taken
      • Phone number calling from and where the caller can be reached
      • Chronic health issues
      • Medications
      • Allergies, if pertinent
      • Recent visits or hospitalizations
      • Who took the call
      • Advice provided
    • Obtain sign off by the dentist providing the advice or “per the direction of Dr. …”?
  • Does the policy address when calls must be returned or when staff should interrupt the provider?
  • Does the policy include guidelines for scheduling urgent appointments?
  • Have state-specific guidelines been reviewed with regard to providing clinical information to patients?

As a policyholder, please contact us if you have questions about the risks associated with this topic.