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Telephone triage is a demanding role where small misunderstandings can lead to serious consequences. Where are the greatest risks in a call? How can you best manage the encounter with the patient and avoid these pitfalls? Elisabeth Almgren Eriksson, an expert in communication methodology and telephone triage, shares tips to help facilitate the conversation.

Telephone triage places high demands on focus, structure, and professional judgment. “Telephone triage is a cognitively demanding job with common pitfalls that you can learn to avoid,” says Elisabeth.

She has worked on developing The Consultation Process, a method for advisory calls based largely on the analysis of real-world healthcare conversations. By listening to calls retrospectively, it has become clear when things go wrong—and why.

“When listening to a recording, you can often hear the exact second a call takes a turn and the risk of misjudgment increases. This provides fantastic opportunities for learning and development.”

Listening to and analyzing calls increases understanding of one’s own workflow, allows for reflection, and serves as a concrete basis for quality assurance and patient safety.

According to The Consultation Process, a healthcare call is divided into five phases: opening, listening, analysis, action, and closing. The biggest pitfalls often occur during the listening and analysis phases.

Three Common Risks and How to Handle Them

1. Interrupting the Patient

In the listening phase, it is common to interrupt the patient too early and begin forming a diagnostic hypothesis before hearing all current symptoms. We also tend to interrupt the narrative by asking questions too quickly. This increases the risk of missing the patient’s full symptom picture, their concerns, and the actual reason for the contact.

“If we interrupt too early, we risk never getting the full story. Then, the rest of the call is built on a fragile foundation,” Elisabeth explains.

Elisabeth’s Tip: Let the patient finish speaking. If you must interrupt, do so clearly and ask: “I’m sorry to interrupt, but I’d like you to tell me what made you decide to contact us right here and now?” This increases the chance of capturing the most critical parts of their story.

2. Accepting the Patient’s Hypothesis

It is easy to get caught up in the patient’s own theory about what is wrong. This often leads to the responder stopping their own line of questioning and critical thinking, moving straight to an assessment or action. Both your own internal hypotheses and the patient’s can prevent a thorough investigation of symptoms.

“When we ‘buy’ the patient’s hypothesis, we often stop asking questions,” says Elisabeth.

This phenomenon is known as premature closure, which is a common factor in Lex Maria reports (patient safety incident reports). When alternative explanations are not explored, there is a risk that serious conditions are missed.

Elisabeth’s Tip: The risk of misjudgment arises when you accept a hypothesis without further investigating the symptoms. Always ask your own questions, broaden the symptom picture, and summarize what you hear. You can ask: “Now that you are contacting us, which symptoms are bothering you the most?” Adapt the phrasing to fit the specific conversation.

3. Not Speaking Directly to the Patient

Sometimes a relative calls on behalf of a patient—for example, a parent or a partner.

“If someone says the patient is too ill to speak for themselves, you should be on high alert. Be persistent and ask to speak with the patient directly to ask questions and assess their general condition.”

Elisabeth’s Tip: Do not forget children, the elderly, or people with cognitive disabilities. Even if a relative initiates the call, you should ask to speak to or at least listen to the patient (e.g., to hear their breathing). They can provide vital information.

Additional Tips to Minimize Risk

The Importance of Summarizing

To avoid misunderstandings, summarize what the patient has said and ask them for feedback. This ensures you both have the same understanding of the symptoms and reduces the risk of misjudgment.

“Summarizing is a central safety tool in the conversation.”

Ending the Call Safely

How you conclude a call is vital for patient safety. After presenting your assessment and providing advice, guide the patient on what to expect next. Clarify that they should reach out again if their condition changes.

“Tell the patient what the expected course of events is after the call, which symptoms they should watch out for, and tell them to contact you again if they don’t improve or if symptoms change.”

This increases the likelihood that the patient will seek help if they deteriorate or if new symptoms appear.

The Consultation Process serves as a support tool for telephone triage, helping nurses structure calls effectively and safely.