Triage and Telehealth -- Pre-hospital, virtual, On-site - A national organization or subspecialty under umbrella? by Laura Mahlmeister, MSN, PHD @ UCSF

Although telehealth lacks its own professional nursing organization, the american academy of ambulatory nursing (aaacn), recognizes telehealth nursing as a subspecialty. Aaacn has developed telehealth standards, resources and educational opportunities that may offer guidance to nurses specifically performing this task. However, the absence of a formal national professional organizational structure, with national standards and training, may place patients at risk and increase the likelihood of nursing negligence claims.

Two nursing groups have made formal statements about telehealth and telephone triage – the american academy of ambulatory care (aaacn) and emergency nurses association (ena). Nurses working both settings may, and often do manage calls. Aaacn has developed scope and standards of practice for professional telehealth nursing, 6th edition (december, 2020).

Telephone triage is currently accepted as a professional nursing function, although it is still an evolving area of practice. At present, neither aaacn nor the ena have developed a formal organization or provided monetary support for ongoing research specifically required to advance and improve the telephone triage process for nurses.

Telephone triage occurs in emergency departments; it has always been a source of controversy. While the ena is a recognized professional nursing organization, it has traditionally discouraged the practice of telephone triage in the emergency department.

The ENA’s “position paper on telephone triage in the ed” (2015), stated that with rare exceptions “emergency nurses do not give advice or clinical management recommendations over the telephone,” adding “formal commercial telephone triage nurses require specialized education; follow pre-established and physician-approved policies and protocols, complete patient documentation, and participate in quality improvement programs for safe and quality patient care”. (this position paper is currently retired).

More than two decades of research in patient safety confirms that the most effective approach to nursing practice is formalization. Specifically, in relation to telephone triage, this implies developing a formal in-house system, or outsourcing calls to an existing, formal commercial clinical call center. Unfortunately, nurses continue to perform telephone triage in the ed, labor and delivery units, urgent care and ambulatory settings, without adequate education, protocols and methods for documentation (mahlmeister).

Currently the american college of emergency physicians (acep) recommends that ed nurses not attempt clinical assessment or management by telephone (2018). And if nurses do practice informally in ed and urgent care settings, the calls they receive might actually be more serious. Complicating the picture is the fact that these settings typically have no system in place. Despite current ed policies, some experts note that calls still happen daily to monthly, depending on the site. Yet, some experts have noted that it is rare to find a paper trail of ed patient telephone encounters (Mahlmeister, 2019)

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Yes, triage nursing is considered a nursing subspecialty. It involves specialized skills in rapid patient assessment, prioritization of care, and decision-making, whether in emergency departments, telehealth, or remote settings. Triage nurses play a critical role in ensuring patients receive timely and appropriate care based on the severity of their condition.

Based on Laura Mahlmeister’s perspective, triage nursing, particularly in telehealth, pre-hospital, and emergency department contexts, is an evolving nursing subspecialty, but it lacks a unified national organizational structure and formalized support systems.

While triage nursing functions as a recognized and essential practice area, particularly in telehealth and ED settings, it is still developing as a subspecialty under broader bodies like AAACN and ENA, without a dedicated national organization to govern standards, training, or research comprehensively.