Quality telephone medicine. Training and triage.

The telephone is an integral part of medical care, yet it ranks as the number one source of patient and clinician dissatisfaction. Problems fall into three categories: (1) volume overload with access difficulties, (2) staffing and telephone triage, and (3) the stress on clinicians of non-emergency night calls. This paper summarizes a telephone medicine satisfaction survey among HMO pediatric department chiefs, reviews the variables that influence the quality of telephone medicine, and discusses the importance of training in telephone management skills. A four-step approach to improving telephone medicine is presented along with a telephone quality-of-care checklist applicable to most practices.