From Drs. Schmitt and Thompson, authors of the clinical content used in ClearTriage:

The terms guideline and protocol are often used interchangeably.  For example, one online definition defines a clinical guideline as a “best practices protocol for managing a particular condition, which includes a treatment plan founded on evidence-based strategies and consensus statements by peers in the field”. Another definition that still stands the test of time, developed by the Institute of Medicine (1990), defines a clinical practice guideline as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. The Schmitt-Thompson clinical content conforms to these definitions of a clinical guideline. The Schmitt-Thompson clinical content is a decision-support tool that was developed systematically through a survey of the relevant medical literature, incorporation of evidenced-based information when available, and reviewed by an expert panel of nurses and physicians. The Schmitt-Thompson clinical content is updated annually based upon changes in the medical literature, feedback from triage nurses, physicians and call center medical directors, input from the Schmitt-Thompson expert reviewer panels, and results from ongoing analysis of outcome and quality assurance information.

One can define an algorithm as a logical sequence of steps for solving a problem that can be translated and loaded into a computer software program.  The Schmitt-Thompson clinical content meets this definition of an algorithm.  The Schmitt-Thompson clinical content is stored in a highly structured relational database and organized algorithmically. The central elements of each guideline are stored within a table named “Algorithm”. Other linking tables provide search words, triage questions, care advice, and references.

  • A table of specifically selected search words or chief complaints directs the triage nurse to the most appropriate guideline(s).
  • A definition is provided at the start of each guideline to help the nurse determine if this guideline is the best match for the patient’s symptom. If not, additional prompts re-direct the nurse to related (more appropriate) guideline(s).
  • Within each guideline, triage questions from the relevant table in the database are presented in descending order of acuity from symptoms of the highest acuity to those of lowest acuity. Nurse triagers find this question arrangement both logical and intuitive as it supports their natural clinical assessment and thought processes.
  • Each triage question is linked to targeted, explicit care advice.

Regardless of whether one describes the Schmitt-Thompson clinical content as telephone triage guideline or as an algorithm, its purpose is:

  • To facilitate a safe telephone triage process and sort patients to the most appropriate level of medical care (disposition) based upon the acuity and severity of their symptoms (triaging the right patient to the right place at the right time);
  • To provide decision-support to telephone triage nurses;
  • To deliver best practice care and advice based on expert consensus and evidence-based research;
  • To reduce variability in triage practice and provide a standardized basis for referral and patient education;
  • To promote efficient use of resources;
  • To serve as a framework for quality assurance audits and quality improvement.
  • To provide a reference for ongoing nurse education both during and after triage calls.

Footnotes

  1. https://medical-dictionary.thefreedictionary.com/Clinical+guideline
  2. Institute of Medicine. (1990). Clinical Practice Guidelines: Directions for a New Program, M.J. Field and K.N. Lohr (eds.) Washington, DC: National Academy Press. Page 38.
  3. https://www.merriam-webster.com/dictionary/algorithm