Telephone Triage: A Challenge for Practicing Midwives


  • Nancy E. DeVore CNM, MS

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    • 1Nancy E. DeVore received master's degrees from Washington University in St. Louis, where she studied psychiatric nursing, and from Columbia University in New York City, where she received her midwifery education. She has an extensive background in clinical practice, has served as a midwifery director of both a small private practice and a large public hospital service, and is currently Director of Ambulatory Women's Health Services for Montefiore Medical Center in Bronx, New York. She is a member and a former chairperson of the New York State Board of Midwifery and serves on the Examination Committee of the ACNM Certification Council, Inc.

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Telephone triage is the process by which a health care provider communicates with a client via the telephone and, thereby, assesses the presenting concerns, develops a working diagnosis, and determines a suitable plan of management. Determination of the seriousness of the situation will dictate whether a client can be cared for at a distance or whether a more comprehensive in-person evaluation is in order.

The process of telephone triage is fraught with potential problems, including difficulty in establishing a reliable database, environmental distractions, cost concerns, liability issues, and, frequently, inadequate documentation. This article will describe an approach to these concerns by discussing the use of appropriate communication techniques, the development of a working diagnosis, the establishment of a plan of intervention, and the appropriate documentation of care. Such steps will go far toward diminishing the growing legal threats that arise to midwives who utilize this technology to render care to their patients.