Pediatric Telephone Triage: Interview with Dr. Jack Siedel
Jack Seidel, MD, is a pediatrician in Dallas, Texas and is affiliated with multiple hospitals in the area, including Children’s Medical Center Dallas and Dallas Medical Center. He received his medical degree from University of Texas Southwestern Medical School and has been in practice for more than 25 years.
AccessNurse: Please tell us, in your years of experience as a pediatrician, what are some tips on handling difficult or extremely anxious parents?
Dr. Seidel: Hear them out and repeat their concerns to them so that they know you have heard and are going to address all of their concerns.
AccessNurse: You write guidelines and review many triage calls. What are your thoughts on what you consider a superb triage call?
Dr. Seidel: A superb triage call can take many forms: such as when a nurse picks up something subtle that the caller said that results in a big difference in the way the call is handled; or when a parent who is very worried is reassured; or when the caller is asked if they have any other questions or concerns.
AccessNurse: What would you consider the greatest challenge in pediatric telephone triage?
Dr. Seidel: Not being able to examine the patient, look at the rash, see what the kid looks at, etc. Second would be language barriers – even with translations.
AccessNurse: In your opinion, what is the most commonly missed or underemphasized symptom in pediatric triage?
Dr. Seidel: Not with AccessNurse, but in general, an extremely important part of evaluating kids is how the kid looks and is acting. With telephone triage, getting that information from the caller may require great interviewing skills from the triage nurse.
AccessNurse: How would you recommend a nurse handle an after-hours caller who demands antibiotics and who has not been seen or refuses to be seen?
Dr. Seidel: It is generally bad medical care to prescribe antibiotics without a thorough examination. Taking even a single dose of antibiotics can prevent certain tests from being accurate, can cause resistance in the patient and can have detrimental and occasionally serious side effects. That is why we also try to educate people to not give anyone, especially children, leftover antibiotics without a doctor deciding if antibiotic treatment is in that patient’s best interest at that time and which specific antibiotic would be appropriate.
AccessNurse: After years of being involved in pediatric triage, what is the most common symptom in pediatric after-hours triage and has it changed over the years?
Dr. Seidel: I believe that viral infections are the cause of most sick visits and likely most phone calls. Snotty, runny noses and coughs along with vomiting and diarrhea are the bread and butter (excuse the pun) of pediatrics and that hasn’t changed.