Evidence Behind the Schmitt-Thompson Office Hours Protocols

ClearTriage is uses the Office Hours telephone triage protocols for nurses created and maintained by Dr. Barton Schmitt and Dr. David Thompson. The creation of new protocols and the annual updating of existing protocols use the following evidence-based resources:

  1. After Hours Telephone Triage and Advice Protocols

    The Office Hours protocols were all derived from the After Hours protocols. The After Hours protocols are used in over 400 medical call centers in the United States and Canada. They have been the preferred decision-support tool in many call centers since 1995. Triage nurses use them to manage over 20 million calls per year. Many physicians and nurses refer to them as the standard of care. The Schmitt-Thompson protocols are based on the following resources and evidence:

    • National Guidelines and Policies (AAP, AAFP, ACEP, ACOG, CDC, FDA, AHA, ADA and other national organizations)
    • The medical literature (each protocol is referenced)
    • Expert reviewers (over 100 physicians and nurses)
    • Published research studies in peer-reviewed journals (11 publications on the protocols themselves)
  2. New Information from the Yearly Updates of the After Hours Protocols

    Every year the Office Hours protocols are updated. Updates are based on the following:

    • Changes in the medical literature
    • Requested reviews from national organizations
    • Findings from Quality Improvement projects at 9 medical call centers
    • Findings from reviews of high-risk calls
    • Recommendations from nurse managers and medical directors of call centers
    • Reviews from 2 office-based PCP Advisory Panels
  3. American Academy of Pediatrics (AAP) Review and Approval
    The AAP publishes Dr. Schmitt’s book Pediatric Telephone Protocols. The 15th edition was released in late 2015. The current book contains 140 Office Hours printed protocols. They are used by triage and advice nurses in over 90% of pediatric offices in the U.S. The protocols were initially reviewed and approved by the AAP Committee on Practice and Ambulatory Medicine.
  4. Requested Reviews from National Organizations
    National Committees and Sections are great resources. Drs. Schmitt and Thompson sometimes request reviews of selected Office Hours protocols from them. These reviews are very helpful for resolving controversial issues that need an authoritative position. For example, the dietary management of gastroenteritis in young children has considerable variance in private practice. In 2011, Dr. Schmitt requested a special review of the Home Care Advice for the Diarrhea and Vomiting protocols. The AAP Committee on Nutrition and the AAP Section on Gastroenterology reviewed the protocols and provided helpful suggestions that were incorporated.
  5. AAP Section on Telehealth Care (SOTC) Input
    The SOTC is a forum for pediatricians to address all aspects of telephone care and other non-face-to-face encounters: education, research, risk management, access, advocacy and practice innovation. The SOTC Listserv provides members a mechanism for sharing new ideas or asking for help from telehealth experts. Dr. Schmitt has posted new protocols on this site and elicited helpful feedback. During the H1N1 pandemic, he posted urgent flu protocol updates on this site to help office practices with changing recommendations. In 2013 he provided a new Office Hours protocol (Psychosocial Problems) that had been requested by SOTC members. In 2014, he posted an Ebola Exposure protocol within 1 week of the first report of Ebola disease in the US.
  6. National Awards
    Several Air Force and Army bases use the Office Hours protocols for nurse triage, advice and scheduling. The Schmitt-Thompson Clinical Content was selected as the winner of the DoD/VA iEHR and HIE Summit’s Award for Best in Clinical Quality Aims for integrating Electronic Telephone Triage Protocols with AHLTA and VistA iEHR. The award was presented in Washington DC on September 30th, 2013.

Author: Dr. Barton Schmitt, July 2015