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Telephone triage. The rules are changing.

The pressures of increasing clinical practice productivity as well as the limitations on parents' ability to make pediatric office visits has made it more difficult for children to be seen emergently in primary care clinics. For many children this translates into visiting an acute care center or emergency room to have urgent care needs quickly assessed and treated. Because of the gatekeeping now imposed on many organizations, it has become necessary for many primary care office settings to develop telephone management systems to triage the acuity of office visits or emergency room needs. This article reviews the issues inherent in developing an office-based telephone triage system, demonstrates some legal guidelines to follow for documentation, and describes the process of emergent management of parental concerns about child health.