# Tele-triaging: a qualitative study exploring pharmacists’ clinical decision-making in a Poisons Information Centre using interviews and a clinical vignette

## TL;DR

This study explores how pharmacists in poison centers make clinical decisions during emergency phone calls, highlighting the balance between guidelines and real-time judgment.

## Contribution

The study provides new insights into pharmacists' tele-triage decision-making processes using qualitative methods and clinical vignettes.

## Key findings

- SPIs use a three-phase process involving information gathering, risk stratification, and management decisions.
- Clinical autonomy and experience are crucial in complex cases despite structured guidelines.
- Time pressure and documentation requirements create challenges in workflow prioritization.

## Abstract

Specialists in Poisons Information (SPIs), most of whom are pharmacists, work in Australian Poisons Information Centres (PICs) and provide telephone-based triage (tele-triage) and management advice for poison exposures. Australian PICs answer calls from the public and healthcare practitioners and are considered an emergency telephone service. While tele-triaging and clinical decision-making have been explored in other health professions, limited studies are available exploring how pharmacists apply their knowledge to make clinical decisions in a busy tele-triage emergency setting.

To explore how SPIs apply clinical judgement in tele-triage and to understand the factors that shape their decision-making.

This study represents the second, qualitative phase of an exploratory sequential mixed-methods design examining calls related to unintentional poisoning exposures in older adults (≥ 75 years) to the New South Wales PIC. Semi-structured interviews with 12 SPIs were conducted, supported by clinical vignettes and analysed using an inductive approach. Thematic analysis was combined with process mapping to describe the decision-making process.

SPIs followed a flexible, three-phase process of information gathering, risk stratification, and management decision-making. This process was iterative, shaped by experience, clinical knowledge, and the urgency of the call. Decision-making relied on the ability to balance known and uncertain risks, interpret caller information, and assess social and clinical context. While structured guidelines supported consistency, SPIs emphasised the importance of clinical autonomy, particularly in complex cases. A strong collegial culture and peer learning were central to developing decision-making skills. Time pressure and documentation requirements created tensions, highlighting the need to align workflows with clinical priorities.

SPI decision-making is a dynamic, context-dependent process that combines clinical expertise, guideline use, and real-time judgement. Findings have implications for SPI training, documentation systems, and the design of telehealth services involving complex risk assessment.

The online version contains supplementary material available at 10.1007/s11096-025-02000-3.