This retrospective mixed-methods study explored patient safety within a pediatric telemedicine triage service by assessing the appropriateness and reasonableness of the diagnosis reached by the online physician. The researchers analyzed a random sample of telephone consultations and conducted qualitative interviews with physicians to obtain their perspectives about factors impacting their reaching diagnosis and deciding on reasonable and appropriate treatment. Analysis of telephone consultations found high levels of diagnosis appropriateness, decision reasonableness and accuracy. Physician interviews revealed six themes for appropriate diagnosis and decision-making: (1) use of intuition, (2) experience, (3) use of rules of thumb and protocols, (4) making shared decisions with parents, (5) considering non-medical factors, and (6) using additional tools such as video chat or digital photos when necessary.