Capturing the information shared by patients at the front desk and prioritising appointments appropriately reduces risk and helps practitioners enjoy a better organised day. In the healthcare world we call this triage.
Unfortunately, triage is often only associated with heart attacks, bleeding or some other life-threatening condition. Although the triage process may include these conditions, they represent only a small component.
Good triage is making a better decision about every phone call or presentation; it is the receptionists’ method for appropriately organising the practitioners’ schedule. Triage is relevant across all disciplines of healthcare because all disciplines have conditions, requests and patients that range from ‘needing to be seen now’ to ‘being able to wait’.
Procedures vary greatly and depend on:
- the health discipline
- the practice model and speciality areas
- the patient health profile and/or demographic.
Developing a practice-specific triage process
The important thing is to make sure your triage procedure is appropriate for your practice.
Developing a practice-specific process should involve the team. I have often seen a receptionist consider something urgent, that a practitioner may not. I have also seen a practitioner change their mind on whether a presentation is urgent when they hear a receptionist’s perspective. For example, an anxious mother who upsets the waiting room may be placed high on the triage list.
Involving practitioners in the development process ensures the influence of clinical knowledge and helps them understand the importance of keeping the reception team informed about patients that may be at risk. For example, a patient exhibiting severe mental health issues may need to be prioritised on the triage list and important information may need to be divulged to the front desk staff. The practitioner may need to advise the administration team what questions to ask this type of patient. For example, “Has the doctor told you to request an urgent appointment?” Or the practitioners may decide that certain patient names are known to the administration team so they can be placed as a high priority without any questions being asked.
Follow these steps
Initially, it’s a good idea to ask the practice staff to conduct some research on examples of different triage procedures. Ask the practice team to bring these examples to the triage planning meeting to guide thinking and planning.
Ask the team to consider what the practice can do for the patient. For example, a surgeon’s practice might offer: speak to the nurse/go to hospital/make an appointment this week or make an appointment within a month.
On the other hand, a general practice might tell the patient: speak to the doctor/come in now for an urgent appointment/come in at end of day/make an appointment within a week or make an appointment within six weeks. Receptionists may also be trained to tell the patient to ring 000 or call 000 for the patient.
Ask the team to list the types of conditions, requests and patients they routinely receive. Then decide where they fit into what the practice can offer. For example, a patient ringing the surgeon’s practice with postoperative bleeding would possibly be placed under ‘go to hospital’ or ‘speak to the nurse’. However, a man ringing a general practice with asthma might be placed under ‘come in now for an urgent appointment’ or a patient with chest pain and shortness of breath may trigger a call to 000.
There are many different requests or conditions, but it’s important to list them as this may motivate a change to your appointment schedules. For example, this step could highlight a lack of spaces for urgent appointments in the week following surgery, or on a Tuesday after a long weekend.
Decide on a set of questions that will help the receptionist distinguish the condition, request and/or patient. Some practices keep a list of ‘fit in any time’ patients that the workstation displays confidentially. So asking the patients name would automatically allow the receptionist to categorise the patient correctly.
Other questions to ask might be “when was the surgery?” or “has the blood stain on the dressing increased by more than three centimetres in diameter?” In general practice some common questions might include, “how long have you been vomiting?” or “how old is the child?”
Once you have finalised the triage procedure, it’s important to ensure:
- Everyone has access to it.
- It’s reviewed annually and the practice team is reacquainted with it.
- It’s part of the orientation process.
Rural HealthWest’s Triage: A guide to urgency for non-clinical staff in general practice for telephone and walk in presentations
The RACGP’s psychological triage in general practice
If you would like further advice on this issue or any other issues, visit our website or for immediate advice, call our Medico-legal Advisory Service (MLAS) on 1800 128 268, 24-7 in emergencies.
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