General practice is inundated – staff are managing more patients many with increasingly complex healthcare needs. Triage is being considered as a means of effectively and safely dealing with demand while meeting the needs of patients.
The concept of triage is nothing new; practice teams will be accustomed to conducting face-to-face, telephone and online triage. While the ways practices use triage differ, the essentials remain the same. We explore telephone triage – how it supports patients and healthcare providers, as well as the challenges to be aware of.
Triage is used to ensure patients are referred to the appropriate clinician, for the appropriate level of care, within the appropriate period of time and, ultimately, aims to improve access to care. There are certain questions that need to be asked and certain information that needs to be collected; a patient’s symptoms and concerns must be assessed, and the course of action must be agreed upon with that patient.
Telephone triage in practice
Urgent or same day appointments – and even routine care, such as follow-ups of long-term conditions – are regularly triaged at an administrative or clinical level, by practice nurses, nurse practitioners, or GPs. Most often, however, it is the receptionist who is the starting point for triage – establishing the patient’s problem and the degree of urgency.
Identifying the problem, severity, duration and particular concerns helps to prioritise the urgency with which a patient needs to be seen and decide the next steps to be taken. Any information collected at this point will be passed on to the relevant healthcare provider.
Mind your manner
To safely and effectively manage telephone consultations – and provide an effective triage service – there are some essential skills and considerations that should be kept in mind. It must be remembered that patients may be uncomfortable with the prospect of sharing personal information with receptionists at this early stage – in certain circumstances, deeming it intrusive. It’s important for all practice staff to approach the collection of patient information in a sensitive way – for example, explain why this information is important.
The triage challenge
Triage comes with particular challenges; when considering introducing it to your practice the Medical Protection Society (MPS) advises that you consider the purposes of triage, the potential benefits and risks involved and ensure – until further evidence is available – that you adopt a triage system that meets the particular needs of your patients and your practice. It’s essential that there is a clear protocol in place.
Training is available to help practice staff develop the skills they need.
Telephone triage limits your assessment of a patient’s needs as you are relying only on your communication skills – speech and hearing – there are no visual clues. For this reason, there are certain steps that need to be adhered to.
It is important, for example, to ensure that you introduce yourself clearly and in an open and friendly manner. You must allow the patient – your caller – to express themselves and give you a clear idea of what they are expecting – this will require you to be assured and structured in your interrogation. Finally, having identified the patient’s request and summarised it, you must repeat it back to them and close your consultation with an agreement on the course of action.
GP Training has broken telephone triage down into identifiable stages – which you can review in full here. They are as follows:
- The introductions: introduce yourself in full – including your practice. If the caller is not the patient identify the caller and their relationship with the patient.
- Gathering information: listen to the caller, giving yourself time to assess what they are saying. Allow the caller to give you their account of the problem – with the minimum of interruptions. Use the five ‘W’s as a guide:
- What is the problem?
- Where does the problem occur?
- When does the problem happen?
- What makes the problem better or worse?
- What is the timeframe of the problem?
Armed with this information, you have the necessary data to address the problem.
Things to avoid:
- Long-winded build-ups
- Multiple choice questions
- Medical jargon.
- The action plan: ensure that your caller is listening – in a plan involving two people negotiation is necessary. Your goal is a win-win situation.However, it can sometimes be the case that you are dealing with a patient who does not share this goal – you’ll need to be prepared for this and ensure you can confidently make the right interventions.
When a decision is made, there are three main outcomes:
- information or advice required
- face-to-face consultation with a GP is necessary
- consultation with another healthcare provider is needed – paramedics, nurse referral, or other.
Always check that there are agreement and understanding.
- Concluding the call: by the close of the call, you will have identified key elements to enable a resolution for the caller’s situation. Before finishing the call you must ensure that all parties agree and understand the outcomes decided upon.