Triage in general practice settings. What guides decision making?

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Non-clinical (reception) staff are usually the first port of call for patients to access care in general practice. They make decisions about who receives an appointment that day, who needs immediate care, or who can wait until the next available appointment. These are not clinical decisions, so what guides this decision making?

Triage is supposed to be a rapid, systematic process for determining a person’s level of urgency at the point-of-entry to a service to ensure people receive appropriate care. But more often than not, it is an ad hoc, even chaotic, process of balancing patient access to care with workforce pressures, and often relies on the skill, experience and ‘common sense’ of non-clinical staff to make the right ‘call’. Triage policies may not always be implemented or processes can sometimes be unclear, which can have both medical and legal implications.

Are non-clinical staff supported through policies, procedures, training and decision making tools? How is ‘urgency’ determined? The decision making involved in triage requires a collaborative approach with processes in place to ensure that patients have access to care in order of their clinical urgency. The clinical team need to drive triage policies and procedures to ensure non-clinical staff are able to triage patients appropriately and safely. ‘Urgency’ needs to be determined and described by the clinical team – what is considered urgent in a given general practice setting should be clearly articulated, as well as the circumstances under which a patient should be immediately transferred by phone or seen by a clinician. ‘Redflags’, or those conditions determined as needing immediate clinical attention, should also be outlined by the clinical team using clinical evidence and consideration of the practice population. For example, ‘redflags’ might be patients who: are unwell after returning from overseas travel, have sustained burns, have an eye injury, chest pain, difficulty breathing, or display a mental health issue. An algorithm or flow chart is useful to support non-clinical decision making and can help staff quickly identify some of these ‘redflags’. Practices can develop flowcharts and triage training can be provided by clinical teams or external providers.

Clear communication is also critical for appropriate and safe triage in general practice and should underpin triage policies and procedures. Issues such as: when calls should be transferred through to a clinician and whether a non-clinical staff can or should call an ambulance need to be clearly documented and understood by all staff. A short list of questions for non-clinical staff might also be very useful to support and guide staff in questioning patients who request same-day appointments. It is very difficult to expect non-clinical staff to triage patients without them asking some fairly basic questions such as: Are you in pain? How severe is the pain? How long have you had the pain? The key is for non-clinical and clinical staff collaboration and communication at all times. Clearly articulated policies, procedures and decision making guidelines are not just a matter of providing better access to appropriate health care; they are critical for risk management, avoiding medical and legal ramifications and important for meeting accreditation standards for quality improvement.

If you are interested in receiving or organising training in ‘Triage in general practice settings’ please refer to our Education and Training for more details. We also developed an infographic Triage poster that outlines best practice triage in general practice.