Introduction to Triage Dr Nikki Tooley Update

Objectives By the end of the session you should be able to Feel more confident about your role in triage Be able to identify clinically urgent symptoms Be aware of where to direct different clinical scenarios based on this knowledge

What is triage and should I be doing it? It is a process for sorting people into groups based on the urgency of their medical needs and It is a system used to allocate a scarce resource based upon this urgency Based on the premise that if we increase the speed at which patients access appropriate care we will improve patient outcomes

BMA Advice Confidentiality Triage systems should be open e.g informing pts of limited emergency appts resulting in additional questions which are needed to appropriately use the resources available The surgery should try to comply with any reasonable request or preference In terms of patient care you are not qualified to give advice but you are able to filter patients in the right direction

Triage Is it urgent? If a pt states a request is urgent it is not your role to decide on the merits of the request BUT you can triage the level of urgency by asking appropriate questions So what question should we be asking ? What things should make us more concerned

Part 1 – Urgency of clinical symptoms Team races to put symptoms in categories RED = sound worrying/urgent AMBER = could be concerning, not sure GREEN = not usually something to worry about Your Doctors are your runners only You have 3 mins and 23 seconds Imagine you answer the phone ‘ hello my name is at pulborough medical surgery how can I help?’ And the response you get is ‘ I am worried about my ….chest pain, cough etc’ Based only on your instincts to the words written I want you to tell your doctors where to place the paper – red, amber or green

Part 2 - discussion Review of consensus/divergent symptoms

Part 3 – the influence of extra details Turn an amber into a red or green with additional clinical story and nominate a spokesperson to explain your reasoning

Part 4 – what to do next? Advise to call 999 Speak to duty doctor IM duty doctor Task urgent named doctor Routine task named doctor Offer on the day appt Offer minor illness 5min slot Offer routine appt Signpost to more appropriate service

Summary No matter what system of appts we use by answering the phone first you will be faced with situations where a judgement is required Remember good communication Awareness of the systems in place If you are not sure ASK! Leading onto surveys on how we make sure we support eachother

BLOODS WHAT YOU NEED TO KNOW

It’s all about being ‘normal’ What is normal result? 95% are within the normal range so 5% of normal people are outside it. The individual result is important but so is th trend of that pattern.

So when can things be abnormally normal? Kidney tests Known diabetics Expected results eg. UTI, Swabs, menopause Pregnancy, age or sex differences

It’s all about the trend!

Fasting Tests Advise patients not to eat anything and only drink plenty of water for 9 to 12 hours before having the test

Cholesterol – the facts Lipid Profile is… The impact… Calculate the risk of developing heart disease or stroke (cardiovascular disease) within the next 10 years. Risk also based on BMI, BP, Diabetes, age, sex, family history and ethnicity ‘Good’ cholesterol HDL ‘Bad’ cholesterol LDL Total Cholesterol Triglycerides (other fatty stuff)

Diabetes – HBA1C 1. Normal 2. Pre- diabetes 3. Diabetic range

Why might a patient need another blood test ? Trends Common myth about blood tests NOT one for all and all for one! Further information needed due to result Timing eg.Vitamin D, ovulation Diagnostic certainty e.g. diabetes

Part 3 – talking the talk

Group Work Allocate a BAD COP to respond to the patient Allocate GOOD COPS Allocate a reporter to jot down some of the good phrases used

Examples of discussion points We need a doctor to visit my mother today Why do I need to tell you what I want to speak to the doctor for? Why do I need another blood test? When is my favourite doctor X next duty? Get the doctor to call me today I need antibiotics I haven’t seen a doctor about this yet I want to book a blood test? When can I see doctor X? What does that result mean? Why should I call 999 now? I want to talk to the doctor about my results? Can I also talk about my long term back pain in the duty doctor appt?