Triage is Good Medicine Author: Erich W Mack LDO, ABOC-AC, NCLC

Abstract A sometimes overlooked and critically important process to the optometric practice patient care is telephone triage. Most practices have multiple people answer patient phone lines, whether its their main job duty or not, and this can leave opportunity for patient care to fail. Giving proper medical need recommendations is a responsibility to all employees that have access to the phones. Good triage equates to good medicine and reduces practice liability.

What You Will Learn What is triage and why it is important How to create your own triage chart How to create a triage phone algorithm How to deploy a successful triage program in your practice

Ocular Distress Phone Calls HELP, what should I do? Ummm...

Handle Emergencies Using Triage We don't have open appointments. What should I do?

Which System Is Best?

Utilize Staff on Hand if Possible SALES Optical Management Reception Pretest And NOW TRIAGE

Its a Matter of Good Medicine What happened? When did it happen? How did it happen?

Does Your Office Have a Triage Protocol? Triage protocols OR ?

Don't Put Yourself in a Liability Situation No Triage Plan Lawsuit Lost $$$$$$ and potential losing your business and license

Physician Insurers Association of America $12,400,000!

Infamous Lawsuit Triage was performed Triage protocol did not accurately assess patients severity Infant lost hands and feet as a result Family was awarded $45,000,000

Another Lawsuit Example Elderly man wanted to see his doctor Receptionist said the doctor was on vacation Man wasn't seen for a couple weeks later When the initial call was made he was having a mild heart attack He suffered further heart damage due to the delay

Should He Be Seen Or Not? We are very busy so call back if it gets worse. It's not that painful. I don't think I should come in.

Don't Let This Happen My whole family is infected! Why didn't you let me see the doctor!

Detached Retina's are Emergencies My eye is acting weird If it doesn't hurt its not An emergency. Call Us if it gets worse.

Don't Let This Happen I'm blind in my eye. If only I could have been seen sooner.

Creating a Triage Protocol Triage Urgency Chart

First, Classify Urgency Levels EmergencyUrgentSemi-UrgentNon-Urgent

Second, Determine Medical Response Times EmergencyUrgentSemi-UrgentNon-Urgent 911 / ImmediateWithin 1-4 hoursWithin 24 hoursNext Available Appointment

Third, Populate Chart with Symptoms and Conditions EmergencyUrgentSemi-UrgentNon-Urgent 911 / Immediate Within 1-4 Hours Within 24 Hours Next Available Appointment Chemical Burns Traumatic/Penetrating Injury (massive eye trauma) Angle Closure/Acute Glaucoma (painful sudden vision loss) Retinal Detachment (spider webs/veils) Loss of Vision (not painful) Corneal Ulcer (painful sore on the cornea, photophobic, usually contact lens wearers) Intra-Ocular Foreign Body (accidental injury, high velocity) Iritis (red painful eye, blurred vision, photophobic) Corneal Foreign Body (non penetrating, painful, scratching sensation) Corneal Abrasions (accidental scratch on the cornea) Loss of field of vision Flashes/Floaters Acute pain (asymptomatic high level of pain) Conjunctivitis (pain, crusted lids, photophobic, watery or puss discharge) Styes (painful swelling of the lids) Blepharitis (usually bilateral, pain in upper and lower lids, photophobia, tearing) Dry Eyes (general water/tearing of eyes)

Make Your Own Office Triage Chart Let's talk triage

Ask the Right Questions ALGORITHM If This Then That process will lead you to proper recommendations

Know the Symptoms and Urgency Triage 24 Hours 1-4 Hours 911

Document Everything! Calm and Caring Take notes of phone interaction

Step 1 – Phone Triage What, where, how...

Step 2-5 – Phone Triage Symptoms History

Step 6 – Phone Triage Let me repeat back to you so we are clear

Step 7 and 8 – Phone Triage Triage Urgency Chart ASSESSMENT! DOCUMENTATION!

Some Patient Will Call With Non- Ocular Emergencies I just feel and I think my leg Is broken and my Eyes are sore. What should I do? Call 911

Triage Implementation in the Office Triage Urgency Chart Triage Q's Staff Training is Important

Post in a Conspicuous Area Good thing I have my chart and Question algorithm right here

Triage Equals Good Medicine Caring Triage Urgency Chart Triage Questions Documentation GOOD MEDICINE!

Thank You! Ganske G. Weekly report from Representative Greg Ganske (4-IA). 25 Jan 1999 Coons C Kathryn Telephone Triage 2000 American College of Physicians Grasso Jillian, Long Janet, McCulloch Joanna, Moore Cheryl Eye Education for Emergency Clinicians Dec 2008 Graves D. Distance Learning Course: Triaging Ocular Emergencies 2010 Katz Harvey. Patient Safety and Telephone Medicine Some Lessons from Closed Claim Case Review Wheeler SQ. Anecdote related to S. Wheeler during conference presentation of “Telephone Triage: Essentials for Expert Practice,” at the Contemporary Forums Conference, Dublin, California REFERENCES