sample practice triage policy

Practice Policy for the Triage of Patients
Commencement Date:
Revision Date:
Responsible person for review:
 
Purpose: 
This policy is designed to ensure effective triage processes and principles are incorporated into the care of practice patients and that each member of the practice team understands their responsibilities.
 
Scope:
All members of the practice team have a role in the safe management of patients moving through the practice and in supporting triage functions.  This policy applies to all members of the practice team, including; GPs, Nurses, Practice Managers, Receptionists and Health Workers. Measures in this policy are consistent with RACGP Standards in General Practice 4.
 
Policy Statement:
To reduce the risk to patients and comply with RACGP general practice accreditation standards, all patients seeking care from the practice (or whilst in the care of the practice) are subject to specific and appropriate triage processes and procedures. All staff are required to follow the policy and procedures in place and undertake suitable training to ensure an effective understanding of current triage processes and methodologies.
 
Policy:
All patients seeking urgent same-day care (by phone in person) must be triaged by receptionists to establish the urgency of the need for care, specifically:
  1. All patients entering the practice need to be visually screened (triaged) by reception staff and concerns relayed to an appropriate nurse of GP in a timely manner (immediately if indicated).  The interaction with a patient representative (e.g. relative or friend) does not constitute a triage process.
  2. Reception staff will refer acute/urgent presentations/calls to a GP or RN unless referral to a higher level of care (ED and/or 000) is directly indicated by triage policy.  Acute/ urgent presentations that show reluctance to comply with direction to a higher level of care (ED and/or 000) should be directed to a Nurse or GP.
  3. Other calls to GPs and Nurses (that are not related to urgent presentations) should be made between consultations where possible.
  4. All information supplied to staff during triage processes is to be treated as confidential and private.
  5. All patients calling the practice by telephone, being placed “on-hold” must first be ask if the matter they are calling about is an “emergency”.
  6. All patients being booking in to same-day appointments must be advised that if “In the meantime their symptoms worsen or they are concerned they should contact the practice back immediately”.
Responsibilities
Each member of the practice team has triage responsibilities, specifically the responsibilities include:
 
GP Principal
  • Ensure that there is an appropriate triage policy and procedures in the practice.
  • Ensure that opportunities are provided to staff for appropriate triage training that is commensurate with their position in the practice.
  • Ensure overall practice compliance with RACGP Accreditation Standards in relation to triage.
GPs
  • Comply with the practice triage policy and procedures.
  • Provide clinical triage support and ongoing education for other staff in the practice.
  • GPs are expected to promptly and appropriately respond to calls/approaches from other staff, relating to urgent presentations/ calls during consultations.
Practice Manager/s
  • Ensure that triage policy and processes are effectively implemented in the practice.
  • Ensure staff compliance with triage policy and procedures.
  • Review any incidents where there is a failure in triage processes that result in actual or potential harm to a patient.
Nurses
  • Provide clinical triage support and ongoing education for other staff in the practice.
  • Comply with the practice triage policy and procedures.
  • Report and review any incidents where there is a failure in triage processes that result in actual or potential harm to a patient.
  • Nurses are expected to promptly and appropriately respond to calls/approaches from other staff, relating to urgent presentations/ calls during consultations.
Receptionists
  • Comply with the practice triage policy and procedures.
  • Report any incidents where there is a failure in triage processes that result in actual or potential harm to a patient.
Health Workers
  • Comply with the practice triage policy and procedures.
  • Report any incidents where there is a failure in triage processes that result in actual or potential harm to a patient.
Procedure:
All patients seeking urgent same-day care (by phone in person) must be triaged to establish the urgency of the need for care.  Appropriate process may include: 
  • Asking the patient if they believe the matter that they need to see the GP about is “urgent”.  It must be remembered that the term “urgency” relate to a range of situations.  These include the following and are ranked in descending order of importance.
    1. Clinical Urgencies – where the patient’s condition necessitates immediate evaluation and/or treatment.
    2. Therapeutic Urgencies – where a patient requires a prescription.  Note: These should be treated as “Clinical Urgencies” as they require clinical interpretation by a nurse and/or GP of the importance of the drug.
    3. Emotional Urgencies – where the patient and/or their care require reassurance for feelings of distress or concern. 
    4. Administrative Urgencies – where the patient requires paperwork within a short period i.e. medical certificate or specialist referral.
    5. Logistical Urgencies – where the patient has a window of opportunity to attend an appointment.
  • Asking the patient “What is the main problem they need to see the GP about today”.  Note: This question may not be appropriate in some cultural circumstances or where there is a sex/significant age difference between parties.
  • Same Day Care (SDC) patients who are ≤ 3 years old should be brought to the attention of the nurse upon arrival.  The expectation is the nurse will visually observe the patient (“eye-ball”) in the waiting room for signs of more acute pathology.
  • Due to the risk of allergic reactions, patients receiving any immunisation must be observed for a minimum of 15 minutes after the immunisation.  There are no circumstances that alleviate this responsibility.
  • Patients directed to the waiting room, post immunisation, are to be given an Immunisation Waiting Card (IMC) and directed to:
    • Remain in the waiting room in clear view of reception for a minimum of 15 minutes.
    • Read thoroughly the symptoms of allergy set out on one side of the IMC
    • Hand the IMC back to the receptionist after 15 mins.
  • Reception staff should regularly visually observe patients in the waiting room directly i.e. in the waiting room, away from the reception area (paying special attention to any hidden areas that cannot be directly observed from the reception desk).  An excuse like “straightening the magazines” is a good strategy to do this inconspicuously.
 
General Triage Principles and Practices:
  • The first contact made with a patient (by phone or in person) is the first and best opportunity to triage.
  • Reception staff should take note of patients entering the practice toilets to ensure that a longer than expected delay is investigated.
  • Reception counters should ideally be a mix of both high and low levels.  High levels are required for patients to complete forms; however they also obstruct the view of the waiting room and tend to make patients feel disconnected.  Low level counters are more patient friendly and facilitate interacting with patients that are seated (i.e. patients in wheelchairs and children)
  • Patients with the following symptoms/ signs should always be considered to be at a higher risk of deterioration and/or more serious underlying pathology:
  • Patients under the age of 3 months specifically, generally under 3 years, over 65 years or pregnant;
  • Any patient looking or sounding acutely unwell;
  • Any patient describing their reason for calling  or presenting as:
    •    Chest pain; (suspect heart attack regardless of age or sex)
    •    Abdominal pain; (any pain that is so severe that is changes the patient’s posture i.e. walks bent over or lies with knees drawn to chest, should be directed to the closest Emergency Department).
    •   Breathing Difficulties;
    •   Severe headache;
    •   Back pain; (Note: any severe back pain associated with an injury e.g. fall, MVA, lifting is rarely an emergency unless there is evidence of loss or feeling/function of a limb/s or loss of       bladder and/or bowel control.  However severe back pain that in not associated with an injury is always an emergency and should be directed to the nearest Emergency Department)
  • Agitated or anxious patients, parents or carers, including mental health;  (Note: always look for an underlying cause rather than immediately dismissing the patient as “difficult”)
  • Terms used such as ‘severe’
  • Distressed for any reason;
  • Actively vomiting; (Note: vomiting except in the very young, very old, pregnant or diabetic patient is very rarely in isolation or the most important issue).
  • Actively bleeding; (Note: any bleeding from a body orifice should be considered urgent)
  • Feeling faint/light-headed or sudden loss of quality of sight;
  • Any patient whom reception staff are concerned about;
  • High Risk - Mechanism of Injury (MOI) suggests more serious underlying injury (regardless of stated injuries) e.g.  motor cycle/ cycle impact > 30km/h, fall from a height of > 3m (or standing height if over 65 years old), struck on the head by an object falling > 3m, an explosion, a passenger or driver in a MVA at > 60km/h, occupant in a vehicle roll-over, where there is a fatality in the same vehicle, any motor vehicle impact with a pedestrian or a fall from a horse.