How to make triage decisions

Why do we collect triage decisions?

  1. Applying triage decisions can increase the safety and efficiency of your GP practice workflow. For example adding an urgent or emergency triage decision applies an orange / red flag and sends the request to the top of the inbox so you and your colleagues know which requests need attention first. Triaging a request as an admin or medication request applies a purple flag and sends it to the bottom of your inbox so you know you can deal with it later.
  2. They collect important data for your PATCHS reports. All your practice triage decisions are  available for you to view in your Practice Reporting Dashboard so you know what you and your staff have done with each request. You can use this data to evaluate your own practice performance and patient demand e.g. how many PATCHS requests have a required a face-to-face appointment or telephone call, how many should have been sent somewhere else, or what type of clinical topics they presented with. This can be helpful to plan your capacity and the skill mix of staff you may need.
  3. They train PATCHS AI to triage and workflow requests on its own. PATCHS AI uses machine learning, meaning that each time you triage a patient request you're teaching what to do. PATCHS can do tasks for you, like automatically flag requests as urgent or emergency, signpost patients awayask patients further questions about their request, assign requests to clinicians, and highlight if a request may need a face-to-face consultation - thereby reducing your workload and increasing patient safety.
  4. They monitor how PATCHS AI is performing. As a Class I Medical Device we continually monitor the performance of PATCHS AI to see how well it's doing and if it could be improved. We do this through the triage decisions you make - in particular decisions made by clinicians. Without triage decisions we would not be able to monitor PATCHS AI to ensure it is safe.

There are four questions to answer to make a triage decision:

  1. How clinically urgent is this request?
  2. What are the main topics of this request?
  3. Ideally, who do you think should have dealt with this message?
  4. What actions are required from you to resolve this request?

1. How clinically urgent is this?

Your answer should relate to the clinical urgency of the request. The options are:

  • Routine: Patient unlikely to be harmed if this request is not resolved within the next 48 hours
  • Urgent: Patient could be harmed if this request is not resolved within the next 48 hours.
  • Emergency: Patient could be harmed if this request is not resolved on the same day.
  • Admin / Med request: Administrative or medication request.

Requests marked Urgent or Emergency are sent to the top of the inbox. Those marked Admin / Med request go to the bottom.

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It's important you make your decision purely based on the clinical urgency of a request. For example, you shouldn't mark requests urgent just because a patient is chasing a response about a clinically non-urgent request they haven't received a reply about yet. This is because each time you mark a request as 'urgent' or 'emergency' it is being registered as such for clinical purposes in the audit trails.

2. What are the main topics of this request? (Optional)

This refers to what is written by the patient in their request - not what they tell you on the phone (if you phone them). There are over 90 different topics to search and choose from. Please tell us if there are other ones you'd like to see by using the 'Give Feedback' button.

3. Ideally, who do you think should have dealt with this message?

You should answer this question in terms of what should happen in an ideal world if this same request was submitted again in future. For example:

  • You're a GP. The patient has athlete's foot which they could have had treated at a pharmacy, but you gave them a prescription for anti-fungal cream anyway. You should choose 'Pharmacist outside my practice (e.g. minor ailments scheme)'.
  • You're a receptionist. The patient has chest pain and you advised them to go to A&E but they refused and asked to speak to a GP instead. You assigned the request to a GP to deal with urgently. You should choose 'A&E / 999'.

It doesn't matter if you don't have a particular service nearby, like a pharmacist that can deal with minor illnesses, you should answer what should happen in an ideal world

The options to choose from are:

  • Me. You are the right person to resolve the request. You should only choose this option if you are clinically the most appropriate person to resolve the request. If you are a receptionist and the patient requires input from a clinician, you shouldn't choose this option. Instead you should choose the next option below and assign the request to the clinician to complete in PATCHS.
  • Patient themselves (e.g. self-care). You think the request should not have been submitted to your practice at all, and the patient should have instead resolved the request on their own. Don't select this option if you have given advice to the patient that only you could have provided e.g. reassurance about a potentially serious condition.
  • Pharmacist outside my practice (e.g. minor ailments scheme). The request should not have been submitted to your practice at all, and the patient should have instead gone to a pharmacist to resolve their request.
  • A&E / 999. The request should not have been submitted to your practice at all, and the patient should have instead gone to A&E or called 999.
  • Dentist. The request should not have been submitted to your practice at all, and the patient should have instead gone to the dentist.
  • Receptionist.* A receptionist could have resolved the request, but you have dealt with it anyway. Or, choose 'Someone else in my practice' and assign it to them instead.
  • Pharmacist inside my practice.* A pharmacist could have resolved the request, but you have dealt with it anyway. Or, choose 'Someone else in my practice' and assign it to them instead.
  • Secretary.* A secretary could have resolved the request, but you have dealt with it anyway. Or, choose 'Someone else in my practice' and assign it to them instead.
  • Nurse.* A nurse could have resolved the request, but you have dealt with it anyway. Or, choose 'Someone else in my practice' and assign it to them instead.
  • Advanced practitioner.* An advanced practitioner could have resolved the request, but you have dealt with it anyway.
  • Physiotherapist.* A physiotherapist could have resolved the request, but you have dealt with it anyway.
  • OOH service (including NHS 111) The request should not have been submitted to your practice on this occasion and the patient should have instead used an OOH service, including NHS 111
* These options are only visible to clinical users.
 

4. What actions are required from you to resolve this request?

The options for clinical staff are:

  • Give patient information (e.g. advice)
  • Order tests (e.g. blood tests, X-ray)
  • Prescribe new medication
  • Re-authorise / issue repeat medication
  • Make a referral (e.g. to a specialist)
  • Signpost to another service (e.g. IAPT, physio)
  • Fill out paperwork (e.g. Med 3, TWIMC letter)
  • Telephone patient
  • Video call patient
  • See patient face-to-face
  • Visit patient at home
  • Mark as duplicate (e.g. if patient chasing)

The options for non-clinical staff are:

  • Give patient information (e.g. advice)
  • Issue medication (e.g. repeat)
  • Signpost to another service (e.g. pharmacy, DNs, physio)
  • Book pre-agreed appointment (e.g. blood test, smear, decision by GP). This option should only be used to book a GP appointment after a GP has assigned a triage decision saying they need an appointment.
  • Chase something (e.g. results, referral, prescription)
  • Telephone patient
  • Mark as duplicate (e.g. if patient chasing)

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You should select as many actions as you think are relevant to resolve the request. Each time you do this you are teaching PATCHS that similar requests will need this amount of work to resolve them in future.