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How to make triage decisions

Dr Ben Brown
  • Updated

Why are triage decisions important?

Adding triage decisions are important because it:
  1. Flags urgent requests in your inbox.
  2. Tracks your activity and workload. Such as how many PATCHS requests have a required a face-to-face appointment or telephone call, or should have been sent somewhere else.
  3. Teaches PATCHS how to triage requests on its own. PATCHS can automatically flag requests it thinks are urgent, though this functionality is only available in a few practices at the moment.
  4. Teaches PATCHS how to fairly share patient requests to staff in your practice. Based on how complex they may be to deal with and how much work it they may take to resolve.
  5. Teaches PATCHS how to flag cases that may be difficult or easy to deal with. So you can better manage your time.

Make triage decisions as soon as you read the request

This is because we want to teach PATCHS to do the same thing as soon as patients submit requests. You can always update your decision if you change your mind later. For example if you receive more information the patient.

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

  1. How clinically urgent is this request?
  2. Who is most clinically appropriate to resolve this request?
  3. What actions are required from you to resolve this request?

Each one is explained in more detail below.

 

1. How clinically urgent is this request?

Answering this question is important because it:

  1. Flags urgent requests in your inbox.
  2. Teaches PATCHS how to triage requests on its own.

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 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 had received a reply about yet. This is because each time you mark a request as 'urgent' or 'emergency' you're teaching PATCHS that similar requests should be prioritised above others in future.
 

2. Who is most clinically appropriate to resolve this request?

Answering this question is important because it:

  1. Allows you to assign a request to someone else. For example, someone else in your practice.
  2. Track if requests should have gone elsewhere. For example, the dentist, or pharmacist.
  3. Teaches PATCHS to send similar requests to other people or services in future to reduce your workload. For example, send requests to someone else in your practice, advise the patient they should self-care in future, or go straight to A&E.

The options 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 so that PATCHS is taught properly. If you are a receptionist and the patient requires input from a clinician, you shouldn't choose this option - you should instead choose the next option below and assign the request to the clinician to complete in PATCHS.
  • Someone else in my practice (assign to them below). You want to assign the request to someone else in your practice. If you select this option, an additional menu will appear which allows you to assign the request to that person.
  • 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 though 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 should 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 should 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 should 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 should 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 should have resolved the request, but you have dealt with it anyway. Or, choose 'Someone else in my practice' and assign it to them instead.
* These options are only visible to clinical users.

 

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When a request is:

  • In the Unassigned inbox, the default answer will be 'Someone else in my practice (assign to them below)'
  • Assigned to a user and in a Personal inbox, the default answer will be 'Me'.
  • In a Personal inbox because a task has been assigned, the default answer will be 'Me'. In this scenario, all questions should be answered from the view of completing the task.

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

This question only appears if you choose any other option than 'Someone else in my practice (assign to them below)' in the appropriateness question.

Answering this question is important because it:

  1. Tracks your activity and workload.
  2. Teaches PATCHS how to fairly share patient requests to staff in your practice.
  3. Teaches PATCHS how to flag cases that may be difficult or easy to deal with.

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)

Nov-23-2020_16-07-16_actions.gif

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.