Hospital and Telephone Triage

89 videos, 4 hours and 22 minutes

Course Content

Introduction to telephone triage

Video 2 of 89
5 min 18 sec
English
English

So, Shawn, I am thinking about doing some telephone triage. How is that different to face-to-face triage?

Well, that would be really useful if you did support us with telephone triage and, yeah, there are a couple of differences. It is quite difficult, to be honest, Mark. It is quite a skill and you use all the skills you have already got as an advanced practitioner and you have also got the benefit now of using your prescribing skills, but it is a slightly different approach because you can not physically see the patient. So you rely on the patient to give you some cues over the phone. What you need to do is, first of all, you need to introduce yourself to the patient and make sure they understand why you are calling them, gain consent to have the conversation with the patient, and actually confirm the patient from their name and date of birth before you engage in a conversation with them.

What you need to do is gain as much information from the patient as you can do about why they have contacted the service today, and also within that conversation, you can determine how unwell that patient is, or indeed how well that patient is. You need to use your medical model of history-taking and get as much information as you can, and then focus in on their main complaint of the day, and this will then determine: Is this patient safe to be treated at home, do they need a face-to-face consultation, is it something that we could deal with by means of a prescription without seeing the patient, or is the patient that acutely unwell that you actually need to contact the emergency services and get them seen in ED? At the end of the conversation, wherever you put in, one of the key points, the most important thing, is make sure that your documentation will stand up to scrutiny.

So you need to document as much as you can about what you have discussed. Make sure you get the medications in definitely. Especially if you are going to prescribe any medications, you need to know about their allergy status. And at the end of the conversation, make sure the patient understands what is going to happen next. They need to understand what the plan is moving forward. And then you also need to ensure that you discuss red flag symptoms. Make sure they understand safety netting options available to them, such as, "Speak to your doctor if you are getting no response from these antibiotics. If you take these antibiotics and you start with a new rash or shortness of breath, then you need to contact us urgently, and stop taking the medications." And make sure that they understand that once this consultation is over, they have always got another option to speak to somebody else, if they feel their condition is not resolving. Do not just say, "If you feel no better, contact us." Give them specifics to look for.

Okay, so in my triage, I do face-to-face triage, I rely a lot on non-verbal communication, how people present, and how I behave around other people as well. How can you compensate for that, or how you deal with that?

Actually one of the things I do is if there is another person in the room with the patient, you may say to the patient, "Ask the lady or the gentleman who is with you at the moment, 'Do I look the same color as I would normally look, or do I look pale or more flushed? Have I got any clamminess on my forehead?'" And ask for somebody else to give you their view because you are not physically seeing the patient yourself. You can ask the patient to do certain things as well, so if they are saying that they have got a sore throat, "Have you looked in the mirror? Can you look in the mirror? Open your mouth and tell me what you are seeing, and actually physically describe." Some services have the ability, and we use Q Health in the out-of-hours service where we can do video conferencing, as long as the patient has got a smartphone that enables the technology. Obviously, a lot of elderly patients have not got this, and other services will do a photograph. So, "Send the photograph to this link, it is a secure link, and we can then see the rash," et cetera, so we have got something else to rely on rather than just a verbal description rather than physical.

So it is about asking the patient to do certain things for you. It might be if somebody is saying, "My partner is got difficulty breathing," you may say, "Can you put the phone close to them so I can listen?" and you can get a respiratory rate and hear any audible abnormal respiratory sounds, which may then determine what happens with the patient. All I would say to you, Mark, is draw on your existing patient assessment skills, involve the patient and their relative or friends who are with them as much as you can do to get as much information as you can, and make sure whatever you are doing is safe and appropriate for the patient, and they understand what the plan is.

Okay, would you say that you need a good imagination in terms of being able to imagine where the patient is, what their environment is?

Yeah.

That all goes into the triage process. That must be difficult.

It is. It is very difficult, and you need to think about, do not just home in on one possibility, think about all the differential diagnoses, and at the end of the day, if you are not confident that you can not rule out something else, then we need to see that patient, and we can arrange for that patient to come in and be seen face to-face.