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First impressions count – triage in reception

GP Dr Carmen Gerber looks at how high-quality urgent care begins with the first impression – the key player here is often the receptionist answering the phone

Triage, performed correctly by non-clinical staff, can protect patients from suffering catastrophic events due to unnecessary delays. However, if performed incorrectly by inappropriately trained and unsupervised non-clinical staff, the consequences can be harmful and even fatal.1

Receptionists are often a patient’s first contact with healthcare services and are seen as the gatekeepers to medical practitioners, and so they play an important role in assigning patients to the most appropriate level of care at the right time. 

Medical practitioners need to understand that they can be held responsible in the event that a patient suffers harm due to unnecessary delays in accessing or being directed towards the most appropriate level of care in an emergency.2 For this reason, reception and front-desk triaging is very important. 

Training

It is essential that all non-clinical staff are appropriately trained and receive the necessary support and guidance from medical personnel in the practice.1 Practice staff should be encouraged to immediately alert and consult the medical practitioner or nurse whenever there is any uncertainty about the urgency for medical care. Several factors need to be considered when planning to implement safe triage strategies at a practice.
 

Medical practitioners should always adhere to the HPCSA’s regulations and remain sensitive to patients’ rights. Additional factors that need to be considered include the practice’s location (rural or urban setting), benefits and risks associated with triaging of patients at the particular practice, access to resources, as well as the level of skills and capabilities of the staff available at the practice.3 All of these factors can determine the practice’s capacity to respond and deal with emergencies.4

Rural practices are particularly vulnerable to unnecessary delays due to topographical barriers, scarcity of resources, and limited access to medical staff, specialist services and medical facilities (such as laboratories, radiographic imaging centres etc). Effective triage strategies and protocols in both rural and urban areas play a significant role in ensuring timely access to appropriate emergency care. 

Look out for warning signs

It is essential that receptionists are able to identify warning signs and appropriately prioritise patients for appointments. In the initial triage process, patients can be classified as either adult, paediatric, geriatric or pregnant.4 Patients can then be screened further for the presence of any danger signs. According to the level of urgency for medical care, patients can be triaged into one of three appointment groups. Emergency appointments should be provided to patients that require immediate treatment. Urgent appointments should take place on the same day, while routine appointments do not need to be on the same day.2

If a patient is unsure about the urgency for a consultation, or if a patient indicates that they need urgent care, the receptionist should screen the patient according to the triage protocol for any danger signs. The general practitioner should immediately be alerted and informed if any danger signs are present, or whenever the receptionist is unsure about the level of urgency for care.2

Non-clinical staff SHOULD:

  • Screen patients for danger signs and symptoms
  • Make a record in the notes of the outcome of the enquiry into danger signs and symptoms
  • Protect patients’ privacy and confidentiality
  • Reassure patients where necessary.

Non-clinical staff SHOULD NOT:

  • Enquire in detail and/or have a long interview into a patient’s reason for visiting
  • Provide advice or perform duties outside their roles and capabilities
  • Offer medical advice or prescribe treatment.

It is important that appropriate measures are in place to ensure continued protection of a patient’s privacy and confidentiality throughout the triaging process. Explaining the practice’s triage system to patients in advance will minimise and avoid confusion and conflict, as well as ensure that patients understand why they are questioned by the receptionist about their reason for wanting to see the doctor.2

MPS advises members to implement better risk management strategies on triaging of patients at their practices. Medical practitioners are encouraged to implement evidence-based triaging protocols5 and to train, as well as supervise, non-clinical staff. In addition, keeping good records on all front desk and telephone enquiries can be very important in defending any claim which may later arise.2

Dr Carmen Gerber is a Medical Officer in the Eastern Cape.

References

  1. Aacharya, R P, Gastmans, C, Denier, Y, Emergency department triage: an ethical analysis, BMC Emergency Medicine 11(16), 2011 
  2. MPS, Triage protocol for non-clinical staff (Ireland)
  3. Dinwoodie, M, Triage in general practice, MPS Practice Matters UK 1(3), 2013 
  4. Quinlan, D, First Impressions Count – Triage in Reception, MPS Practice Matters Ireland 2(1), 2014 
  5. For an example see: Emergency Medicine Society of South Africa, The South African Triage Scale (SATS) http://emssa.org.za/sats
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