Are the results of this single study valid? Some of us have personalities which make triage intrinsically easy or difficult. • Where a receptionist is unable to determine the urgency of a telephone call, the patient should be transferred to the practice nurse or on-call doctor for triage. ), Flowing (Colleagues and patients follow the thought train easily), Right to refuse a request if it is unreasonable or unacceptable, Introduce yourself clearly and in a friendly way. • Consolidating the skill sets of current receptionists alongside training ... do in general practice every day. AMBULANCE OOO . Remember your ‘rights’ must not be violated, “I am sorry that….” Can be an expression of sympathy only and does not have to imply that anything was your fault, “We’ll come back to that later. In any plan involving two people, there is a negotiation necessary. Are the results of this harm study valid? Try to deal with issues one at a time. An aggressive person suborns and dominates (Hitler was not a negotiator!). When a decision is made the following main outcomes are the result: Share your thinking with the caller, i.e. Practices report two things here. Thursday 28th January 2021 9.30am-12.30pm. Back by popular request! Educators, trainees, patients or any person in general should not use this website as a substitute for consulting a doctor.READ THE FULL DISCLAIMER HERE, PPDP – personal professional development plan, PPDPs – reflective questions for practices, Practice professional development planning (PPDP), Practice Professional Development Plans (PPDP), The appraisal interview – notes for the appraiser, Agenda-Led Outcome-Based Analysis (ALOBA), GP trainee patient-problem-management log. 5 Seek first to understand… then be understood, Notes on the 7 habits of highly effective people, Hard skill-based questions for would be leaders, Ten characteristics of the servant leader, The 4 Characters – Aggressive, Passive, Indirectly aggressive & Assertive, Don’t sweat the small stuff… and it’s all small stuff, 03 MRS – Physical examination 1: General observation, 04 MRS – Physical examination 2: Considerateness, 05 MRS – Physical examination 3: General approach, 06 MRS – Problem definition 1: “Hypothesis formation”, 07 MRS – Problem definition 2: “hypothesis testing” (the diagnostic process), 08 MRS – Problem definition 3: Coping with complexity, 09 MRS – Problem definition 4: Practicality, 10 MRS – Management 1: Coping with uncertainty, 11 MRS – Management 2: Using community resources, 12 MRS – Management 3: Prescribing (a) Technical, 14 MRS – Emergency care 1: Initial assessment, 18 MRS – Professionalism 4: Working with colleagues, Appendix A – Professionalism: communication, Elements of a good action plan: SMART + support, Directly Observed Procedural Skills (DOPS), Preparing for the Educational Supervisors Report, Top tips for managing your new practice manager, Identifying, preventing and tackling trainee problems, Learner difficulties, issues and problems, Learners, Students and Trainees in difficulty, Logical Levels to make an educational diagnosis, When trainees struggle – the aetiology of errors, Using Transactional Analysis to handle a complaint, Traditional and behavioural models of the tutorial, Hormone replacement therapy and the menopause*, Speech Development Milestones in Children, Stammering & When to refer, The Mental Health Act – summary of the sections, 10 discriminators of the good General Practitioner, Explaining risk in the consultation – tutorial plan. September 2014; May 2014. ), NHS jargon that might be confusing (“Pyrexia is tricky in kids under 2, was it a grand mal seizure he had…? try anythingl”), Negative (“He hasn’t got chest pain has he?…”, Mumbling, Muffled (“I don’t know what he said dear – something about A/E and being very busy”), Monotonous, Slow (“Oh dear me, dear me, dear me…”, Clear (‘Dr X here from Good. While it is important that you are in charge of the call it is vital that the caller is not made to feel in a vulnerable position. What is GP Triage?. This web site is provided for information only. All of us can learn to do it better and feel more comfortable in the process. Just as clear management plan is essential for those looking after patients, it is vital for patient confidence that they share an understanding of the plan. Learning Objective: To gain an understanding of what GP Triage is and how to implement it in your practice. While we all recognise aggression and will feel uncomfortable especially when it is directed towards us, we wili often feel comfortable in the presence of assertive people. Your reception staff play an imperative role in the success of your practice, in their pressurised roles at the practice front-of-house, making potentially life-or-death judgement calls based on what they are told by patients over the phone. Sometimes the caller/patient’s ideas, concerns and feelings become evident without more direct questioning. Using ‘I’ Statements allows a person to ‘own’ their thoughts feelings and opinions rather than using ‘you’ statements, which may implicitly blame the other person. First impressions count triage in reception. A confident assertive clinician delivering good advice makes everyone feel better! People who are non-assertive in their lives are often very comfortable to be with as they avoid conflict but they often do so at the expense of their own needs. She didn’t speak for two weeks the last time I mentioned anything”. Training Recommendations, all frontline staff wishing to be considered for telephone triage: Should be experienced GP Practice staff and understand the course outcomes. Search. Triage. GP Support. • They assist the TCP through the data collection, triage, decision-making, disposition selection Mrs Wimp (Receptionist) “You want an appointment to talk about your holiday? I Phrases can make repeated or sensitive questions or statements less threatening. Is there evidence that communication skills affect outcomes of care? Medicolegal advice 1800 936 077. What’s the difference between the patient id and the internal patient id? Checklist: Using chaperones to reduce risk, Repeat prescribing: Don't repeat the risk, Careers - Core skills series: Communication, “What would YOU do if a patient phones the surgery reporting…”, Pregnant woman with very frequent contractions, Attend the Emergency Department immediately. You need to be persistent, to stick to the point of what you want to say, and just keep saying what you want to say over and over again. You are looking for win/win as the ideal outcome. Deliver questions/information in a clear manner, without ‘waffling or padding’ or ‘beating about the bush’. Always empathise as few patients, no matter how offhand they seem, take the decision to call lightly. Since then, she has worked for several corporate and privately-owned small animal veterinary practices. Always introduce yourself by name and ideally mention your organisation. E.g. Are the results of this diagnostic study valid? When someone is ringing up with a clinical problem and you are trying to obtain information, the five ‘W’s are useful guides: Make sure the other person is listening. GP Triage is a telephone call-back service that offers convenience for patients and increases capacity for practices. First impressions count - triage in reception, Example triage protocol for non-clinical staff, How to encourage professionalism in your trainees, Example of triage protocol for non-clinical staff, Example triage protocol for non-clinical staff », High reliability in healthcare: A personal failure, Why patients sue... and how to try and avoid it, Legal reform must help control spiralling costs, Common problems: Your medicolegal dilemmas resolved, The changing face of cosmetic interventions, Followership: the forgotten part of leadership, Closing the loop: lessons from surgical cases. “If the pain/temperature has not settled in an hour please call back”. review showed that TCs and triage reduced GP workload and revealed that at least 50% of calls could be managed by telephone advice alone (referral to face-to-face appointments were not needed).7 Dedicated TC clinics are employed in many of AT Medics’ practices, with an average cost of £8 per consul-tation compared with £17 for a face-to-face GP consul-tation. Emergency patients should be directed to the emergency department or … Ensure that opportunities are provided to staff for appropriate triage training that is commensurate with their position in the practice. In those rare instances of complaint, “contemporaneous written notes” are extremely helpful. Telephone triage: Assessing the priority and need for assistance and advice This guide for nurses general practitioners and anyone who might consult on the telephone describes the essential ingredients in managing the process. This is an area where assertive negotiation may be required to establish a genuine win/win relationship with the caller. It makes the listener uncomfortable, anxious and makes them aggressive in turn. How we see ourselves is very important in triage. Open questions can never be answered with a yes or no e.g. They put their wants and needs above those of others. Should attend or have ‘Medical terminology’ training. Allocate physical space for GP triage room; Adjust GP hours to cover peak morning period (8–9am) Arrange increased telephone system capacity Organise training in booking appointments for GPs; Practice nurses. Whilst this can be increased to a maximum of 25 if desired, it can extend the duration of the Workshop slightly in order to accommodate the necessary role play exercises. Think positively and do not presume a negative outcome will occur. If a person feels unable to communicate directly with another they may ‘bottle feelings up’, which spill over into subsequent interactions. Mental Health Training. Thank you for the comment! Perfect preparation prevents poor performance. try imodium …. Armed with this information you have the necessary data to enable the problem to be addressed. Overview Webinars; Podcasts; Resources; Workshops; Bush Support Services. The location of your practice can influence how you respond to an emergency situation – the appropriate response for a city centre practice may prove fatal in remote rural Ireland. All three forms of screening involved similar costs, but patient satisfaction was lower in those practices using nurse triage than in those using GP triage or usual care. The call management techniques that help communication and make for a good outcome for clinician and patient are described. •Have a P&P to support the work of receptionists when assessing patient needs •Have clear guidelines for priority of appointments including when to refer to practice clinical staff or elsewhere for urgent treatment •Provide staff training and regularly review triage system •Comply with RACGP Standards on Triage Give concrete examples of worrying signs and symptoms. A GP then contacts the patient to determine how they can most appropriately meet the patient’s needs. In completing the safety net, remember you may need one too! Triage is relevant across all disciplines of healthcare because all disciplines have conditions, requests and patients that range from ‘needing to be seen now’ to ‘being able to wait’. “If we can meet at the Primary Care Centre I will be able to see you more quickly”. Decision support specialists Plain Healthcare have launched a new triage system for receptionists dealing with patients on the telephone or presenting at the surgery, called Reception Odyssey. How to implement GP triage What is GP triage? Respect for others in negotiation begins with self respect. Listen to the caller and give enough time to place yourself in a position to assess what they are saying. Expressing thoughts, ideas and feelings in a way that doesn’t threaten or punish other people is very important. Well established models exist for establishing the venue for a face to face consultation. Have you a simple procedure for receptionists to follow when these rare situations arise? Whilst this can be increased to a maximum of 25 if desired, it can extend the duration of the Workshop slightly in order to accommodate the necessary role play exercises. There are certain predictable errors that occur when asking questions: Asking questions and getting the right answers is not always easy! Receptionists and GPs sometimes say they can think of some patients who would never be prepared to seek help from anyone other than a GP. Comply with the practice triage policy and procedures. We hired a new receptionist who doesnt have telephone triage experience. It is uncomfortable to listen for too long! MPS® and Medical Protection® are registered trademarks. “I cannot arrange an outpatient appointment any more quickly than your own clinician but I am happy to listen and see if there is anything I can offer….”, A face to face consultation with a GP is necessary. “Are you happy with that?” etc. Ensure overall practice compliance with RACGP Accreditation Standards in relation to triage. Telephone triage: Assessing the priority and need for assistance and advice This guide for nurses general practitioners and anyone who might consult on the telephone describes the essential ingredients in managing the process. Early recognition of the sick patient is to be encouraged, throughout our health care services to ensure the care received is appropriate to the illness. Feb 16, 2018 Step 1. Because the guide is primarily aimed at GPs working out of hours, the analogies chosen often refer to ‘Dr’ X. You may need to use ‘Broken Record’ for this purpose before you move onto your main message: To be very clear about what you want to say and to make this known without getting angry, uncomfortably irritated or loud. Always check that there is agreement and understanding of what you propose. An assertive individual listens, negotiates and effectively influences other people. However, there … Telephone Triage Techniques Read More » The evidence regarding feasibility, safety, user acceptability, costs, and workload implications of telephone triage is mixed. Contact our GP Support team if you need help or advice.. Step 2. Being able to help is wonderful but it is important to stress, where necessary, what you are unable to do so that the caller does not have unrealistic expectations. Sometimes you can help the caller who is anxious or angry with the use of “I” Statements. Be prepared to work together towards a compromise without neglecting yourself or your beliefs (a win-win situation). If the agenda is agreed the clinician will have reassured the patient that the best action is being taken. We haven’t got any Mrs Stalin but I’ll put you in as an extra with Dr Spineless”. If it is settling you will take him to the Health Visitor tomorrow but if not, you will ring back and I will see him at the Primary Care Centre before 11 o’clock. Despite routine recording of most telephone triages, adequate note keeping is still vital. Options include having a GP or nurse available for triage, either face-to-face or over the phone, with receptionist prioritisation also becoming more commonplace. Your comment must be approved first, You've already submitted a review for this item, Thank you! We were therefore surprised that such a high number of simulated calls were correctly referred for immediate care. Ireland. Catherine Barnette, DVM graduated from the University of Florida College of Veterinary Medicine in 2006. If possible, allow some time for reflection and if not entirely happy with any element of the triage, never be afraid to phone the patient again. • If a patient presents in person and requires urgent medical assistance after the doctor has left – call 000 for ambulance. When a home visit is advised, a (realistic) estimate of the expected time of arrival (ETA) of the visiting clinician is greatly appreciated by patients and carers and in closing the conversation, it is often helpful to end with an expression of “hope it goes well” or “I hope he is better in the morning” etc. Office-Hours Telephone Triage Protocols User’s Guide. Research evidence on ending the consultation. The evidence regarding feasibility, safety, user acceptability, costs, and GP workload implications of telephone triage is mixed. It is a new system of ‘triage‘, carried out at the first point of contact with the GP Practice by non-clinical staff under direction of the clinical team. Mrs Roberts has no transport of her own and Amy is often too unwell to get to the surgery. ACTION: Ensure staff are appropriately trained and supported and that they are fully aware of practice protocols for dealing with appointment requests. If you are trying to get the person on the other end of the phone to talk more you need to use open questions e.g. Professionals training professionals M&K Update Ltd, The Old Bakery, St Johns Steet, Keswick, Cumbria, CAI2 5AS. An urgent issue will be placed on the triage list for a call back within 3 hours. - Dr James Sheppard, MRC Research Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford. She doesn't get that everyone CAN'T be seen today just because they want to. Amy often misses school because of stomach aches and sore throats. Are the recommendations in this guideline valid? Schmitt-Thompson Clinical Content (STCC) Introduction • The Schmitt (pediatric) and Thompson (adult) telephone protocols are decision-support tools for telephone care providers (TCPs). MPS is not an insurance company. The framework is divided into 14 competency areas and each broad task is outlined. We are running a further Triage Training for Reception Staff course on Wednesday 13th January 11am-1pm. Infection control - time for a clean sweep? Why patients come in – 10 questions to answer, How to use the computer in the consultation (Calgary Cambridge principles), Using the computer during the consultation: a skills based approach – notes for trainers, Using the computer in the consulting room – some teaching ideas. The whole process is broken down in detail but the key parts of a good triage are: There are several identifiable stages of a phone consultation, or triage just as there are in face-to-face contact. Log in. The system is designed to help practice receptionists determine how urgent a request for an appointment is and what priority to give the patient, ensuring patients are seen […] Since the total triage system has been introduced, waiting times for an appointment have been reduced from an average of 3.75 days to 1.45 days. If you feel this is the case, how do you tackle the situation? With the increasing concern about COVID-19, what should practices be doing to protect themselves against coronavirus? Consider undertaking an audit of reception staff responses to the life-threatening scenarios already mentioned. “this sounds highly likely to be a nasty virus” or “if it was something that I need to see immediately, such and such would be happening”. Medicolegal advice 1800 936 077. Trained administration or reception staff – to handle any non-clinical requests and/or who have care navigation training; GP – acting in a triage only role to determine what type of encounter is required, if any; Nurse / nurse practitioner – who is able to triage appointments; Paramedic – due to their triage training All nurse training for the extended role has been fully funded and supported by the practice. This may be either at a centre or at home. You can use GP triage every day your practice is open. Respiratory and/or Cardiac Arrest; Chest pain or chest tightness (Chest pain lasting longer than 20 minutes or that is associated with sweating, shortness of breath or radiation to another part of the body is to be considered a ‘heart attack’ until proven otherwise, regardless of the age of the patient). When we are assertive rather than aggressive we are able to negotiate. No claims are made of accuracy or validity, and no responsibility will be taken by the authors or owners for events arising from the use of the information provided. A first-hand history tends to be more reliable although there are clearly situations when an additional history from a third party will be valuable. Notes need not be voluminous but they should be legible. Why should we implement GP triage? Step 3. Men­tal Health Train­ing for health pro­fes­sion­als in drought and bush­fire affect­ed com­mu­ni­ties made pos­si­ble through the grant by the Com­mon­wealth Depart­ment of Health . The evidence regarding feasibility, safety, user acceptability, costs, and GP workload implications of telephone triage is mixed. Emergency and Critical Care - Receptionist tips Courtesy of Deb Stafford, CVT, VTS (ecc) It is important for receptionists and support staff NOT to ATTEMPT TO DIAGNOSE . Explain what to do if your plan is not working, including when and how to seek help. If not, the patient may be made even more anxious and refuse the ambulance when it arrives. What are your zones of comfort, challenge and fear? Mrs Roberts is the mother of Amy, an only child who was born as a premature baby. By comparison passive speech is also readily identified. The trained. PATIENTS at an overstretched GP surgery can no longer make any appointment with a doctor - without first being quizzed about their health by receptionists. It is important to engender the confidence of the caller by making it clear that you are interested in what they are saying. ), “You sound upset, how long would you say you have been like this?”, Anytime you want to share your feelings in a frank, unthreatening, undemanding way, If the caller uses ‘you’ or blaming statements a lot. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association. ‘I’ Statements can be used to diffuse hostility: ‘I’ Statements that disclose your feelings in a professional manner and create empathy: Having drawn together the information we need to assess the situation a management plan can be devised. GPs’ receptionists are deterring patients from going to the doctor, with almost half of patients put off by worries they will be grilled about their symptoms, a study has found. Live Well; Common Health Questions ; Conditions A to Z; BBC Health News. Receptionists receiving calls from patients asking for a same-day appointment offer the option of a doctor ringing them back. It is very important to ignore all the side issues. TRIAGE TRAINING FOR RECEPTION STAFF. It is equally important to avoid any unnecessary questions that might be regarded as an invasion of privacy or make the conversation sound like a police interrogation! Receptionists. On the morning of the incident, she had to do her shopping and called in the surgery afterwards to request a home visit for h… Should attend or have ‘Medical terminology’ training. Do not be deterred by or respond to anything, which is off the point you are trying to make. Try to speak directly to the patient if possible/appropriate. High-quality urgent care begins with the first impression. This is important. A total of 20 places are available. GP Triage . “Just to recap, we’ve agreed that you will try to use the calpol on a four hourly basis and check his temperature each hour. But it is also useful for anyone into education and training – plenty of generic material free to use. Closing date 14th January. November 17, 2020 - November 18, 2020 ... Oxfordshire Training Hub (OTH) is hosted OxFed Health & Care Ltd.. ... Health& Care Ltd. is a provider of NHS services and the not-for-profit trading company of the Oxford Federation for General Practice and Primary Care. 4.3 Section 3 - Triage All patients who request a same-day appointment will have their call returned by a GP (ideally their own), within a short timeframe. During the course of the call you have identified the key elements to enable you or a colleague to resolve the caller’s situation. This might be expressed as: Sarcastic (“I suppose its too much to ask but…”), Grating (“Yeah, Yeah I suppose he’ll have to be seen…”), Insinuating (“If you’d done as Dr X told you he wouldn’t still have the temperature….”), Pleading Jerky (“Why couldn’t you try calpol …. Allow the caller to give their own account of the problem in their own words with the minimum of interruptions. Report on Signposting / Triage / Telephone First Survey Page 5 of 19 4.2.12 Ideas for developing Signposting services include: staff training, increased team skill mix, new practice software systems, developing online services, widening scope of services to signpost to. Consider whether enough information has been gathered to allow a safe assessment of the problem and a safe management decision and crucially, have all conditions requiring more urgent action been reasonably excluded? Avoid poorly timed questions and try hard to avoid repetition as this diminishes the confidence of the caller. New areas of advice have been included, for example the use of flow methodology and GP triage in the diagnosis and treatment options sections. Us to better manage the increasing concern about COVID-19 triage training for gp receptionists what are the result Share! With asking questions, be assertive but not aggressive a telephone call-back service offers. 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