Team triage

The scenario

Vincent, practice owner

“A patient has complained that we did not see them quickly enough after they told us they had noticed new floaters, resulting in them being admitted to hospital with a retinal detachment two days later. Our receptionist says the optometrist was consulted and recommended an appointment in one to two weeks, but the optometrist says they were only told the patient had symptoms of dry eye. How should I proceed?”

The advice

Henry Leonard, head of clinical and regulatory at the AOP

All optometry practices should have a written protocol setting out how they deal with complaints. As the practice owner, you should acknowledge receipt of the complaint promptly, and let the complainant know how long it is likely to take for you to investigate and respond in full to the concerns raised.

To properly investigate this complaint, you should provide the members of staff involved with copies of any relevant information and ask them to draft a written statement about the incident. If the practitioner is an AOP member, they should be advised to contact the AOP for advice and support with their statement.

Once you have completed your investigation, you can then decide what action is necessary, before drafting a suitable response to the complainant, with assistance from the AOP’s legal and regulatory team.

What should patients expect?

It is important to ensure that anyone seeking advice from your practice receives accurate advice and information. When a patient contacts your practice with symptoms, they will expect to receive advice on whether an appointment is necessary, and if so:

• Which healthcare professional they need to see; and
• Where this should take place; and
• How quickly this needs to be arranged.

Unregistered members of staff should not be expected to offer clinical advice and should be trained to consult a registered practitioner where necessary, who can assess the situation and offer appropriate advice.

In a busy practice, it is not always possible for patients to speak to a registered practitioner straight away, so there needs to be a robust system in place to ensure that all relevant information is passed on promptly, and any advice given by the practitioner is relayed accurately back to the patient.

Once you have completed your investigation, you can then decide what action is necessary, before drafting a suitable response to the complainant, with assistance from the AOP’s legal and regulatory team

Practices should ensure that practitioners have sufficient time to review the information and offer appropriate advice. If it becomes apparent that more information is needed to reach a decision, the practitioner should take steps to ensure the patient is contacted again.

If there are times when a registered practitioner is not available to offer advice within an appropriate timeframe at your practice, you should have a protocol in place for members of staff to follow. This should include making patients aware that there are no registered practitioners currently available to offer advice on their symptoms and advising patients to contact another provider, such as a local optometry practice or their GP, for advice on their symptoms. It is important that staff are made aware of this protocol through regular training, and reminded about it when there is going to be a period of time where a registered practitioner will be unavailable.

Next steps

If the investigation shows there was a breakdown in communication between the receptionist and the optometrist, you should think about how similar incidents could be prevented in future.

For example, many practices use a triage form which a member of staff can complete whilst speaking to a patient, before presenting it to a registered practitioner for advice. This ensures sufficient information is gathered at the outset, which helps the practitioner decide how urgently the patient needs to be seen and reduces the risk of a miscommunication arising. The form also serves as a record of which symptoms the patient presented with, and what advice was given by the practitioner. This is important in terms of the patient’s ongoing care, but it is also worth remembering that this information may be crucial in defending the actions of the practice and/or the practitioner in the event of a complaint.

If the investigation shows there was a breakdown in communication between the receptionist and the optometrist, you should think about how similar incidents could be prevented in future

Finally, it is important to use these kinds of incidents as a learning opportunity to improve the care your practice offers. If you have chosen to put additional measures in place, such as introducing a triage form and arranging regular staff training, you can explain this in your response to the complainant, and should the complaint escalate, these actions would be viewed positively by an investigatory body.