Mastering triage

Every team member, from receptionists and optical assistants to optometrists and dispensing opticians, has a role to play in making sure that patients receive timely care.

This is particularly pertinent during the pandemic, when optical practices are seeing a wider variety of clinical cases as secondary care faces a daunting backlog.

A 2021 General Optical Council urvey of more than 2000 members of the public found that the number of people who would visit an optometrist as their first port of call has increased significantly in recent years – from one in five respondents in 2015 to one in three respondents in 2021.

Hospital optometrist and OT CET author, Stanley Keys, highlighted that joined-up working between the practice team and clear communication are key to ensuring a successful triage process.

“When a patient develops new symptoms which are worrying them and they contact your practice, everyone has their role to play in getting that patient seen in an appropriate timescale,” he said.

Keys highlighted that the first person to speak to the patient needs to have awareness of the red flag signs and symptoms that may indicate that the patient has a significant condition.

“They should be able to record the relevant triage information, which then allows the optometrist to decide on the urgency required, and then for the relevant member of staff to get the patient booked in as appropriate,” Keys said.

He added that there should be a clear process for asking the correct triage questions and recording that information, so that the optometrist can base their advice on the best information possible.

A hallmark of a good triage system is that communication with the patient is “empathetic, calm and very clear,” Keys emphasised.

The underlying goal here is to minimise the risk of sight-loss where possible

Turning to the importance of triage in practice, Keys highlighted an accurate and effective process helps to get the patient’s journey towards clinical investigation and any potential treatment off to the best possible start.

The aim is to minimise delays in the patient being seen by the most appropriate clinician – whether that is an optometrist, ophthalmologist or GP, he added.

“The underlying goal here is to minimise the risk of sight loss where possible, and in some systemic conditions you might even be minimising the risk to their general health or life by getting the initial steps right,” Keys shared.

Optometrist and AOP clinical adviser, Kevin Wallace, echoed Keys view that an effective triage system is “vital” to ensure patients are seen within an appropriate timescale.

He added that many patients present without symptoms to optical practices, so the first stage of any patient contact is ascertaining whether the patient has a problem or is just booking a routine examination.

Wallace highlighted that sight threatening conditions must be prioritised while an efficient practice system makes allocating patients an appointment more straightforward.

“It is important that the whole practice team is involved in setting up the process so that they understand their role in care of patients. There are many good question templates available to guide staff when a patient contacts the practice and highlight red flags which prompt them to either offer an urgent appointment or seek the opinion of an optometrist,” he shared.

Wallace observed that an audit of whether practice appointments were appropriate can be helpful.

“If there is not good agreement between front of house staff and clinicians then you can use the results of this audit to adjust the processes and improve concordance,” he said.

Wallace highlighted that restrictions on routine care prompted by the COVID-19 pandemic had honed the experience of practice staff in determining whether and how soon a patient needed to be seen.

“As restrictions ease these triage systems will continue to be extremely valuable to provide a safe and effective service to patients and help the practice run smoothly,” he shared.

When asked for top tips on implementing a successful triage system, optometrist Josie Evans emphasised the importance of education.

New members of staff involved in triage should be offered a tutorial discussing the different symptoms a patient may present with and advising on the urgency at which these conditions should be seen.

Having an ‘open door’ policy can be helpful, Evans added, ensuring that the triage team feel comfortable speaking to an optometrist if they are uncertain about a patient’s management.

She also pointed to the need to maintain records of the symptoms reported by the patient, the advice given and if earlier appointments were offered.

Senior optical assistant and team leader, Lisa Skelton, emphasised the importance of understanding how minor eye care services works.

Patients can be directed to other services where appropriate and should be given an appointment as soon as possible where necessary.

Skelton also highlighted the value of being friendly and helpful through the triage process, as any new patient may become a future patient if given a professional service.

For contact lens optician, Nick Howard, listening to the patient is key during triage.

“Trust instinct and intuition: not all circumstances or discussions fit nicely into tick boxes,” he said.

Howard added that it is “absolutely essential” to provide specific, adequate and continuous training for all supporting staff involved in the triage process.