Want to keep learning?

This content is taken from the UCL (University College London) 's online course, Conducting Remote Consultations and Triage. Join the course to learn more.

Skip to 0 minutes and 4 seconds Triage is defined as the process of identifying which patients medical needs are to be prioritised and which clinical setting is best suited to manage them. For example, you may have a list of five or six patients on your triage list and a patient presenting with chest pains and shortness of breath would take priority over a child with a 40 hour history of fever and malaise. The patient presenting with the chest pains may need to go to A and E when you assess them, whereas the child may need to be seen by a GP in clinic.

Skip to 0 minutes and 36 seconds Due to the increased demand on GP access, many UK local health commissioners have invested heavily to promote the uptake of alternative approaches based on telephone or electronic consulting. There are an increasing number of admin staff, nurses, and GPs who work in after hour services, commonly assessing patients presentations on the phone and making decisions regarding the most appropriate service for the patient. In the UK, the most common example being a notice 111. There are two studies that have critically analysed the effectiveness and impact of triage in primary care particularly.

Skip to 1 minute and 16 seconds The esteemed trials findings concluded that use of triage or telephone consultations had no greater cost effectiveness when compared to face-to-face appointments, but they did find that triage was a useful aid to deliver on primary care services. Another more recent observational study looked at telephone first approach. Their results support the conclusions of the esteemed trial that there are no significant cost savings to primary care using the triage model. However, they also conclude that many problems in general practise can be dealt with over the phone. A growing number of practises are going beyond the use of triage on the phone and using the phone to conduct for consultations. For many, this has been a gradual progression from triage.

Skip to 2 minutes and 5 seconds In light of the recent pandemic, we’ve seen a complete shift in all GP practise in the UK to use triage and remote consultations. The aim was to maintain patient access to primary care and to ensure continuity for patients’ health. The neighbour model in this unique setting has the advantage to allow clinicians to extract as much information from the patient in the tight time constraints they have in this setting. The decision, therefore, to offer remote consultation as opposed to a face-to-face consultation will be based on the initial trial process. The triage process will broadly assess four aspects. The first, the need for review or to assess the severity of symptoms, both physical and psychological.

Skip to 2 minutes and 54 seconds The second, any previous knowledge of the patient and their background alongside access to the clinical records. The third, a need to physically examine the patient, and finally, previous medical history. For example, seeing a patient for a follow up, or review of their pre-existing condition, a history of safeguarding concerns, or a child who has been failing to thrive may trigger a need to see the patient in person. In the UK, the general medical council has provided information to support remote consultations, such as a simple flowchart to support the decision making process. Ultimately, it does still lie with the clinician to make the clinical decision with the information available to them on a case-by-case basis.

Skip to 3 minutes and 44 seconds It may be appropriate, for example, for some of the consultation to take place remotely, and then bring the patient in for a short time to administer treatment. For example, childhood vaccination or contraception injection. There may be other situations where the clinician feels that the social and clinical background warrants for the patient to be seen. In summary, we have seen how triage has become common practise in most general practises in the UK. In order to meet patient demand for GP led care in response to the COVID pandemic and generally to be able to manage patients in the right setting with the right service.

Skip to 4 minutes and 28 seconds We will not move on and ask you to look at some articles, which will have a more detailed analysis of triage in practise.

Triage

The video above provides an overview of triage within a remote consultation and introduces some important research into the impact and effectiveness of triage in primary care. You can access the GMC flowchart discussed in the video here. Watch this video first before accessing the further reading below.

Further reading

We have provided three articles which present an overview of how triage has been applied in practice.

The first two articles are an analysis of the use remote consultations in UK GP surgeries and in Dutch out of hours centre.

The Dutch study (Derkx et al, 2008)[1] analyses the quality of care based on how patients were triaged by the clinicians. Read the methods section, results section and conclusion in this paper, paying particular attention to the obligatory questions to be asked for each case in the methods section.

The UK study (Campbell et al. 2014)[2] assesses the effectiveness and cost of GP-led and nurse-led telephone triage compared with face-to-face care for patients seeking same-day consultations in primary care. Read the discussion section to see how the authors came to the conclusions on the cost effectiveness of the use of this model in primary care and the benefit of triage on primary care services.

The final article (Mansab, Bhatti and Goyal, 2020)[3] is a recent analysis of the use of triage in the COVID-19 pandemic. It is an important analysis of how the UK, in particular, fared against other countries in the world. In the conclusion of the paper, there are further discussions on how appropriate triage is important to counter risks when remotely managing patients.

If you are interested in reading these studies in full, you can go ahead and read through the rest of the papers in your own time.

Bibliography

[1] Hay P Derkx, Jan-Joost E Rethans, Arno M Muijtjens, Bas H Maiburg, Ron Winkens, Harrie G van Rooij, J André Knottnerus. Quality of clinical aspects of call handling at Dutch out of hours centres: cross sectional national study. BMJ 2008;337:a1264.

[2] Campbell J, Fletcher E, Britten N, et al. Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): a cluster randomised controlled trial and cost-consequence analysis. Lancet. 2014;384:1859–1868.

[3] Mansab F, Bhatti S and Goyal D. Patient-Led COVID-19 Triage Systems and Case Fatality Rates: A Comparative Study Between Singapore, Japan, Norway, the USA and the UK

Share this video:

This video is from the free online course:

Conducting Remote Consultations and Triage

UCL (University College London)