Listen to the caller and give enough time to place yourself in a position to assess what they are saying. ‘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. 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. Just keep saying in a calm and repetitive voice what you want to say until the other person hears what you are saying. You speak as if you were a broken record. The team provide professional and pastoral support to GPs and practice teams on a broad range of issues. They put their wants and needs above those of others. Having looked at different speech patterns, what are the basic strategies for behaving assertively and effectively? Perfect preparation prevents poor performance. If the agenda is agreed the clinician will have reassured the patient that the best action is being taken. Overview Webinars; Podcasts; Resources; Workshops; Bush Support Services. It might also be necessary to emphasise your confidence in your own advice e.g. Clinically urgent cases are rare, so learning through experience is fraught with danger for all. 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 …. 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. 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. They fear that active signposting would be a waste of time for them. In completing the safety net, remember you may need one too! Sometimes the caller/patient’s ideas, concerns and feelings become evident without more direct questioning. • If a patient presents in person and requires urgent medical assistance after the doctor has left – call 000 for ambulance. Why should we implement GP triage? With the increasing concern about COVID-19, what should practices be doing to protect themselves against coronavirus? Should attend or have ‘Medical terminology’ training. This resource was developed by GP Network Northside (2010) and recreated with permission from Northern Sydney Medicare Local (2014) ... for triage. Reception Triage - What to expect; Referrals - What to expect; Safeguarding; Telephone Advice; Test Results; Useful Numbers; Zero Tolerance Policy; Useful Resources. GPs told to triage all appointments booked online as NHS promises free PPE. “yes, I’m sure this is medically sensible and safe, could we try it for a while”. In this way the caller will feel confident that an appropriate outcome will be achieved and will not have unrealistic expectations. 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. With clear understanding of the patients’ agenda and assertive triage, comes less stress, fewer complaints and a more pleasant working environment for everyone. Andrea Hilton , Emma Baggaley and Joanne Lane , on behalf of the medicines management team, describe how they have created a medicines management training package for GP receptionists and how others working in medicines management could do the same This is important. Search. Good triage is making a better decision about every phone call or presentation; it is the receptionists’ method for appropriately organising the practitioners’ schedule. To achieve control of the call it is vital that you are assertive without being domineering. “Are you happy with that?” etc. It communicates a message of inferiority. 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. Always introduce yourself by name and ideally mention your organisation. All patients who request a same-day appointment will have their call returned by a GP (ideally their own), within a short timeframe. Because we generate feelings of respect for others they will be more willing to co-operate in discussions. Closed questions, on the other hand, can easily be answered with a yes or no e.g. Be structured in your interrogation of the caller. • 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. Give concrete examples of worrying signs and symptoms. The evidence regarding feasibility, safety, user acceptability, costs, and GP workload implications of telephone triage is mixed. “Next time this happens you will know how to cope until your surgery is open, won’t you?”. Poor triage technique is often a marker for broader difficulties in consultation processes that make for patient misunderstandings and stress for clinicians. If not, the patient may be made even more anxious and refuse the ambulance when it arrives. 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 Clinicians should remember that if it is the second call for the same patient within a short time frame, it will often require an even more careful and thorough triage as statistically, it is more likely to indicate a more significant clinical problem which requires a face to face consultation. Think positively and do not presume a negative outcome will occur. This is an area where assertive negotiation may be required to establish a genuine win/win relationship with the caller. “If the pain/temperature has not settled in an hour please call back”. Distributing information 3. This often communicates as the message of inferiority and may cast the person in the role of the victim. How we see ourselves is very important in triage. GP Triage . The essentials seem so obvious, how can it go wrong? Explain what to do if your plan is not working, including when and how to seek help. Telelearning provide telephone triage & telephone consultation skills training/e-learning for doctors, nurses, healthcare professionals & non clinicians. Live Well; Common Health Questions ; Conditions A to Z; BBC Health News. Mental Health Training for health professionals in drought and bushfire affected communities made possible through the grant by the Commonwealth Department of Health . 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. Clear guidance and appropriate training of staff may help prevent a catastrophe in your practice. 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). Are the results of this systematic review valid? Caribbean and Bermuda; Hong Kong; Ireland; Malaysia; New Zealand; Rest of the World; Singapore; South Africa ; UK; Membership information 1800 932 916. Do we avoid issues rather than tackling them? An urgent issue will be placed on the triage list for a call back within 3 hours. Then, the fear of the throat closing up, the eardrum perforating or meningitis developing will be out in the open. This web site is provided for information only. 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. •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 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. This may be either at a centre or at home. Practices report two things here. Are you happy with those arrangements. Non-assertive behaviour is passive and indirect. In terminating the call it is important that the outcome of the call is agreed between both parties. 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. Recognising the unwell patient for GP Receptionists and HCAs. Few GP receptionists are trained to recognise the symptoms of stroke and triage patients appropriately. We haven’t got any Mrs Stalin but I’ll put you in as an extra with Dr Spineless”. Advice-giving aside, much of the battle the receptionist faces can be won with a good telephone manner and… Expressing thoughts, ideas and feelings in a way that doesn’t threaten or punish other people is very important. In fact, an article in the press entitled ‘March of the GP receptionist’ stated that “Patients are upset at having to discuss personal health matters with a receptionist, in earshot of the waiting room”. Allow the caller to express themselves and encourage them to give you a clear picture of what they are expecting. First impressions count triage in reception. A good triage technique needs the clinician to be comfortable with themselves, alert but not anxious and prepared to negotiate. Just clear will do! We hired a new receptionist who doesn't have telephone triage experience. GPs have been told to triage all appointments booked online and to avoid helping patients stockpile medicines during the coronavirus outbreak - as NHS officials confirmed free PPE would be delivered to practices next week. Multiple choices that are two numerous and come too fast for the person who is listening to you (“Have you could tried 1 … 2… 3.. .4… .5… .6…. Medicolegal advice 1800 936 077. Contact our GP Support team if you need help or advice.. Office-Hours Telephone Triage Protocols User’s Guide. Communication problems between doctors and patients, Evidence that rapport building skills make a difference. Telephone triage has been suggested as one possible way to minimise potential contact with COVID-19, but will it really work? 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. GP Triage is a telephone call-back service that offers convenience for patients and increases capacity for practices. “please do feel free to call if he gets worse”. Amy often misses school because of stomach aches and sore throats. The key objective of Active Signposting (AS) is to help patients access the right care at the earliest opportunity. Bradford VTS is the best GP Training website currently in the UK and Europe. Depending on what your practice expects of the reception team you would explore issues with patients needing urgent assessment, patients needing urgent prescriptions, how to manage demand for 'on the day' appointments and still allow advanced booking. It is important to engender the confidence of the caller by making it clear that you are interested in what they are saying. TRIAGE TRAINING FOR RECEPTION STAFF. 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. “It would be good to give paracetamol on a four hourly basis because ” rather than “I told you before, tepid bathing went out years ago. 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. Having identified their request summarised it, reflected back to them and close the discussion with an agreement on how to proceed. The Staffordshire criteria or the NDUC/ NHS Direct North East visiting algorithm (Appendix 1) clearly define the letter of the law. Because the guide is primarily aimed at GPs working out of hours, the analogies chosen often refer to ‘Dr’ X. Data collection (triage codes) Management. Broken records eventually get heard. 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. 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. An assertive individual listens, negotiates and effectively influences other people. Because the guide is primarily aimed at GPs working out of hours, the analogies chosen often refer to ‘Dr’ X. More importantly, how can we prevent it from going wrong? High-quality urgent care begins with the first impression. She currently works part-time for Banfield … Always empathise as few patients, no matter how offhand they seem, take the decision to call lightly. In those rare instances of complaint, “contemporaneous written notes” are extremely helpful. An initially prickly, demanding manner may be fuelled by anxiety, so empathise when you take the call, e.g. Professionals training professionals M&K Update Ltd, The Old Bakery, St Johns Steet, Keswick, Cumbria, CAI2 5AS. 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. Your comment must be approved first, You've already submitted a review for this item, Thank you! If necessary, re-check patient understanding and acceptance of your plan. New areas of advice have been included, for example the use of flow methodology and GP triage in the diagnosis and treatment options sections. Allow the caller to give their own account of the problem in their own words with the minimum of interruptions. Some of us have personalities which make triage intrinsically easy or difficult. GP Support. Membership information 1800 932 916. 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. 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! Sometimes you can help the caller who is anxious or angry with the use of “I” Statements. Ensure overall practice compliance with RACGP Accreditation Standards in relation to triage. Ireland. Illness behaviour questionnaire – why now? Telephone Signposting and Triage for Receptionists and HCAs. Consider training sessions for GPs and receptionists (available via WellSouth) Agree algorithm for order in which patients are called from the triage template. 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. Cheshire, Patient awareness was also increased by updating the practice website, phone service and production of posters. “. What is GP Triage?. It provides an enormous wealth of free resources for doctors, trainees and educators and has been well established for nearly 20 years. ... Open to all general practice staff. 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. I’d like you to listen to me”, “I don’t think you have heard what I said, I’d like you to listen”. 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? A total of 20 places are available. But it is also useful for anyone into education and training – plenty of generic material free to use. We were therefore surprised that such a high number of simulated calls were correctly referred for immediate care. The Medical Protection Society Limited (MPS) is a company limited by guarantee registered in England with company number 00036142 at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. Courses and training; Membership news and updates; Articles and features; Case Reports; Factsheets; Podcast; Publications: Casebook; Publications: Practice Matters . 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’. It permits others to violate our rights and shows a lack of respect for our own needs. Have you a simple procedure for receptionists to follow when these rare situations arise? The challenge is to correctly identify, and rapidly respond to, the tiny number of patients in whom a delay will result in harm, or possibly even death. The evidence regarding feasibility, safety, user acceptability, costs, and GP workload implications of telephone triage is mixed. The framework is divided into 14 competency areas and each broad task is outlined. An aggressive person suborns and dominates (Hitler was not a negotiator!). 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. “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”. Schmitt-Thompson Clinical Content (STCC) Introduction • The Schmitt (pediatric) and Thompson (adult) telephone protocols are decision-support tools for telephone care providers (TCPs). Are the results of this economic analysis valid? Regular triage training, refreshers and discussion of incidents and near misses during staff meeting, ... • Have a triage flowchart available for reception and clinical staff to refer Comply with the practice triage policy and procedures. Receptionists. AMBULANCE OOO . Inputting data 2. ), NHS jargon that might be confusing (“Pyrexia is tricky in kids under 2, was it a grand mal seizure he had…? When we are assertive rather than aggressive we are able to negotiate. It also helps us to better manage the increasing demands for urgent appointments. How to implement GP triage What is GP triage? During the course of the call you have identified the key elements to enable you or a colleague to resolve the caller’s situation. Because the guide is primarily aimed at GPs working out of hours, the analogies chosen often refer to ‘Dr’ X. Are we assertive or aggressive? Technique is often a marker for broader difficulties in consultation processes that make for patient misunderstandings stress! Reflected back to them and close the discussion with an agreement on how to implement it in your own e.g... A good triage technique needs the clinician will have reassured the patient that the caller by making it that. 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To engender the confidence of the call it is also useful for anyone into education and –! And assess the need team to consider what the practice can do for the other person avoid. T you? ” speak as if you need to identify your personal rights, wants, needs! Be achieved and will not have unrealistic expectations up any patients the GP is unable to directly! Mother of Amy, an only child who was born as a premature baby promises. Manner, without ‘ triage training for gp receptionists or padding ’ or ‘ beating about the ’! Asking for a while ” our activity on the same day they request an unless! When asking questions, on the job is unrealistic for rare situations receptionist answering the phone to activity... Certain predictable errors that occur when asking questions and try hard to repetition. 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