Unfortunately, many veterinary practices have a narrow view about broadening the responsibilities and opportunities afforded to their technicians. My opinion: Don’t waste the talent of these critical team members. One pivotal role they can take on is triage technician, a position that elevates client communication and your hospital’s efficiency and medical care, all of which will improve the bottom line.
Triage means organizing patients according to the severity of their conditions and providing treatment within an appropriate time frame. Good triage should occur at every stage of patient care, from the initial phone call to arrival. Triage isn’t a new concept in veterinary medicine, and it isn’t just for emergency practices. Every hospital can benefit from establishing triage protocols for all types of visits.
Telephone Triage
The initial triage might occur when a client calls. We continue to struggle with appointment availability and servicing every pet that needs care without too long of a delay. Therefore, the more impacted your practice is, the more essential the need for triage protocols.
Routine wellness appointments are easy to book based on availability. But what if the client isn’t calling for regular care and you have no immediate schedule openings? This is when triage is appropriate. A triage system allows a technician to quickly determine the severity of a pet’s condition and decide when the animal should be seen. The front desk is a busy place, and emergency calls take time. Instead, transfer those clients to the triage technician.
Pick a Point Person
Technicians responsible for phone triage must be familiar with urgent conditions and situations, the practice’s scheduling protocols, and available appointments.
Not every patient needs to come in immediately, so determining the condition’s severity is the first step. Handling a vomiting cat is different than a dog with itchy skin. Both cases are important, but the urgency isn’t the same.
Phone triage can be challenging because the patient isn’t in front of you. The client has a primary concern, so the technician must ask concise questions to determine when the patient should be seen. Making the determination can include these questions:
- What is the primary concern?
- If an injury is the issue, how and when did it occur?
- Does the situation involve a preexisting condition?
- How long has the problem existed?
- Is the pet bleeding or in respiratory distress?
- Was the pet exposed to toxins?
Come Now or Wait
A technician who understands the pet’s condition and symptoms well can decide when the patient should arrive. Reserving a handful of same-day appointments for urgent care makes accommodating those pets easier.
When your practice is fully booked, the decision comes down to how to serve the client and pet. If your hospital offers drop-offs for urgent care, that solution might be best. However, sometimes you must say no. Overburdening the doctors and technical team is not in the team’s or patient’s best interest. If your practice can’t see the pet in a reasonable period, referral to an emergency practice is the appropriate option. Tell the pet owner which emergency practices you recommend.
If the pet needs immediate veterinary care and you can provide it, alert the front desk, doctor and technical team so everyone can prepare. Advise the client about the best way to transport the pet and get an estimated arrival time. You can give treatment advice over the phone when appropriate and if it doesn’t delay the arrival. Examples include cooling a hyperthermic patient during transport or applying direct pressure to a bleeding wound.
Recordkeeping is a critical part of the process. When an established client calls, document the interaction in the patient’s medical record, including the presenting complaint, symptoms and your recommendations. Use a triage call log for new clients and note the same information. Keep logs for at least a year if your jurisdiction mandates it.
On-Site Triage
When a patient arrives, the triage technician can evaluate the situation. A quick basic history is necessary. The initial assessment is intended to identify whether the patient requires immediate diagnostics and treatment or can wait in the car, lobby or exam room. Some emergencies require a patient to be taken directly to the medical team — profuse bleeding, severe trauma or seizures, for example.
Remember the TPR
Assessing the patient must address the respiratory, cardiovascular and neurological systems. Start with the standard temperature, pulse and respiration (TPR). Temperature is a vital emergency indicator, especially in the summer months.
Direct observation of the patient’s respiration is required. Any change in breathing can indicate a potential emergency. For example:
- Is respiration labored?
- Does the animal have an obstruction?
- Is the patient panting profusely?
Assess the heart rate and pulse strength. One key indicator of shock is a higher heart rate. If you have concerns about poor pulse quality, arrhythmias, tachycardia or bradycardia, the patient should be admitted immediately for monitoring, diagnostics and treatment. Also, check the mucous membrane’s color. Capillary refill time should be under two seconds. Cyanosis must be addressed immediately.
Assess the level of consciousness, too. Healthy patients typically are anxious at the veterinary hospital. A marked decline in mentation is concerning and should be considered an urgent situation.
Consider these questions:
- Is the patient alert (normal behavior and responsiveness)?
- Can the patient stand and walk?
- Is the patient depressed (awake but subdued and uninterested in the surroundings)?
- Is the patient delirious (awake but showing an inappropriate response to stimulus)?
- Is the pet stuporous (a deep sleep state aroused only by strong stimulus)?
- Is the pet comatose (unconscious and cannot be roused)?
After making an assessment, your triage technician is better positioned to communicate the urgency of care to the client and medical team. The goal is to ensure that all patients receive the best treatment and veterinary care as efficiently as possible. Your triage technician can make that happen.
MORE INFORMATION
Check out VetFolio’s “Back to Basics: Implementing a Triage Protocol” at bit.ly/triage-TVB.