Why do we have a Triage system? – a commonly asked question

No system is perfect and there has to be a balance of what is overall the best way to deal with the logistics of a situation measured against any disadvantages the system itself brings.

Having said that, the practice staff do constantly monitor how well triage is working and are always open to listen to constructive suggestions.

Dr Jefferies gave a talk on the subject in June 2012 and below is a précis of the salient points covered:

Essentially, triage had been introduced to counter the difficulties of the previous system (particularly on Monday mornings) where 08:30 saw a sea of people at the door, and ironically the ‘fittest of those, (i.e. those able to reach the desk first) were able to secure an appointment.  All appointments were usually taken by 08:35, leaving countless patients disappointed (plus those trying to get through on the phone)

Prior to triage, a patient may have booked in automatically with the doctor, resulting in a wasted appointment for both patient and clinician.  Triage calls are taken right up until midday, thus avoiding the need for an 08:30 ‘rush’, and reducing waiting times on the phone.

Under the triage system, all patients receive a call back and are appropriately treated. e.g. if a dressing is required, an appointment with a nurse, rather than the doctor is arranged.

Perception of ‘urgent’ is not always the same as the reality of clinically urgent and triage is a very good system for identifying these categories thus ensuring that those who need priority do get it.

90% of calls are handled by the triage nurse, with the remaining 10% being picked up by the duty doctor.

There is a tendency for triage to be blamed for the lack of pre-bookable appointments. In fact this is not the case.  The situation was much worse prior to triage.  For example, on a Monday we now have a 50/50 triage/pre-bookable slots balance.  Pre-triage, all of the slots would be solely on a ‘book on the day’ basis.  Currently, there are 18 appointments per doctor in the morning (a mixture of pre-bookable and triage) and 12 in the afternoon.

The possibility of continuing triage into the afternoon has been considered (some surgeries do this) however, staffing would be an issue.  Employing a nurse to do triage leaves them less time to do other work. A duty doctor would have the same problem.

Concern has been expressed that elderly patients, particularly those on the Park, neither understand nor like triage.  They are particularly unhappy at relaying their problem to a receptionist, then again to the nurse, and potentially, once more to the doctor.  They want to see their own doctor.

One option, frequently suggested, is for the receptionist to take sufficient detail to enable nurse to book an appointment without having to speak to the patient and ask all over again.

Dr Jefferies explains that in terms of manning the calls, the receptionist is the starting point and whilst all staff are bound by the same strict rules of confidentiality the problem is that receptionists are not clinically trained.

Leaflets explaining the system, especially for elderly patients, are available at the surgery.

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