What is Clinical Triage? 

Triage is a telephone call-back service that offers convenience for patients and increases capacity for practices. All patients who request a same-day appointment will have their call returned by a GP (ideally their own), within a short timeframe. The GP can then determine the most appropriate next step for the patient.  

Clinical triage is not a consultation. A consultation (virtual or in-person) is one of the possible next steps after this triage. 

Why implement Clinical Triage? 

Evidence from Health Care Home practices suggests 40% of patient same-day appointment requests can be resolved over the phone: this means 40% of patients requesting a same day appointment do not have to come physically to the practice. 90% of these resolved calls are “advice only”, with the balance being prescriptions. Nurse practitioners have resolution rates similar to GPs. Practice nurses typically resolve 15-20% of triage calls on the phone. 

Clinical triage creates more appointments than it takes to run, providing additional capacity, and means patients who most need a same day appointment are prioritised, rather than the conventional first-come, first-served model. Patients who do come in after triage often have shorter appointments as a history has already been taken. 

For patients, triage saves time by not having to come into the practice, as well as an earlier contact with a GP to discuss their urgent need. Patient feedback is generally that they feel they have better access to their general practice, and that this triage is a valuable service provided by the practice.  

Telephone triage can also be an important tool for managing respiratory illness, with fewer people traveling to and waiting in the practice. 

For practices with no urgent same-day access problems, clinical triage offers a better patient experience.  

Who does what? 

Measurements 

Prior to implementing triage, same day demand data should be collected over at least two weeks to identify how much GP time will be needed to triage patients. This data also helps identify how many same day appointments need to be reserved for unresolved triage patients, and the best time to triage patients. GP triage is routinely used in the morning but can be used at any point when demand is high. On average, triage calls take four minutes, so assume three calls per 15-minute session. 

Implementation timeline 

Preparation 

- Engage practice team 

- Talk to practices already doing triage 

- Consider supporting services (e.g. high utilisation of a patient portal will reduce call volumes)  

- Prepare communications for patients 

- Review available numbers of phone lines 

- Collect at least two weeks’ worth of same day appointment request data. 

- Consider training sessions for GPs and receptionists (available via WellSouth) 

- Agree algorithm for order in which patients are called from the triage template. 

Stage 1 

- Trial Clinical triage with willing GPs, at your busiest periods 

- Use the KPI data collected from the triage advanced form to determine and allocate resources for expanding clinical triage 

- Monitor patient and staff feedback. 

Stage 2 

- Expand the trial so that triage is routinely occurring 

- Expand Clinical triage to include more GPs 

- Continue to analyse the data collected through the WellSouth triage form 

- Monitor patient and staff feedback. 

Patients

Patients need to be made aware of changes to how their care will be provided. There are a number of ways: 

- The most effective method is for your staff to recommend the service to patients 

- On your website and social media (Queenstown Medical have done an excellent video) 

- Update your telephone message 

- Posters or brochures in your practice. 

Some practices charge the patient for triage, but most do not. Those who do not charge for triage usually charge for the outcome e.g. co-pay if an appointment is made, prescription or work certificate. Agreeing the payment structure for triage is a decision for each individual practice. The most important thing is it is clear to patients.  

How to measure success 

The KPI reporting function in the WellSouth GP Triage Form collects data on the outcomes of triage. The most useful for measuring the success are number of Clinical triage calls, the percentage of those calls resolved over the phone, and the average call length. The definition of successful implementation of Triage will differ from practice to practice. 

It is important to engage with patients and collect feedback on the new service. One way to do this is to give patients a follow up call a few days after they have used the triage service to gather their thoughts and feedback. Alternatively, a survey could be sent out to patients who have used the triage service and the results collated. 

Helpful Tips 

Clinical safety is paramount. Triage is solely deciding how the patient needs to be managed. Triage is not a consultation, it is a contact. 

Monitor the average call time to see if triage calls are turning into consults. A clear understanding for the rationale for the triage call is important for clinicians and patients. 

If a GP has concerns over a patient, then the patient should be seen. Triage is not about trying to see less people but seeing those who need it most at the most appropriate time. 

If a patient does not want to be added to the triage list, they can book an appointment to see their doctor as they always have. 

If GPs are resistant to Clinical triage do not force them to do it. 

Use the data generated to showcase the effectiveness of GP triage to GPs who are unwilling to triage. This data should be displayed on your visual whiteboard (link) for everyone to see. 

Consider implications of payment arrangements for GPs. If GPs receive a percentage for each patient they see, there is no financial incentive for them to triage.