Triage: Are You Doing It Right?
Warm weather is finally upon us—well, most of us—and that means pool time, cookouts, and outdoor fun. For some, that also means fireworks—and emergency visits to the eye doctor. But even if you’ve never received that particular type of urgent call, you’re likely no stranger to patients who report red eyes, weird vision, and other types of ocular trauma.
“Emergencies are a part of medicine so you need to plan for them,” says Sharon Alamalhodaei, COMT, OSC, a presenter at 2018’s SECO conference. And how well you plan for those emergencies affects your patient care, patient flow, your practice’s reputation, and even your bottom line. That’s why your triage processes and procedures are so important.
Who’s Up for the Triage Task?
People who triage well often get promoted to other positions in a practice, but that sends the wrong message, says Mary Pat Johnson, COMT, CPC, COE, CPM, who spoke about triage at ASCRS 2018. In reality, triage is not something you can take lightly. It requires in-depth training in both ocular conditions and customer service, she notes.
Triage isn’t a good job for the shyest person in your practice, and it’s not great for your front desk folks, either. Why? Front desk staffers have patients in front of them and doctors behind them, explains Jane Shuman, MSM, COT, COE, OCS, CMSS, OSC, who taught alongside Johnson. Emergency callers expect your undivided attention. If you can, use a call center or assign dedicated staffers to the task, Shuman recommends.
Triage Training Tactics
Staffers handling triage must follow three steps, according to Johnson. They must determine the chief complaint, assess the severity, and follow office protocol. That may sound easy, but don’t be fooled. If the staffer doesn’t ask the right questions, you won’t know what’s going on. That could hurt your patients and your practice. That’s where good training comes in. In general, those triaging patients must know and understand:
- Basic anatomy and terminology
- Who different providers are and what they do
- How to determine a likely diagnosis from patents’ symptoms and complaints
- Basic understanding of services your practice provides
- Payer information: what plans you accept and what’s covered
Training is not just for triage staff—get everyone involved.
“Techs need to be clear on their roles in caring for emergency patients,” says Jacqueline Pullos, COMT, OSC, another ASCRS instructor. For example, techs must know what physicians want in terms of a workup for emergency patients.
Clinical staff can help train the triage staff.
For example, triage people can shadow clinical staff as part of training. Or, if you’ve got a tech with downtime, have them work in your triage call center alongside staff to train and share their knowledge. And don’t forget that training never stops. Reasons to update your triage training include changes in providers, adding a new service line, or changes in payers, says Pullos.
Ask trainees: “What do you think you do?” That sheds light on what the person you are training is thinking, says Shuman.
Phoning It In
Triaging a patient via phone is a time to stop, listen, and think, according to Dianna Graves, BS, Ed, COMT, who taught tech training courses at SECO 2018. “When you pick up the phone, put everything down and listen to the phone,” she says. Sometimes, the problem is something completely different than what you’d expect, and it takes careful listening to avoid red herrings.
“That one statement is like giving directions to your house by starting with you live on earth.”—Dianna Graves, on when patients call and say “I can’t see!”
You don’t want to be so pushy with your patients that they feel they got the third degree, notes Graves, but you’ve got to get the information. What the patient says is not always what they mean. At the same time, be careful not to scare the patient, she warns. When you tell them to come in “right now,” they don’t know that you just happen to have an opening. “They think they’re gonna die. One [patient] brought her priest,” she recalls. Below, sample questions for triaging your patients’ most common—and frustrating—calls:
“My eye is red.”
A red eye could mean almost anything. “What is a red eye? And what are you going to ask the patient?” Graves asks. To suss out the real issue, try these:
- Is your eye actually red or are you seeing red?
- Where? The eyelid or the white part?
- One eye or both?
- When did you notice it?
- Does it hurt?
- Has your vision changed?
- Is there discharge? Is your eye stuck shut?
“I’m seeing double.”
In most cases patients aren’t really seeing double, says Graves. They’re seeing blurry shadows and they perceive it as double vision. She asks:
- Do you have pain when you move the eye? Sided to side or up and down?
- Is your eyelid drooping?
- Have you injured your eye lately?
- Have you had a head injury lately?
- Close one eye, do you still see double?
- Are you diabetic? (This question could lead you to serious conditions like 3rd nerve palsy or even an aneurysm.)
“I’m Just Sayin”
This patient calls to report an eye issue, but they have a number of reasons why they’re too busy and can’t come in. They simply want the doctor to know, and they want you to tell them they don’t really need to come in. Graves suggests that you put down the phone and act like you are talking to the doctor. Then tell the patient that “the doctor would really like to see you today.”
In general, the manner of onset will determine how quickly a patient needs to be seen, says Pullos. Quick onset or rapid worsening means they probably need to be seen right away. If the problem is gradual or has been going on for months, it can probably wait. But remember, there are always exceptions, she warns. Below, our experts explain the three classes of urgency:
Tip: Create more open slots on Mondays, and Tuesdays after a holiday weekend, recommends Alamalhodaei.
This is when the patient risks permanently losing their vision or their eye. They’ll need to be seen immediately or even go to the ER. Examples include a chemical spill, change in Amsler, vision loss, forceful entry of a foreign object, blunt trauma with vision change, corneal foreign body, monocular patients, and diplopia (especially on otherwise healthy adult).
These patients must be seen within 12-24 hours. Examples include floaters and flashers, sudden change in vision, irritation/redness without pain or visual changes and lid bumps or swelling.
It is also urgent if a patient with a high refractive error breaks or loses their glasses and doesn’t have a backup pair. If you don’t accommodate them, and they fall or injure themselves, your practice could be liable. Oh, and get someone else to drive them.
Some practices may call this “routine,” but it’s when a patient has a non vision-threatening problem. They should be seen within a few days. Examples include general discomfort, eyelid twitching, and itching/irritation/tearing without redness.
What if you want a patient to come in within a certain timeframe but they refuse? To protect your practice from liability, be sure to document that in their chart, advises Graves. Example: “We wanted Thursday, patient wants Friday, again offered patient advice to see Thursday, patient still wants Friday.”
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