benefits & barriers to clinical secondary triage

By David Ross Garvey

RNMH05th April 2016

‘Any form of health care delivered on an outpatient basis’.

Any medical condition that does not need to attend Accident & Emergency, which can be treated, managed or referred to an alternative health care provider within the community.

(NWAS)

Better management of resources. Increase the ability to direct patients to the

most appropriate care.

Results we hope to achieve using effective secondary triage

Fewer emergency ambulances being utilised. 999 resources available for life threatening

emergencies Reduced A&E attendances Customer satisfaction

Patients own GP Out of Hours GP Walk in Centres Minor Injury Units/Urgent care centres District Nurses Mental Health Services NWAS Green Car Eye Hospital Maternity

Best care for patients, at the right time and in the right place.

Ability to hear, treat, advise and redirect. Reduces pressures on Accident and Emergency. Reduces pressures on Paramedic Emergency

Services. Reduces pressure on service for statutory

targets and statistics. Secondary triage has the ability to do more jobs

than if each job was to receive an ambulance.

Cost effective for the service. Increases profile of the service and increases

relations with other services Makes patients feel valued and have trust in

the service they use. Safe system which doesn’t compromise

patient care and easy access to other services.

Identify life threatening calls that primary triage (Pre QA) had missed.

Can upgrade or close calls when completed.

Understanding of questioning. Unable to see the patients condition. Inability to obtain baseline observations. Language and cultural issues. Clinicians can be over or less cautious

when triaging. Abusive callers and/or family members

making it difficult to triage effectively.

Inability to contact patient back via telephone.

Not seeing the environment. Inability to fully assess Risk. Pain scoring. Inability to assess patients under 16

unless its consistent with Trauma.

CMS directory of services

Manchester Triage System

C3

Ability to review calls to ensure standards are kept to a high standard.

52 Discriminators.

5 point scale- response time indicators.Patient safety is paramount.Systematic approach.Able to identify critically ill.Clinical Risk Management.

23% average deflection rate for ‘hear and treat’.

30% deflection rate by the end of the financial year.

95% of Clinical Performance Indicators to be met each month.

5 Peer reviews each month.

3 or more calls per hour.

According to past, recent and current research it is known that the positives outweigh the negatives to secondary triage.

It is essential patients are listened to and directed to the best care possible.

Care and compassion is what we are structured on and safety of our patients is paramount.

The use of MTS safeguards and is used as a clinical risk management of the 52 presenting complaints.

Department of Health, Taking Healthcare to the Patient 2, 2011

Francis Report, 2013 Keogh Report, Mortality Review 2013 Nice Guidelines, Quality and productivity

case study, 2012 Transforming urgent and emergency care

services in England, 2015