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Telephone Triage and Open Access?

QUESTION:

One of my employees recently attended your conference and we saw in your outline the statement "open access without triage is anarchy!" We are moving in the direction of open access and I would appreciate any information, references or directions you could give me on this.

ANSWER:

My comments about the need for triage with Open Access are based on my experience. One of the "marketing tools" used by many who promote Open Access is based on the notion that if you have Open Access, you don't need a triage nurse. Unfortunately, that reasoning supports the idea that telephone triage as a barrier to care, which it isn't (or it certainly shouldn't be). Although in the early, demand-management days of telephone triage, emphasis was often on redirecting patients to a less expensive disposition, we now know that telephone triage exists to FACILITATE care, not to prevent it.

If you have an Open Access model (which, incidentally, in my experience works very well) you still need a telephone triage component. Without a triage function, there are two types of problems that can occur:

  1. Very sick patients often present to the office when they would be more appropriately treated in an Emergency Department. One real-life example I have of this is a woman who called requesting a same day appointment, was given a same day appointment, and then presented to the office in respiratory failure. She had to be intubated and transported to the closest facility. Unfortunately, it was reported that she didn't have a good outcome. The office setting just isn't the right place to try to deal with high acuity patients or those requiring extensive care (like chest pains, dehydrated patients requiring parenteral fluids, diabetics in DKA and so forth).

  2. Low acuity patients often request a same day appointment when home care would be ideal (and desirable to the patient). Without telephone triage, patients who would benefit from home care, and who would probably appreciate the opportunity to have home care, aren't given that option.

It's just very important (as you know) to keep in mind that the telephone is just another vehicle through which we provide care to patients. The purpose of telephone triage isn't to keep patients out but rather to help them determine the best time and place to seek care for their problem. Without a professional assessing these patients and advising them properly, your office hours are likely to be largely devoted to caring for the very ill who are too sick to be in the office setting and/or many who would have benefited from (and appreciated) home care.

If you want more information on this subject, my colleague, Krist Pottorff, is an expert in this area. You can contact him directly at Krist [at] telephone-triage [dot] com.