Article

Build a successful triage team

Identify and develop traits that fuel efficiency and excellent patient care.

Effective triage methods are a win-win for any ophthalmic practice: Not only do appropriate triage methods lead to excellent patient care, keeping patients happy, but efficient scheduling keeps doctors, staff, and management happy. To become effective at triaging, there are certain traits, as described in this article, that ophthalmic professionals need to either possess naturally or acquire with training and practice. These include:

  • a knowledge of ocular conditions
  • compassion and reassuring demeanor
  • excellent communication skills
  • analytical skills and discipline
  • ability to identify and learn from errors in scheduling — and correct them.

What is triage?

Triage is the act of assessing the severity of a patient’s signs and symptoms, classifying them according to urgency, then scheduling the patient accordingly.

A knowledge of ocular conditions

For the successful triage professional, knowledge of common ocular conditions and their symptoms is required. Clinic technicians and scribes often work well in triage positions because they likely possess this knowledge. Most importantly, they may know how to determine the urgency with which the patients should be seen by a physician.

While nonphysicians should not attempt to diagnose eye conditions, technicians already likely gather ocular history, chief complaint, history of present illness, medical/ocular history, and medications, which is very similar to the information gathered by the triage staff during a call. If a triage professional does not have clinical experience, expect the training to take a significantly longer period of time.

Triage professionals need to increase their ophthalmic knowledge on an ongoing basis. Spending time with the technicians and doctors in clinic or reviewing charts can be quite valuable. Additionally, numerous continuing education opportunities are available. Anatomy and physiology are great starter courses, and courses that cover common ocular conditions, pharmacology, ocular emergencies, and triage are all very pertinent to take and retake as refresher courses.

Shown at Cincinnati Eye Institute, glaucoma triage, are (from left): Debby Dalton, triage; Angie Hyde, triage; and Brittany Griffith (surgery scheduler).
COURTESY OF AMY JOST

Compassion and a reassuring demeanor

These traits put the patient at ease. Remember that the person on the other end of the phone may be worried, scared, or even desperate. A friendly, reassuring voice helps keep the patient as calm as possible while addressing needs and capturing information in a concise manner. Extending compassion will validate that the patient’s complaints are worthy of concern.

In this regard, select triage staff who are personable and kind, but can also politely keep control of the conversation. It’s a balancing act between encouraging the patient to share and keeping the patient on track to provide relevant information. Whether the call can be addressed with verbal advice or warrants an office visit, these staff should assure patients that their concerns are reasonable. Staff should educate patients on what is normal vs. abnormal, and what to do if the problem persists or worsens. How the patient was treated over the phone, including how the employee made them feel, can significantly influence patient satisfaction scores.

In the case of those patients who frequently call in, it can be difficult to determine if there are true problems. It could be that these patients are overly worrisome or have another reason they feel compelled to call in multiple times, but be careful to not get frustrated or dismissive. There is a good chance these repeat callers do have real problems. Address them accordingly.

How to determine urgent vs. emergency

EMERGENCIES (require immediate attention within hours)

 Sudden & persistent loss of vision within last 48 hours (central or peripheral)

 Sudden onset of severe pain, with or without vision loss

 Red eye with pain

 Red puffy lid with pain

 Detached retina (as diagnosed by an optometrist or ophthalmologist)

 Ocular trauma within last 48 hours

 Ruptured globe, trauma with a “gush of fluid”

 Foreign body in the eye

 Temporal arteritis

 Sudden flashes of light; “spider web” opacity; with areas of blurred or decreased vision

 Extreme light sensitivity

 Any patient referred by another doctor who feels that the patient has an emergency

 Chemical burns, acid, etc., should be directed to go to an emergency room — not clinic

 Signs of stroke should call 911 or go straight to emergency room

URGENT (can wait 24-48 hours)

 Recent onset of binocular double vision that has been present for more than 48 hours

 Recent onset of distorted vision (not just blurry)

 Redness and discharge of eye and/or lids

 Recent onset of unexplainable or vague ocular discomfort

 Itching, mild discomfort, tearing

 Blurry vision without pain that is not clearing with blinking

 Subconjunctival hemorrhage (in the absence of hypertension, bleeding disorder, pain, or vision changes)

 Lost or broken glasses (unless extreme prescription needed)

Excellent communication skills

The triage person must listen for content and inflection, without interruption and without jumping to conclusions. It is important to be able to ask questions in a way that clarifies and confirms what the patient is trying to say. The triage person must capture enough information to make appropriate decisions about whether or not, and when, to schedule the patient for an office visit.

A successful conversation ends with both parties in agreement of next steps, whether that is an office appointment, instructions on medication dosing, other treatments, or simply observing the condition for changes. Perhaps subsequent steps are also applicable, for example, “Continue your eye drops as directed (step 1) and call us back in two days if your eye is not feeling much better (step 2).” Steps should be simple, clear, and concise in order to maximize compliance and a successful outcome.

In fine-tuning communication skills, train the triage staff on what questions to ask. The usual questions are critical: “What is going on with your eye(s)?” “Which eye is it, or are both eyes affected?” and “When did this start?” A lot can be determined by this information alone. Incorporate the “see, look, and feel” questioning technique to capture a more detailed understanding of the complaint and/or condition. For example:

  • How well do you see? Or, how has this affected your vision? (Look for descriptors such as blurry, glare, halo, light sensitivity, wavy/distorted, blind spots, etc.)
  • How does your eye look? (Listen for descriptors such as red, swollen, bumps, presence and color of discharge, cuts, scrapes, bruising, bleeding, foreign bodies, etc.)
  • How do your eyes feel? (Identify descriptors such as pain, itchy, burns, stings, twitches, etc.)

The “See, Look, and Feel” questions are a great starting point for new triage staff and can extend into more advanced methods to isolate specific issues of concern by more experienced staff. (See the grid on page 19 for ideas on how to clarify what problems the patient is having.)

Finish with, “Is there anything else you want me to know about your eyes?” This question allows the patient to add information about anything not specifically asked. Repeat back the information to confirm accuracy.

Casey Jeffers, triage, at the Urgent Eye Clinic of Cincinnati Eye Institute.
COURTESY OF KELYE CONRAD

Patient intake representatives at Cincinnati Eye Institute (from left): Becky Butler and Francie Springer.
COURTESY OF KELYE CONRAD

Analytical skills and discipline

It is imperative to identify specific ocular complaints to schedule the patient accordingly. Early in the training process or with any symptoms introduced for the first time to the triage person, it is a good idea to check with the doctor to ensure the patient is scheduled appropriately. By becoming more familiar with the specifics of the doctors’ preferences, the well-disciplined triage person will be able to schedule appropriately and more independently.

Collaborate with the doctors and key staff to create a cheat sheet or a list of questions for various symptoms and determine what constitutes emergency, urgent, or next available appointments. This may vary slightly by doctor or practice, but defining these categories is a necessity for empowering triage staff to make good decisions about the timing of scheduling.

Ability to learn from scheduling errors

By identifying scheduling errors, the triage team can make changes to processes. Of course, if patients are scheduled too soon or unnecessarily, especially when double or triple booking, this overbooking will lead to delays in the overall patient flow. This results in a clinic full of unhappy patients, staff, and doctors. If the patient’s appointment is delayed, it is possible that the delay itself could cause harm to the eye or jeopardize vision, healing, or comfort.

As mistakes occur, discuss each in a professional manner and determine how this eye condition should be addressed the next time it presents. Add to the decision making documents, and retrain, as necessary, on specific eye conditions so that all triage staff can recognize similar situations in the future, further improving patient care.

Bring it all together

An effective triage set-up includes ample staff and time to answer calls and field patient questions and concerns. The triage staff needs to be friendly, knowledgeable, analytical, and able to effectively communicate with the patients, doctors, fellow staff members, and even staff and doctors from other practices or services. The doctor’s schedule should allow time for emergency or urgent appointments to avoid excessive double booking and the resulting extended wait times for other patients. OP

Daniele Salterelli, OD, Kelye Conrad, COA, Christine Castetter, COA, and Casey Jeffers also contributed to this article.