Triage: explaining triage (as used in general practice) to patients

[georginaplatt]

What

The problem During Covid many practices have implemented or increased use of triage to assess and prioritise incoming requests for appointments from patients.

Sometimes patients are asked for further information about their concerns (in person, on the phone, or via an ‘online consultation form”) to help health professionals prioritise their need and decide the appropriate next step (which type of health professional to see and how they might speak with the patient).

Triage is an important process and model. In the past appointments were often allocated on a “first come, first served” model with patients being asked to call again tomorrow if they were unsuccessful today. Triage aims to “see” all demand and allocate resource more equitably and respond to the most urgent needs first.

Triage is not a single uniform process. Not all GP surgeries have a formal triage process. There is also considerable variation in how triage is undertaken across practices (for example in the number of stages and how triage is undertaken).

Below is an example from a GP surgery website that has implemented “total triage” which means every incoming request from patients are put through a single triage process and prioritised accordingly.

Why

What do we know?

User research with patient users showed limited understanding of the word triage especially in the context of general practice.

User research with patient users showed some participants had some awareness and vague understanding of a triage process in emergency care.

We are planning to test some simple sentences which explain the principle of triage as an alternative to having to use (and therefore define the word).

However you get in touch, we’ll ask you to tell us a bit about your health problem and your choices around appointments. This helps us to understand how urgent your problem is and the best person for you to see.

Anything else

We’d like your help:

1. User research: have you seen or undertaken any patient research which has explored triage?
2. Have you seen any simple patient-facing sentences explaining triage?

[sarawilcox]

More about this in the report by the Primary Care Digital First team on Creating a highly usable and accessible GP website (on FutureNHS website, PDF for now). You need a FutureNHS login to view it.

They're hoping to publish an open HTML version soon.

[sarawilcox]

A proposal for the style guide from the Digital First Primary Care team:

Triage

Do not use the word ‘triage’ in the context of general practice. People do not understand what it is and if they do, they associate it with A&E

[sarawilcox]

At October 2022 Style Council meeting, we approved an initial entry for style guide A to Z. Still needs clinical approval.

Triage

Do not use the word "triage" in a GP setting. People do not understand what it means and if they do, they associate it with A&E.

In a GP setting you could say, for example: "We will look at the information you give us and decide the most suitable person for you to see and when they are available”.

If you have to use "triage" in the context of A&E or urgent treatment centres, explain what it means. For example: "A doctor or nurse will work out what order to see patients in, so they see the most serious cases first. People who arrive after you may be seen before you." [Wording amended in light of comments below.]

Discussion: This was backed by 111 online who have also found that people don’t understand what triage means, even in emergency settings.

There were suggestions that, rather than say, “the most suitable person to see you”, we might want to say “to talk to” or “who will contact you” or “help you”. But there is huge variation in what will happen next. The Digital First Primary Care team found no problems around the word “see”, so we will go ahead and use it but make it clear that it’s an example.

Action: Agreed to add some wording to explain that people who come after you may be seen before you in A&E example and added “for example” re GP setting.

Agreed to come back and look at triage in the context of symptoms checkers and self-service triage tools (where the doctor or nurse doesn’t do the triage).

[sarawilcox]

After the October Style Council meeting: Sara spoke with Lauren McAllister and discussed:

• symptoms checkers
• self-service triage tools

We agreed following wording to take to next Content Style Council meeting.

Re self-service tools and symptoms checkers, we propose something like this:

To avoid the word “triage” in the context of online tools or phone triage (for example, NHS 111), explain that users will be asked some questions to find out what help they need, and if relevant where to go or what to do.

[sarawilcox]

Entry approved at October Style Council meeting has been approved by clinicians. Prepping for publication. One outstanding issue to return to next Style Council meeting.

[sarawilcox]

The following wording was approved by clinicians:

If you have to use "triage" in the context of A&E or urgent treatment centres, explain what it means. For example: "A doctor or nurse will work out what order to see patients in, so they see the most serious cases first. People who arrive after you may be seen before you."

Published January 2023