New and effective triage system

Dr Shkelzen Gashi

Introduction
 
There is currently an on-going inter-disciplinary project aiming to deliver safe, effective and user friendly healthcare pathways for the Medway Nursing and Elderly Care home staff. The aim is to provide clearer guidance on early recognition of sepsis in an unwell patient/resident, optimal management of falls and of those requiring end-of-life care.

The exciting and innovative aspect to the fundamental aims of this project is that in addition to hopefully an early recognition and therefore improved delivery of emergency medical care, it is also anticipated that GPs would receive a more clinically detailed home visit request; something that is highly regarded when planning and performing such consultations. Such clinical information that would be derived from following these guidelines is then anticipated to be conveyed to the general practice in an SBAR (Situation, Background, Assessment and Recommendation) format, which is already widely available in most other healthcare settings.   

The need for more concise, up to date and user friendly pathways in this locality was identified and so the project was eventually commissioned by this CCG group. More in-depth discussions during the strategic planning stage of this project by senior clinicians (Elderly Care, Mental Health and Palliative Care Consultants and GPs) as well as Medway CCG Managers the followed, focusing primarily on two main aspects;

  • Firstly an evaluation of the effectiveness of current/existing regional pathways on this topic 
  • Secondly, the resources locally available and required in order to successfully implement such pathways in this locality  

Method

Dr-GashiThe project started by designing some draft pathways, which were an amalgamation of the combined clinical experience from the specialists mentioned above as well as the existing regional and current NICE guidelines on these topics.  In order to directly engage the end users of these pathways, the first draft (along with what is already available in the neighbouring CCGs) was then presented at an evening workshop to staff from the local Nursing and Residential care homes. In addition to familiarising themselves with the project, they were also able to discuss the overall design, structure and content of these pathways in more detail. Their invaluable suggestions for further improvements were then noted and alterations were then made accordingly.

An improved new version of the pathways was then presented to the local monthly GP meeting in a similar workshop format. The structure and clinical content of these pathways was discussed at considerable length and the constructive feedback derived from these discussions was then embedded in the subsequent version/s of these pathways. The new and improved version of these pathways was then presented to the local Nursing and Residential care homes once again for their evaluation. Feedback from this meeting is currently being processed and utilised so to eventually finalise these innovative and user friendly pathways. 
 
Conclusion

There are currently ongoing deliberations with regards to the level of clinical content embedded within these pathways that non-clinical staff members of Residential Care homes may not necessarily be able to follow due to the lack of training. In addition, they may not have the required resources in order to be able to obtain such information. New ways of overcoming these issues (either through training and/or logistical support) are being considered. Other than this, the project has been well received thus far and will hopefully be in the last stages of its development.

Once completed, the validity and effectiveness of these pathways will then be formally evaluated and in the event of the expected positive outcomes they should then be added to the local healthcare mobile phone app. It is then hoped that these new pathways will eventually be considered as standard practice in the community. Ultimately, it is anticipated that through these new guidelines a more effective community triage system is in place that not only benefits the local healthcare providers and its professionals but the patients are navigated through our healthcare system more safely and efficiently.

The project was well received by the GPs at the local GP Monthly meeting. They were very much in favour of it as it means that home visit requests from these places will hopefully now be more structured and the information provided will be in a way in which us Doctors can make use of in preparation for the visit and in managing the patient. Often GP home visit requests are a mere two lines of ''Please can you review Mrs Smith, She is unwell today''. This can be quite unhelpful, particularly for a new GP who has never come across Mrs Smith before.

It was also well received from the CCG staff as it means that Patients are triaged in a more structured and safe manner and should ultimately receive quicker emergency care if required. The Nursing and Residential care home staff were also in favour of this as it hopefully alleviates any anxiety on how to deal with an unwell patient by providing them with a structured, up to date and clinically supported method.

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