The triage dilemma: when to triage and when not to

Confused woman sat in front of laptop wondering if she should implement triage to her healthcare practice

What is triage?

Quite often digital triage could be confused with data collection points that allow patients to submit information about their condition. This information is then passed onto a healthcare professional to decide on the right care for them. However, digital triage goes beyond data collection. It uses algorithms and decision-support tools to choose the most suitable care pathway for the patient. 

Even though there are different types of triage, they all aim to determine whether you need to schedule an appointment, receive self-care information, be directed to another provider or have your information sent to a healthcare professional who would then decide what you need and prioritise your case. The majority of triage tools decide this by determining the answers of the following four questions: what, when, who and where. 

  • What conditions do you have? – Often, the type of the condition and how specific conditions are treated are the things that define who you see and when you see them.
  • When do you need to receive care? – The level of urgency would dictate when you need to see a healthcare professional but this does not determine who you see.  
  • Who you should see? – This question establishes whether you need to visit a mental health professional, dentist, GP, pharmacist or somebody else.
  • Where is this care provided? – Determining where you need to go helps establish if a patient is suitable for digital consultation, if they have any special requirements or if they need to physically attend. How convenient the place of care is, could also affect where the patient may choose to go. For example, with most mental health services, it is usually up to the patient to decide if they want to attend physically or virtually.

When you should triage

1. When demand exceeds the available resources

If you have a set number of appointments available, you would have to prioritise your patients and see the most urgent cases first. With the help of triage, the available appointments would go to people who really need them and self-care advice would be offered to the people who can manage their illness at home or with the help of over the counter medication. 

2. To reduce pressure for frontline staff 

Patients triaged online would have already entered their symptoms in the system and booked an appointment, meaning they would not need to be phoning your front line staff. This frees up time for your receptionists to do a light touch triage over the phone should someone call or focus on other duties that they need to complete. 

3. When there are a multitude of health options available to your patients 

Triage is great when patients have multiple options available to them, especially in a moment of stress when they are unsure who they need to see. Triage can really help you signpost people to the most relevant care for their health problem.

When you should not triage

1. When you use triage as a data collection point 

If the reason you are triaging patients is merely for data collection and you are not signposting people to other services, then you can ask very few but relevant questions and collect this information in a much simpler, shorter process rather than triaging. 

2. When you don’t signpost 

Certain healthcare businesses that offer appointments often discuss their patients’ symptoms during the actual appointment. For example, most dentists or private counsellors book people for a consultation and discuss their health issues during the visit. In this case, when you allow every patient to book an appointment and you are not signposting people to emergency services, you do not need to triage patients. What would be more convenient for both you and your patients, is a smart appointment booking system and not a virtual triage. Simply put, if you never say no to an appointment, you don’t need to triage.

3. When you don’t have a secure way of collecting and storing data

When you do not intend to use a proper medical triage tool to collect and store patient data, you should not triage patients. Every healthcare business needs to store patient data safely and securely. When handling medical data, in the UK, you should be ISO 27001 compliant to ensure you are handling sensitive information securely. You should also consider safeguarding training for the people who look at and deal with data and have procedures in place to “Delete Personal Data” in line with ICO guidelines. 

Putting the patient first

There is no right or wrong way to triage or a gold standard of how much information to ask when triaging patients. What is important is putting the patient at the centre of it. 

Most triage tools use a decision tree or rule-based logic and often ask between 30 and 50 questions. However, what you need to consider is: does the patient really need to go through this, especially when they are feeling unwell, and what can you do to make their life easier. The answer is to choose to prioritise either accuracy or shortness of triage. 

Accuracy and shortness of triage are really important due to the growing number of impatient patients. Prioritise accuracy when the wait times are long or when the consequences of getting the triage outcome wrong are high. Alternatively, put higher importance on shortness of triage when there is minimal wait time and the likelihood of getting the decision wrong is low. 

Remember, triage is really powerful but you should only use it if you need it.