One of the hardest skills your staff need to learn is the art of triage.

“Triage is the preliminary assessment of patients or casualties in order to determine the urgency of their need for treatment...” according to the Oxford Dictionary.

But triage is not just answering the phone and asking the non-medical person that is calling a series of questions with the help of a cheat sheet the provider created that details when a patient needs to be seen. There’s also the added pressure of then trying to work that patient into a schedule that is already packed (see “A challenging scenario,” p. 15.)

To help both reduce the pressure on staff and optimize the triage process, this article discusses:

• The technician’s role in triage.
• Tips for teaching the art of triaging patients.
• Several common triage scenarios to illustrate these tips.

The technician’s role

As technicians, our role during triage is to gather information from the patient regarding a concern they are having about their eyes. We do this by asking questions based on what the patient tells us.

It is not our role to diagnose or “advise” the patient on what they potentially have, as we have no idea. Our role is to guide them through their concerns and to get them to come to the office to be evaluated for the issues that are bothering them.

Before taking patient phone calls, clinical staff need to have a working knowledge of the anatomy of the eye, as well as basic knowledge of some of the problems that occur in each area, such as retinal detachment, subconjunctival hemorrhage, and blepharitis. This includes an understanding of the urgency of the issue, and once the patient arrives in the office, what needs to be done to prepare the patient for an exam with the provider.

Tips for answering the call

When teaching staff, consider these tips, which can improve the triage process:

1. When taking the call, stop what you are doing and listen to what the patient says. This is not a time to multi-task.
2. Understand that in most cases, patients are calling for one of two reasons, both of which can influence the information they share:
   • Patients are scared and want to tell you about their perception of the problem so they can be seen.
   • Patients want to call so you will tell them they are OK and don’t need to come in. This is the FYI call and can be “dangerous” to both of you as they will hold back information to stay out of the office!

Asking the questions, such as those in the “Examples of triage in action” section (p. 16), can help you to better understand the patient’s issue(s), regardless of their willingness/unwillingness to come into the office.

3. Document the following information:
   • The patient’s name and date of birth.
   • Time and date of the call.
   • Your name.
   • What the patient says is the problem and the duration of the problem.
4. When you determine how to proceed with this patient:
   • Document your recommendation.
   • Document the day and appointment time you give the patient.
   • Document their response. If they say “no” to your recommendation, include the reason they give for refusing the appointment.

• If the patient refused a triage-appropriate appointment, document that you advised the provider that the patient said “no.” If the patient accepted an appointment for a later date, document the date/time of the new appointment.

Keep in mind that these tips apply to anyone in the office (or phone center) who takes the patient phone call, gathers information regarding the patient’s concern, and then makes the assessment/decision that the patient needs to come in (or not) and determines the time frame for that appointment.

Examples of triage in action

Here are some examples of the details involved in triage calls:

Patient states: Flashes and or floaters (these don’t have to occur together).

• Area: retina or brain.
• Patient will need: pupil check and a dilated exam.
• Possible diseases or issues: diabetes, macular degeneration, vitreous, trauma, past retinal tear, hole, or surgery.
• Ask:
  1. What color are the floaters? (Black may indicate a red blood cell stuck in the vitreous potentially due to a hole/tear…colors may indicate brain issue.)
  2. When they say they are seeing “things,” ask what they are seeing. We assume they are seeing floaters, cobwebs, or curtains, but they may really be seeing faces or colored confetti, indicating a brain issue versus an eye issue. You need to get the doctor involved in these situations.

Patient states: Double vision.

• Area: Multiple (brain, eye muscles).
• Patient will need: EOM check, pupil check, potential dilation after checking with provider.
• Possible diseases or issues: diabetes, strabismus, trauma (check chart to see if patient has: multiple sclerosis, brain tumor/aneurysm/stroke).
• Ask: Do you have diabetes? (This is the first question I always ask.)
• If yes:
  1. Look in the mirror and tell me if your eyelid is drooping more than usual.
  2. What is your recent blood sugar level, and when was it last checked? (We are trying to elicit answers that they may be having a diabetic III nerve issue.)
• If no:
  1. Do you have any pain when you move your eyes or pain at your temples or the side of your head? (We are trying to elicit if the patient has temporal arteritis symptoms.)
  2. Do you have a lid droop or mouth droop on the same side of your face? (We are trying to elicit if the patient has stroke symptoms).

Patient states: Red eye. (I have found that red-eye complaints are among the hardest to triage because the red eye can be literally anything, so the best thing to do is bring these patients in to be seen.)

• Area: cornea, conjunctiva, lids.
• Possible diseases or issues: allergies, bacterial or viral conjunctivitis, chemical conjunctivitis, contact lens overwear, adenovirus, subconjunctival hemorrhage and/or multiple other issues.
• Patient will need: vision check, potential cultures.
• Ask:
  1. How long has (have) your eye(s) been red? Is it the white of the eye that is red? Was it like that when you went to bed?
  2. Did one eye get red and then the other? Is one eye worse? Do you any have discharge or crusting?
  3. Does anyone else you know have red eyes?
  4. Have you been in a hot tub, pool, or lake recently?
  5. Do you wear contact lenses? Are you still wearing them?
  6. Do you have seasonal allergies? Do your eyes itch?

Points to remember

A major point to remember: If the patient is concerned enough to call us, we should be equally concerned with what they are telling us.

While patients are non-medical and may censor their issues, we need to listen and use the skills we have, to make sure they are brought to the office to be evaluated.

The best rule of thumb with triage is the following: You have no idea what patients have until you see them, no matter how cut and dried it seems.

Finally, when in doubt, check it out! OP

Dianna Graves is an independent Continuing Education instructor teaching at both national/regional conferences as well as in-office consultation. Over the last 30+ years, she has served as a clinical services manager, clinical services supervisor, and clinical director. She can be reached at: diannagraves1017@gmail.com.