Implementing Triage

With many general practices are staying open later and accepting more emergency cases, Megan Brashear, CVT, VTS(ECC), discusses how implementing a simple triage protocol in your hospital can better organize and manage these emergencies.

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Triage is the act of organizing patients into levels of importance. The worst patients should be seen first, the more stable patients can ‘wait their turn’. By using information given to you by the owner and by using your knowledge and observation skills you as a technician can quickly triage a lobby full of patients and organize your DVM.

Triage list on whiteboard in ER

Technicians and front desk staff need to carry the responsibility of triage. Many times it starts over the phone as a client calls with medical questions. The first step is to never discount a client’s concerns. Even though you’re pretty sure that the limping dog is probably limping because the owner took it for a 6 mile hike the day before, and you’re already double booked, and some rest will cure almost everything, you never know what’s really going on (oh, the dog has also been vomiting blood for 3 days and the ‘limping’ is really collapsing?) until you ask some questions. Phone triage should consist of asking a few important questions:

  • How is your dog breathing?
  • How is your dog’s attitude? Is he still interacting with you?
  • Is your dog eating and drinking?

If there are vomiting/diarrhea complaints you need to ask about duration of symptoms and character of the vomit and diarrhea. I’ll never look at pudding the same… By asking some quick questions you can get a good idea of whether that dog or cat can wait for an appointment, come in soon, or go directly to an emergency hospital. If the front desk staff is not trained to answer those types of questions the phone triage should be handled by a technician.

Sometimes you don’t get the opportunity to ask questions on the phone and the emergency just shows up in your lobby. The DVM is rarely free to jump right in so again, the technician needs to be able to assess the animal and determine if the DVM needs to get involved right away or if the pet can wait a few minutes. Lobby triage starts before the technician can even talk to the owner or lay hands on the pet. It starts with simple observation.

  • Look at the patient’s attitude. This will often change as soon as you greet a dog or cat so pay attention to how they are reacting to their surroundings, to their owner, etc. Is the tail wagging? Are they lying in a lump on the floor? Is the cat appropriately freaked out about being in a vet hospital?
  • Look at the patient’s respiratory rate and effort. This will also change as the animal is approached by a technician. Remember that an animal can have a normal respiratory rate but still need significant effort in order to move air. Look at both together. Any patient with any sort of respiratory distress needs attention immediately.

After you have observed the patient it is time to grab some vital signs. The goal of triage is to be quick and efficient; this is not a complete physical exam. After a lobby triage I want to know a heart rate, pulse quality, and mucus membrane color/CRT. While I am getting these vital signs I am also talking to the owner getting a presenting complaint and maybe some more information about that diarrhea. If the pulses are poor, the heart rate is really high or really low, or the gums are white it’s time to get the DVM involved, and quickly! Your triage is successful when the right animal starts getting the right treatment.

It is also important to communicate with the owner about the triage process. It adds value to your skills as a technician if you explain that you are checking the dog’s heart rate; that you are feeling the cat’s abdomen to make sure he doesn’t have a large blocked bladder; that you are checking the dog’s gum color so you know how well he is breathing. This helps the owner feel better that a technician has evaluated their pet and knows what to do next.

If during your triage you discover something that needs immediate attention it is important to communicate this to the owner before ‘stealing’ their pet back to the treatment area. Let the owner know why you’re worried, what needs to be done, and when someone will come update them.

Before you start seeing your appointments for the day, assign some triage responsibilities. Identify the technician who can quickly assess at the walk-in patients. Assign the doctor who will be responsible for seeing these cases. Have a system to keep track of procedures and drugs administered to an emergent patient, as these often happen quickly and the small things are easy to forget. Set up a small area of your treatment area to accept emergencies and keep it stocked with the basics. A small storage bin with an IV fluid set-up, a few IV catheters, syringes, and a way to administer oxygen is all you need to get started.

Emergencies can be stressful, especially when you have multiple emergencies at the same time. By implementing a triage process and making sure everyone understands who is doing what and when you can streamline the process and make sure clients and patients are well taken care of.

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