The advent of the pandemic has rapidly accelerated the presence of and willingness to use additional online tools to facilitate medical practice. There are now multiple platforms and services that can be used to enhance your ability to triage emergency patients. Additionally, it is now more likely that your clients are used to using these tools regularly. Not only does this mean they are familiar with the technology, but they also have the ability to use it with minimal to no set-up at their end. Tele-triage technology also allows the addition of photos and video to your triaging assessment to help you make a more informed decision about whether the patient needs to be seen urgently.
What do I need to know about tele-triage?
What skills are necessary?
As with any triage situation, you need to remember that the average client does not have medical training or knowledge, so open-ended questions remain one of the most useful tools for you
While a welcome addition, tele-triage does not change the need for good communication skills, not only to assess the situation with the client accurately but to educate them about what care is needed and its urgency. These skills will help you to determine the patient’s immediate needs (such as if they need to take their pet in immediately or if they can wait until office hours), which will also help assure the client they are doing the very best thing for their pet. The ability to reassure a concerned client in the middle of the night that their pet can wait until morning will always result in a happier client.
As with any triage situation, you need to remember that the average client does not have medical training or knowledge, so open-ended questions remain one of the most useful tools for you. Asking a client, “What’s going on with Princess?” will generally receive a more descriptive answer than, “So I understand you called today because Princess has diarrhoea.” This first question breeds open communication, allowing the client to more fully describe the situation in their own words, whereas the second question generates a simple yes or no answer which leads to the need to ask further questions to get the information you need.
What are the advantages of tele-triage?
An advantage of the tele-triage process is that you can often have the signalment of the patient more immediately to hand, which will help you determine the most pertinent questions. For example, when you know straight from the start that your patient is a spayed female cat that is straining to urinate rather than a neutered male, it will help you move the emergency urinary obstruction further down the list. The addition of the ability to have either photos or videos can greatly enhance your assessment of said patient, as you won’t have to rely on the owner’s opinion of colour (for example, of mucous membranes or “red” diarrhoea) and can more objectively assess it for yourself.
It remains highly important to rule out the most life-threatening illnesses first. Significant symptoms to listen and question more about include retching or a bloated abdomen (especially in dogs), two or more seizures in a 24-hour period, irregular breathing, straining to urinate without producing urine and sustained trauma.
Photos and videos
Rather than trying to teach the client how to take an accurate respiratory rate, you can ask for the pet to be put on camera and assess it for yourself
With the ability to receive photos and videos from your clients, you may be able to immediately tell if there is respiratory distress or if the patient is unreasonably pale, or to differentiate between retching foam, vomiting and regurgitation. These observations are things that a traditional telephone-only triage has always struggled with. Another excellent example is not having to rely on the client to know what an appropriate colour is. Also, it is hard to describe the visuals of orthopnoea to the average layperson in such a way that allows for them to tell you accurately if their pet is in distress. Rather than trying to teach the client how to take an accurate respiratory rate, you can ask for the pet to be put on camera and assess it for yourself.
Videos and photos from a tele-triage session can also be included in the patient’s medical record and used as a reference the next time you see the patient, which may help guide future diagnostics. For example, if you already have a video of a pet’s seizure, it will likely help you decide whether you need to pursue a neurological or cardiac work-up first. The ability to directly provide a photo or video may also help calm a distraught client, which will help them communicate with you more effectively.
What choices need to be made when adopting tele-triage?
A choice your practice will need to make is where and how to spend your resources for triaging. Do you want to invest in a service that allows you to perform telemedicine, or would you prefer to use a service that does the tele-triage for you so your staff can focus on the patients and clients at your facility? The second option would reduce the amount of time your employees spend on the phone instead of treating patients, while the first option could help build your practice as people can see and experience the expertise of your employees first-hand.
The ability to accurately triage your patients not only helps their immediate needs but also helps your clients have greater confidence in you and your practice
Another consideration is whether you want to be able to video chat with clients in real-time or use the telephone for primary contact with email as a mechanism for the clients to send further photographic or video information. Or perhaps you want to invest in a service that allows your clients to send and receive text messages from your practice as a way to receive photos and videos in a timelier manner and use a technology that most clients already have in their pocket.
However you decide to spend your resources, remember that the ability to accurately triage your patients not only helps their immediate needs but also helps your clients have greater confidence in you and your practice. When clients feel they’ve made the best decision for their pet in what is often a very emotional time, the trust between you and your clients will grow. This will also help you know that you have provided the best possible decision for the care of the pet in the moment and may decrease the number of patients physically seen in the hospital, allowing you to focus on the pets that are truly critical. This has the potential to help reduce staff fatigue and burnout, making it easier to retain staff.