With the increasing concern about COVID-19, what should practices be doing to protect themselves against coronavirus? Telephone triage has been suggested as one possible way to minimise potential contact with COVID-19, but will it really work?
For practices that don’t currently operate a telephone-triage system, one thing to bear in mind is the level of confidence of staff who need to triage. If you have staff who find it difficult to make quick decisions under pressure, then telephone triage is going to be more difficult for them than for others.
If you don’t currently operate a telephone-triage system, then moving to a full-blown triage system immediately might be unworkable, even without the added pressures of COVID-19. In which case, what are your options?
You might want to consider asking signposting questions, so that reception staff can quickly establish whether someone might be a risk in the practice. This won’t just involve asking about current symptoms of respiratory issues or fever, but also whether they’ve travelled overseas in the last 14 days or whether they’ve had close contact with someone who has. Obviously, as there are some cases of in-country transmission in the UK, having travelled overseas isn’t the definitive risk factor, but certainly, at this stage it’s a reasonable line to draw if the patient is asymptomatic.
The role of the receptionist
Do your reception staff currently pre-screen all appointments by asking what the appointment is for? If not, now is probably the time to start. Some practices have historically been reluctant to ask too much as patients find it intrusive, but not all patients will give a straight answer if you only ask them if they’re experiencing symptoms. You might want to consider sending SMS messages to patients and adding messages to your Facebook page/Twitter feed and telephone messages so that patients are aware in advance that they’ll be asked more questions than usual to establish whether an in-surgery appointment is appropriate.
You might also want to consider whether check-in screens or going to the reception desk is the best way to manage patient arrivals. Although directing patients to the check-in screen may protect staff to a greater degree, what about sanitising the check-in screen? Could you ask patients to write their queries on a piece of paper and drop them in the post box rather than asking reception staff to deal with them there and then? This has the added benefit that the patient will spend less time in the surgery and therefore will be less likely to contract an illness from others while waiting.
We have a Pandemic Management Policy [PLUS] and a Pandemic Staff Management Policy [PLUS].These will need to be adapted for use in your individual practice, but if you’re currently sinking under the volume of things you need to think about, this will provide a good starting point and may help you to delegate some of the actions, thereby freeing up time to manage additional issues that crop up. You might also find that having one shared document which you can point staff to will reduce the number of queries you receive, leaving more time to work proactively rather than reactively.
One of our members started a discussion about things to think about here. Pooling our collective wisdom is probably one of the most time-efficient ways to manage a problem.
Additionally, NHSE have added a page specifically for COVID-19 which should give links to the most up-to-date information they can provide. Each day the government’s travel advice is updated and this will help to inform the questions you should be asking patients before they come into surgery. You may find that some patients answer the questions dishonestly in order to secure a face-to-face appointment; we’d suggest large notices on the doors, in reception and the waiting rooms clearly explaining the consequences of patients ignoring advice.
In short, this too, like all things, will eventually pass, although it looks like we are in for a long haul before it does. Let’s hope that the steps we take now, which may seem trying and difficult to manage, prevent the situation from worsening further down the line. In the meantime, where we can help and support with resources, we’ll continue to do so.
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