Triage and the Veterinary Technician Sponsored by Speciality

Triage and the Veterinary Technician Sponsored by Speciality Veterinary Pharmacy

Triage and the Veterinary Technician Tiffany Bartlett, LVT- SX/Neurology Nancy Valdez, LVT- Internal Medicine

Overview 1. What is Triage? 2. The Front Line: The Receptionist’s Role a. Phone Triage b. What to do and not to do c. Lobby Triage 3. Code Status 4. Triage Fees 5. The Technician’s Role a. Triage Preparation b. Tech Assignments c. Triage

I. Triage vs. Assessment What does it mean in Vet Med? Triage is the quick examination of all patients and classification of the patients according to the urgency in which their injuries must be addressed. ● 30 -60 seconds

I. Triage vs. Assessment What does it mean in Vet Med? Assessment is further evaluation and treatment according to patient priority. ● TPR KNOW the normal values! ● ● BP Weight Full history DVM PE

The 5 W’s WHO will triage the patient? WHAT will be triaged? WHEN should the triage performed? WHERE is the triage performed? WHY sort the patients into categories? HOW is a triage performed?

WHO will triage the patient? 1. Any available trained technician a. Initial Point of Contact (POC): Receptionist i. Train to recognize pale mm, dyspnea, altered mentation, etc. b. 2 nd POC: Technician i. Triage patient into appropriate category for further evaluation

WHAT will be triaged? 1. Every patient, every issue, every time! 2. Even if they seem “stable”. a. If the owner feels like it is an emergency, then treat it like one. 3. Yes, unfortunately even the bleeding toe nail deserves to be categorized!

WHEN should the triage be performed? ASAP 1. Within 2 minutes of initial POC. 2. Communicate time frame with co-workers

WHERE is the triage performed?

WHERE is the triage performed? A triage can take place anywhere. 1. In the car a. Bring a leash, muzzle and pen light 2. In the lobby a. Bring a pen light if the lighting in the lobby is poor. 3. In the exam room a. For the possibly contagious patients

WHY sort the patients into categories? ● To determine how quickly intervention is needed for each patient. ● Life-threatening problems should be treated without delay and the stable patients can wait to be treated. ● An easy way to apply a time frame for re-evaluation.

Triage Classification Critical- 1 st priority Within seconds Urgent- 2 nd priority Within minutes Stable- 3 rd priority Within hours Completely stable- 4 th priority. . . eventually

HOW is a triage performed? ● A primary survey of the patient using the ABC’s ● Should take less than 60 seconds to complete a nose to tail assessment and an additional 30 -60 seconds for a brief history. ● 3 areas of assessment include respiratory, cardiovascular and neurological ○ ○ ○ Observe Listen * Ask

II. The Front Line: The Receptionist’s Role ● NOT limited to receptionists ● First Impressions count ● Goals ○ ○ quickly and correctly identify the emergent patient Be attentive Be patient Be calm!

The Phone Triage: What to do? Be attentive to the owner’s concerns. ● Questions, Questions! ○ ○ ○ ○ Patient Signalment What is the current concern? Previous Medical History? Acute vs. Chronic? Changes with breathing, mentation, behavior, appetite, elimination? vomiting/diarrhea? MM color Any known trauma/toxin ingestion?

The Phone Triage: What to do? Be calm, compassionate and patient. 1. The client WILL hear if you are not calm and collected over the course of the conversation. 2. Show compassion and empathy for their situation. It may not be new to you but it is new to them. 3. Let the client feel that you are not rushing them while rushing them. 4. Confirm an ETA

The Phone Triage: What NOT to do! DO NOT give medical advice over the phone!! * 1. Giving medical advice over the phone can be detrimental to the patient and your clinic/client relationship. 2. Do not tell them NOT to come in. 3. Do not get stuck in a never ending conversation! a. If you are at all concerned, please feel free to come in to have “Fluffy” examined. b. I can hear your concern for “Fluffy”. You are more than welcome to bring him/her in to be evaluated by our doctor. *unless directed by a DVM

Lobby Triage 1. Find the right wording for your facility. ● More than likely stable ○ “I need an assessment for vomiting” ● Needs immediate care ○ 2. “ I need a triage STAT for unresponsive” Decide on the intended audience ○ All hospital page (preferred) ○ Treatment only page

Lobby Triage As the receptionist, your triage duties will include : 1. Money Discussions a. Triage Fee b. Estimates/Invoices 2. Code Status a. CPR b. DNR

Triage Fee 1. Know what is included. i. iii. iv. v. vi. Emergency exam Radiographs/FAST Scan Blood work IVC IVF Pain medications/emergency medications

Triage Fee 2. Know how to discuss it. ○ 3. “Fluffy” has been assessed and is deemed critical by the doctor. We will need to attempt to stabilize right away. The Triage fee of $______ allows us to start stabilizing immediately and I can take care of that for you. ” What if they decline the triage fee? ○ Place client into a room and alert the DVM ■ Discuss PE findings and recommendations for stabilization IF A TRIAGE FEE IS DECLINED A PATIENT IS DNR

Code Status 1. How to discuss this touchy topic? a. “Our staff needs to know how you would like us to respond should “Fluffy” go into cardiopulmonary arrest. ” b. “CPR would include chest compressions, assisted breathing and emergency medications. ” c. Should you decide on a DNR then we will not attempt to resuscitate. 2. Which animals need a code status? a. Ideally, every patient.

III. Technician’s Role Be prepared! Assign jobs for the day/shift Emergency/crash cart stocked Emergency procedure kits stocked Triage area ready Emergency forms accessible

Assignments Triage technician(s) Room technician(s) Recording technician CPR team(s)- CPR is beyond the scope of this CE *SLVS does have a CPR CE, please e-mail tanya. bouchard@slvetspecialists. com for more information

Emergency/Crash Cart

Emergency Procedure Kits

Triage Area

Triage In The Lobby- Know. Your. Normals

Triage in the Lobby 1) ABC + Neurological Status-Primary Survey (60 seconds) a) b) c) d) Airway Breathing Circulation Neurological Status If stable-reassess within 2 HOURS

What To Look At- Snapshot This is not full vitals Respiratory rate & effort-A&B MM- pink, pale, white, icteric, injected? -B&C CRT- <2 sec or >2 sec-C HR* and pulses (DP, femoral)-C Mentation- BAR, QAR, DEP, OBT, COMA-Neuro **adrenaline

Second Assessment- Full Vitals TPR + BP **know your normals Establish base-line Triage approved- place IVC, pull BW, Rads, etc. Fluid resuscitation>pain control Critical patient's- record vitals q 5 min

Example: Albert 3 y MN Pit Bull Dog attack -Owner found with multiple bite wounds ECC

Albert- Triage in the Lobby (Primary Assessment) Femoral pulses not palpable MM-pink/tacky CRT-<2 sec HR- bounding Mentation-Obtunded RR- increased effort, normal rate Large hemorrhaging wounds

Albert- Secondary Assessment (Triage in TX) Weight: 24. 2 kg Temperature: low Fo (normal=(98. 5 -103. 5) Heart Rate: 160 (normal dog=60 -160, normal cat=160 -240) Respiration: 28 (normal dog=10 -40, normal cat=16 -40) mm color: pink ; CRT <2 seconds Blood Pressure: too low to read (normal dog S: 90 -140 mm. Hg, normal cat S: 100 -160 mm. Hg)

Based on presentation. . . IVC placed Heat support ER drug sheet made **before we knew if triage had been accepted or code status

While Albert Was In TX. . . Receptionists were going over triage paperwork, payment, and CPR/DNR status Triage was approved HX was being obtained (by a secondary technician so that triage does not stop)

Triage Approved Fluid resuscitation- vitals recorded q 5 Fent CRI started when T>99 and BP >/= 90 mm. Hg Continued critical care monitoring & transfer to SX in AM

Common Pitfalls of Triage 1. Failure to recognize high-risk complaints. a. Cat is hiding, could be UO-ask the appropriate follow up Q’s. 2. Failure to assess vital signs. a. A patient can “look” stable but not be 3. Failure to reassess within 2 hours.

Triage Worksheet- Answers E. B. C. A. D.

Thank you for attending!- Questions?