Triage review Should they stay or should they

Triage review: Should they stay, or should they go? Dr Susanna Currie ST 4 Genitourinary Medicine Central Manchester University Hospitals NHS Foundation Trust

Background • BASHH Guidance: – 48 hour access for all – On the day review for emergencies • Manchester Centre for Sexual Health: – Triage forms since 2010

Aim • Review the diagnoses of patients who fill in triage forms • And in turn, determine whether triage is effective

Method • A retrospective review of all triage forms completed between 5/1/15 – 24/3/15 and the diagnoses of those patients

Results January – March 2015 ? 698 patients leave fill in triage forms 488 turned away 224 264 210 never returned accepted

Results - diagnoses PEPSE UTI Herpes PID/Epididymo-orchitis Contact of infection Gonorrhoea STI diagnosed elsewhere Non-specific GU infection Chlamydia HIV Primary syphilis Hepatitis B Candidiasis or BV Molluscum or Warts Late syphilis n= 7 4 37 26 22 19 12 37 33 2 2 2 64 65 2 % accepted 100 78 65 64 58 58 54 51 50 50 50 42 15 0 % initially turned away 0 0 22 35 36 42 42 46 49 50 50 50 58 85 100

Results - diagnoses PEPSE UTI Herpes PID/Epididymo-orchitis Contact of infection Gonorrhoea STI diagnosed elsewhere Non-specific GU infection Chlamydia HIV Primary syphilis Hepatitis B Candidiasis or BV Molluscum or Warts Late syphilis n= 7 4 37 26 22 19 12 37 33 2 2 2 64 65 2 % accepted 100 78 65 64 58 58 54 51 50 50 50 42 15 0 % initially turned away 0 0 22 35 36 42 42 46 49 50 50 50 58 85 100

Results - diagnoses PEPSE UTI Herpes PID/Epididymo-orchitis Contact of infection Gonorrhoea STI diagnosed elsewhere Non-specific GU infection Chlamydia HIV Primary syphilis Hepatitis B Candidiasis or BV Molluscum or Warts Late syphilis n= 7 4 37 26 22 19 12 37 33 2 2 2 64 65 2 % accepted 100 78 65 64 58 58 54 51 50 50 50 42 15 0 % initially turned away 0 0 22 35 36 42 42 46 49 50 50 50 58 85 100

Results - diagnoses PEPSE UTI Herpes PID/Epididymo-orchitis Contact of infection Gonorrhoea STI diagnosed elsewhere Non-specific GU infection Chlamydia HIV Primary syphilis Hepatitis B Candidiasis or BV Molluscum or Warts Late syphilis n= 7 4 37 26 22 19 12 37 33 2 2 2 64 65 2 % accepted 100 78 65 64 58 58 54 51 50 50 50 42 15 0 % initially turned away 0 0 22 35 36 42 42 46 49 50 50 50 58 85 100

Results - diagnoses PEPSE UTI Herpes PID/Epididymo-orchitis Contact of infection Gonorrhoea STI diagnosed elsewhere Non-specific GU infection Chlamydia HIV Primary syphilis Hepatitis B Candidiasis or BV Molluscum or Warts Late syphilis n= 7 4 37 26 22 19 12 37 33 2 2 2 64 65 2 % accepted 100 78 65 64 58 58 54 51 50 50 50 42 15 0 % initially turned away 0 0 22 35 36 42 42 46 49 50 50 50 58 85 100

Results - diagnoses PEPSE UTI Herpes PID/Epididymo-orchitis Contact of infection Gonorrhoea STI diagnosed elsewhere Non-specific GU infection Chlamydia HIV Primary syphilis Hepatitis B Candidiasis or BV Molluscum or Warts Late syphilis n= 7 4 37 26 22 19 12 37 33 2 2 2 64 65 2 % accepted 100 78 65 64 58 58 54 51 50 50 50 42 15 0 % initially turned away 0 0 22 35 36 42 42 46 49 50 50 50 58 85 100

Results - diagnoses PEPSE UTI Herpes PID/Epididymo-orchitis Contact of infection Gonorrhoea STI diagnosed elsewhere Non-specific GU infection Chlamydia HIV Primary syphilis Hepatitis B Candidiasis or BV Molluscum or Warts Late syphilis n= 7 4 37 26 22 19 12 37 33 2 2 2 64 65 2 % accepted 100 78 65 64 58 58 54 51 50 50 50 42 15 0 % initially turned away 0 0 22 35 36 42 42 46 49 50 50 50 58 85 100

Results - diagnoses PEPSE UTI Herpes PID/Epididymo-orchitis Contact of infection Gonorrhoea STI diagnosed elsewhere Non-specific GU infection Chlamydia HIV Primary syphilis Hepatitis B Candidiasis or BV Molluscum or Warts Late syphilis n= 7 4 37 26 22 19 12 37 33 2 2 2 64 65 2 % accepted 100 78 65 64 58 58 54 51 50 50 50 42 15 0 % initially turned away 0 0 22 35 36 42 42 46 49 50 50 50 58 85 100

ST Percentage accepted M Percentage turned away initially La te cu m s ili ph ts V B B s ar & iti lis IV H ph i w sy & as is di di lu s ol an C sy ep at H y im ar Pr ia yd am n tio re he fe c in hl C ci fic se w el ct oe a rh ta s hi ti SV TI U H on no on G ed os pe -s on N gn ia Id rc Ic ST -o no di dy pi /E PI D SE PE P Percentage accepted & rejected 100 90 80 70 60 50 40 30 20 10 0

ST Percentage accepted M Percentage turned away initially La te cu m s ili ph ts V B B s ar & iti lis IV H ph i w sy & as is di di lu s ol an C sy ep at H y im ar Pr ia yd am n tio re he fe c in hl C ci fic se w el ct oe a rh ta s hi ti SV TI U H on no on G ed os pe -s on N gn ia Id rc Ic ST -o no di dy pi /E PI D SE PE P Percentage accepted & rejected 100 90 80 70 60 50 40 30 20 10 0

Limitations January – March 2015 When clinic is full ? patients leave 698 fill in triage forms 488 turned away 224 264 210 never returned accepted

Conclusions • Triage is effective for some conditions – Acute needs such as PEPSE – Common, non-acute conditions such as warts and candidiasis • Triage is less effective for patients with chlamydia & gonorrhoea • BASHH concerns are justified

Possible strategies • Asymptomatic screen for all patients – Nearly 10% of those who returned had CT or GC – Saving clinic visits – Would this capture those who leave before triage? • Closer links between clinics in a region with central booking systems

References • Recommendations for core service provision in genitourinary medicine. British Association for Sexual Health & HIV, 2005. www. bashh. org