Veterinary Tele-Triage: the value of Availability in Times of Need

Human resource allocation in a veterinary hospital is no piece of cake. So, when extra, out-of-hours clients arrive with demands and expectations, it is easy for the already scarce triage staff to feel overwhelmed. Diverting veterinarians from their primary tasks or downtime to perform extra tasks can result in a breeding ground for inadequate patient care and veterinary workers’ burnout. Worse still, many of the patients occupying space in the waiting lines are non-critical and could afford to wait without the risk of extreme clinical outcomes. Tele-triage can avert many of these problems.

Veterinary nurse teams can help owners to attend to their pet themselves. But this requires clear instructions and solid communication capabilities from the veterinary hospital. Thus, a well-functioning tele-triage system is crucial in determining the priority of patients, separating those who require immediate attention from those who can wait safely.

WHAT IS TRIAGE?

Triage is the evaluation of patients based on their physical parameters. Patients are subsequently allocated to the appropriate care area according to the acuity and severity of their conditions. This is a critical step as it can identify life-threatening signs early and determine what resources the animal needs.

There are typically three stages in the triage process:

1. Tele-triage or pre-triage
2. Triage on Arrival
3. Post Triage

In this article, we are going to be discussing in detail the assessment measures, information collection and information provision concerning the first stage – Tele-triage – and how effective implementation can lower the caseload of veterinarians.

TRIAGE ASSESSMENT

There are different triage scales and scoring systems, from Animal Trauma Triage to the Manchester Triage System (MTS).

The Animal Trauma Triage (ATT)

A trauma specific illness severity score that objectively measures the seriousness of a patient’s injury through quantification. The numeric values (ranging from 0 to 3) indicate the level of severity, the highest value signifying the lowest likelihood of survival.

The Manchester Triage System (MTS)

A globally utilized clinical resource by healthcare professionals to manage patient flow during times of high demand and limited capacity. The MTS is reductive in that it works backwards from the premise that the patient is in a life-threatening condition. This way, no serious potential conclusions are missed. The MTS does require experienced personnel who have completed approved training from a registered MTS instructor.

The Veterinary Triage List

Developed by Ruys et al (2012) using the MTS as a basis. The triage system was categorized based on different bodily systems such as circulatory, gastrointestinal, respiratory, urogenital, neurological, obstetrical, and generalized, with varying levels of urgency dictating the required wait time.

The Simple Triage and Rapid Treatment (START) technique

Used by first responders during mass casualty incidents. START was designed for triage when faced with a high-density of incoming patients. The paramedics/nurses can segregate patients based on three primary observations: Respiration, Perfusion, and Mental Status (RPM). Included are the patient’s pulse, respiratory rate, capillary refill time, presence of bleeding, and the patient’s ability to follow commands. Victims are classified into 4 categories accordingly: Green (minimal); Yellow (delayed); Red (immediate); Black (dead).

TELE-TRIAGE

Let us turn to the procedures and precautions involved in Tele-triage:

Process

This primary form of triage is done over phone or chat, supplemented by images and video, where necessary. In such dilemmas it is understandable for the pet owner to be flustered so it is paramount that the nurse in question be level-headed and trained in tele-triage methodologies. The nurse should maintain a calm, polite, and sympathetic demeanor as they log and record the call. This must be done to protect the nurse and the clinic as the instructions or counsel given on call could have legal ramifications. First, they must ascertain the owner details and pet’s symptoms, and then provide directions for how to reach the trauma center and handle the pet appropriately, according to their condition. This includes warning the owner of potential aggression, which may require the animal to be muzzled. Based on this, an estimated time of arrival should be generated and submitted.

Tele-triage Questions to help determine whether the pet needs urgent treatment

• Recent incidents of trauma? (Patients who have suffered recent trauma must be seen without delay)
• Is the breathing too labored or shallow – what color is the mucous membrane? (bluish color in the skin, lips, and nail beds must be addressed immediately)
• Any noticeable swelling or discharge?
• Any recent changes in weight or body condition score?
• Development of symptoms – slow progression or sudden decline? (Sudden decline signifies a more pressing issue and demands prompt attention)
• Have prescribed medications been taken? The owner should be advised to bring the medication.
• Has there been any known or suspected exposure to toxins? (In case of toxin ingestion, the patient must receive immediate attention)

WHY IMPLEMENT TELE-TRIAGE?

The benefit of the adopting appropriate tele-triaging is the structure and stability it creates in the emergency department.

It also means you can offer specific, professional advice and aid to patients, which builds your client’s confidence in your ability to serve.

With lower over-crowding, fewer vet techs, nurses, and surgeons would be required to remain on call. Studies have suggested that on-call shifts have a negative impact on veterinarian job satisfaction, well-being and personal relationships [1], especially among female associates. For this reason, veterinary hospitals could benefit from exploring alternative options to traditional on-call shifts.

TELE-TRIAGE SOFTWARE

For small veterinary clinics, this may mean making a choice to invest resources into building infrastructure around tele-triage. But in order to truly reap the benefits of tele-triage as more than just ancillary support, the right software must be adopted. Since animals are unable to communicate their experiences verbally, veterinarians often rely on visual, auditory, olfactory, and tactile cues. These can include the visible breathing pattern, color of mucous membranes, alertness and response to stimuli, capillary refill, and heart rate, among others.

There are three major body systems that must be assessed, namely the neurological, respiratory, and circulatory systems. On the basis of these evaluations, the triage staff can determine whether immediate diagnostic and therapeutic intervention is needed. Thorough triage assessment can ensure the appropriate level of care is provided for the animal. Usually, tele-triage is used as a supplement to in-person triage. But during times of overcrowding or high density.

Neurological assessments

These involve determining mentation i.e., whether the animal is stuporous / obtunded / hyper / comatose. Patients having seizures should be admitted immediately for monitoring and diagnoses. Therefore, voice and video calls should certainly be considered. A tele-triage service would be crippled without the ability to send and receive messages, photos, and documents such as EMRs and lab reports.

Respiratory assessments

These include checking the airways for obstructions and trauma, checking the respiration rate and effort. Oxygen therapy should be commenced in the case of respiratory compromise  or anesthesia and intubation in the case of obstructions. 

Cardiovascular assessments

These include evaluation of pulse rate, peripheral pulse quality, mucous membrane (MM) color, capillary refill time (CRT) and auscultation. Some wearable sensors can measure heart rate, the regularity of pulses, blood pressure, galvanic skin responses, and even perform electrocardiograms (ECGs). Hence, having an app that is compatible with animal monitoring devices would be highly valuable. Having access to such data can really help a trained nurse determine whether the pet is in a critical state. When you are available for your client in a time of distress with accurate and reliable information and assurances, it builds further trust in your service.

A pilot study comparing the performance of real-time remote telescreening and in-person screening showed that properly implemented tele-screening could achieve the same level of efficiency as in-person screening [2].

Implement tele-triage to amplify the efficiency of your clinic with our V-Clinic App, to make yourself and your ER team available to your clients anytime, anywhere. Fast-track your clinic’s performance with an app that gives you the ability to reach your customers regardless of distance while lowering the workload on your veterinary teams. Email us now at sales@celeritasdigital.com or info@celeritasdigital.com to learn more.

REFEREINCES

[1] Kogan L, Schoenfeld-Tacher R, Carney P, Hellyer P, Rishniw M. On-Call Duties: The Perceived Impact on Veterinarians’ Job Satisfaction, Well-Being and Personal Relationships. Front Vet Sci. 2021;8:740852. Published 2021 Oct 27.

[2] Rademacher NJ, Cole G, Psoter KJ, et al. Use of Telemedicine to Screen Patients in the Emergency Department: Matched Cohort Study Evaluating Efficiency and Patient Safety of Telemedicine. JMIR Med Inform. 2019;7(2):e11233. Published 2019