Emergency Triage

Telephone Triage and Advice

Janet Marsden, Mark Newton, Jill Windle, Kevin Mackway-Jones

• Publisher: BMJ Books
• Year: 2015
• ISBN:
  9781118369425
• Edition: 1
• Topic: Medicine
• Subtopic: Emergency Medicine & Critical Care

Emergency Triage: Telephone Triage and Advice complements the highly successful Emergency Triage. The algorithms are rooted in the Manchester Triage System (MTS), which is used in hospitals around the world and which is acknowledged as an effective means of clinical prioritisation.

This telephone iteration of a triage system which prioritises millions of patients each year provides a robust, safe, evidence-based system for managing the clinical risk in patients who are at a distance from health care providers. The basic principles that drive the MTS remain, but this book addresses the specific difficulties of assessment by telephone. The possible triage outcomes are "face-to-face now", "face-to-face soon" and "face-to-face later" together with a self-care option. Information and advice is suggested at every level. The advice ranges from life-saving interventions, which can be carried out until health care arrives, to self-care instructions.

Emergency Triage: Telephone Triage and Advice provides all the necessary information that telephone triage staff must have to hand as well as including examples of questions to be asked. It will be a valuable resource for staff working in emergency departments, health centres and telephone triage organisations. Furthermore hospitals that are already using Emergency Triage will benefit from being linked with a telephone triage system that follows the same protocols. Updated to Version 1.7 in 2023.

CHAPTER 1
Introduction

Triage is a system of clinical risk management employed in Emergency Departments worldwide to manage patient flow safely when clinical need exceeds capacity. Systems are intended to ensure care is defined according to patient need and in a timely manner. Early Emergency Department triage was intuitive rather than methodological and was therefore neither reproducible between practitioners nor auditable.

The Manchester Triage Group was set up in November 1994 with the aim of establishing consensus amongst senior emergency physicians and emergency nurses about triage standards. It soon became apparent that the Group’s aims could be set out under five headings.

1. Development of common nomenclature
2. Development of common definitions
3. Development of robust triage methodology
4. Development of training package
5. Development of audit guide for triage

Nomenclature and definitions

A review of the triage nomenclature and definitions that were in use at the time revealed considerable differences. A representative sample of these is summarised in Table 1.1.

Despite this enormous variation, it was also apparent that there were a number of common themes running through the different triage systems; these are highlighted in Table 1.2.

Table 1.1

Hospital 1		Hospital 2		Hospital 3		Hospital 4
Red	0	A	0	Immediate	0	1	0
Amber	<15	B	<10	Urgent	5–10	2	<10
		C	<60	Semi‐urgent	30–60
Green	<120	D	<120
Blue	<240	E	—	Delay acceptable	—	3	—
		FGHI

Table 1.2

Priority	Maximum times (minutes)
1	0	0	0	0
2	<15	<10	5–10	<10
3		<60	30–60
4	120	<120
5	<240	—	—	—

Table 1.3

Number	Name	Colour	Maximum time (minutes)
1	Immediate	Red	0
2	Very urgent	Orange	10
3	Urgent	Yellow	60
4	Standard	Green	120
5	Non‐urgent	Blue	240

Once the common themes of triage had been highlighted, it became possible to quickly agree on a new common nomenclature and definition system. Each of the new categories was given a number, a colour and a name and was defined in terms of ideal maximum time to first contact with the treating clinician. At meetings between representatives of Emergency Nursing and Emergency Medicine nationally, this work informed the derivation of the United Kingdom triage scale as shown in Table 1.3.

As practice has developed over the past 20 years, five‐part triage scales have been established around the world. The target times themselves are locally set, being influenced by politics as much as medicine, particularly at lower priorities, but the concept of varying clinical priority remains current.

The development of Telephone Triage

After a period where all Emergency Departments in the Manchester area were using ‘Manchester Triage’ and using it on the telephone to triage callers to the ED (prior to NHS Direct), it became apparent that although all Emergency Department staff were using the same language of triage, the interface with paramedic colleagues still faced a language barrier. Key collaborators within the ambulance service recognised that applications of the Manchester Triage method would be extremely useful within the ambulance service and a further group of clinicians across acute care settings and the ambulance service was set up to explore this. Telephone Triage emerged as one of the products of this collaboration and had been used successfully for both secondary triage (since 2006) and latterly primary triage (2012) of those patients accessing care by telephoning ambulance services in a number of ambulance services across the United Ki...