Intelligent Triage: The first step to improving outpatient efficiency

ABSTRACT

Introduction: The COVID-19 pandemic placed a strained NHS under further pressure, resulting in a significant backlog of work. Fundamental change is needed to improve efficiency and allow service re-establishment with a capability to deal with this backlog. Outpatient service structure will be pivotal to the recovery. Within this, intelligent triage plays a key role. Our department has 5 triaging consultants for benign disease GP referrals, interdepartmental referrals, and electronic consultations with 4 departmental Programmed Activities weekly. Patients and Methods: Data from the NHS e-referral system (e-RS) for the 12 months commencing December 2020 was accessed. Data from our E-consultation services was obtained for the same period. Data comprised total referrals, referrals accepted, and referrals managed with advice and guidance without consultation (AAG). E-consultation services were analysed for total volume, and the resulting outpatient consultations. AAG was streamlined using a library of standard guidance for common conditions. Results: From 3380 e-RS referrals, 23.7% were managed with AAG. Some inter-consultant triage variability was observed but appeared unrelated to individual consultant years of experience. Similarly, with E-consultation there was some variability between clinicians in conversion rates to outpatient consultations. Conclusions: Using senior clinicians in intelligent triage ensures appropriate use of outpatient consultations, with 23.7% of e-RS referrals managed with AAG. Whilst argument may be made for administrative staff fulfilling the triage role, we feel algorithmic triaging is suboptimal for patient safety. Appropriate AAG, red flag identification, appropriate timescales for outpatient review, and accurate direction to subspecialty clinics are all enhanced by consultant involvement.