Intake & Triage
A Quality Improvement
Approach
Rosemary Thompson
Rob Jane
Loddon Mallee Regional Victoria
including Department of Human Services regional boundaries
Grampians
Hume
Gippsland
Metropolitan map
Barwon South Western
0 50 100 Department of Human Services regional boundaries
Kilometres based on Local Government Areas
Australian Standard Geographical Classification 1 July 2004
Southern Grampians
Glenelg
Moyne Corangamite
Greater Geelong
Queenscliffe
Surf Coast
Warrnambool
Colac Otway
Barwon-South Western Region
including Local Government Areas
Boundaries based on Local Government Areas
Australian Standard Geographical Classification 1 July 2004
Hospitals current at 1 July 2006
Barwon Regional Aged Care
Assessment Service
• Barwon sub region
• 70+ population of 30,374
• EFT of approximately 14
• 3914 referrals in 2007 (approx 75 per
week)
• 3154 completed assessments in 2007
Intake Service
• Prioritisation commenced with new
MDS in 2003
• 2004 Employment of dedicated Intake
Worker
• Clinicians assisting
• “Read Only” access to data base
• Increasing administrative workloads
2006 Review
• Basic model robust
• Clinical staff input changes required
• Role definitions unclear
• Processing of referrals cumbersome &
inconsistent
• Terminology change to “Triage” to
reflect client service model
QI Approaches
• Surveys
• SWOT analysis
• Data analysis
• Task analysis
• OHS analysis
• Outside consultant
• Reference to Guidelines & Best Practice
• Consultation with other teams
BRACAS
Triage Process
BRACAS has always embraced opportunities to
improve performance in order to provide better
outcomes for clients.
BRACAS Triage Flow Chart 2008
Process
Incoming phone
inquiries,referrals,faxes
1. Client Registration
Intake Triage/Admin Staff
Intake Triage: Referrals from GP‟s,
2. Initial Screening Clients/Carers, Service Providers. Priority
Residential Care Facilities,Hospitals
1
2
3. Clinical Decision Making: Triage Clinician:
Screening, Priority &
Allocation 3
ACAS Manager/Clinical Coordinator: North Blue West
4. Monitoring Medical
& Distribution Monitoring and distribution Team Team Team
Medical Assessment Staff Non Medical Assessment Staff
Triage Today
• Triage Worker - screening, information,
processing, some prioritisation, consent
• Triage Clinician – clinical advice,
prioritisation, allocation, consent
• Administration staff – processing faxed
& mailed referrals
Skills
• Triage Worker - not an assessment
clinician
• Excellent communication skills
• Able to deal with clients, carers &
service providers
• Good computer skills
• Ability to work with a wide variety of
other staff
Allocation
• Geographic area
• Medical involvement
– Medical complexity
– Assessments hospital settings without geriatrician
focus
– Evidence of undiagnosed dementia
– Possible competency or Guardianship issues
– Potential High care outcome
– Frequent unexplained falls
Prioritisation
• Care needs & services discussed with
the client/carer
• Letter for all Priority 3 clients to
client/carer, GP & referring service
provider
• Urgent referrals allocated to a clinician
immediately
Information Technology
• Triage Worker enters referrals onto data
base
• Triage Clinicians enter Priority &
Allocation
• Registration information used to
generate Triage Tool
• Registration Information used to
generate template letters
Staff Survey Outcomes
• Improved team based approach with
more shared decision making
• Roster changes helped eliminate
entrenched work practices
• Decrease in documentation
• Decreased stress levels
• Clearer roles & processes
Standard 2. PRE-ASSESSMENT AND INTAKE
All requests for assessment identify the appropriateness of an Aged Care Assessment
Service assessment in the best interests of the client.
Criteria
• If a referral to an Aged Care .Assessment Service is clearly inappropriate
information is provided on alternative services. Triage clarifies request
and redirects to a more appropriate service
• The likely needs of a client are identified at in-take. Triage examines
referral information and confirms with follow up call by clinician to
client/carer
• Adequate information is obtained at in-take to allow prioritization and client
matching to occur. If Triage identifies inadequate or unclear referral
information then follow up contact is made with the referral source.
• The intake worker - a health professional- allocates a case worker who acts
as the point of contact until a satisfactory outcome has been achieved.
Triage allocates to staff in a geographical area or directly to specific
staff depending upon urgency.
„ACAS Best Practice Manual‟ 2nd Edit
2002 (ACAS Liaison Group, Vic)
Standard 2. PRE-ASSESSMENT AND INTAKE
Criteria continued
•Assessors are matched with clients according to their needs and the
circumstances of the referral. Triage will identify specific skills or
qualifications required & allocate accordingly
•
•A priority for assessment is established based on apparent client need.
Triage will stamp A priority 1, 2 or 3 as well as type of personnel
required such as medical or Staff only on file.
•The client/carer is promptly contacted following acceptance of referral.
Triage clinician will make follow up contact with client/carer soon
after receiving referral to clarify consent and issues.
•A process exists to address high priority referrals. Triage consults
Manager and allocates urgent client assessments to an
Assessment Clinician for urgent assessment