Hospital and Telephone Triage
Course Content
- Course Introduction
- What is Triage?
- Triage in the Medical Setting
- ABCDE and triage
- Active listening
- Analgesia in triage
- Assessing pain
- Documentation and triage
- Establishing patient presentations
- Establishing patient history
- Existing medications
- Managing patient expectations
- Mental health and telephone triage
- NEWS2 and triage
- Computer-based telephone triage
- Triage categories
- Professional considerations
- Ten Second Triage
- Clinical Observations
- Triage Example Scenarios
- Heart Palpitations
- Debrief - Heart palpitations
- Chest pain
- Debrief - Chest pain
- Headache
- Debrief - Headache
- Allergy
- Debrief - Allergies
- Anaphylaxis
- Debrief - Anaphylaxis
- Meningitis
- Debrief - Meningitis
- Vaginal bleeding
- Debrief - Vaginal bleeding
- Ectopic pregnancy
- Debrief - Ectopic pregnancy
- Mental health - Potential suicide
- Debrief - Mental health - Potential suicide
- Mental health - Depression
- Debrief - Mental health - Depression
- Abdominal pain
- Debrief - Abdominal pain
- Testicular pain
- Debrief - Testicular pain
- Urine retention
- Debrief - Urine retention
- Minor arm injury
- Debrief - Minor arm injury
- Lower back pain - Difficult patient
- Debrief - Lower back pain - Difficult patient
- Falls vs collapse
- Debrief - Falls vs collapse
- Head injury
- Debrief - Head injury
- Dental problem
- Debrief - Dental problem
- Eye injury
- Debrief - Eye injury
- Poisoning
- Debrief - Poisoning
- Circumference burn
- Debrief - Circumference burn
- Unknown condition - Possible stroke
- Debrief - Unknown condition - Possible stroke
- Diarrhoea and Vomiting
- Debrief - Diarrhoea and Vomiting
- Rectal bleeding
- Debrief - Rectal bleeding
- Ear, nose and throat
- Debrief - Ear, nose and throat
- Telephone Triage
- Course Summary
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Scenario 1 - Tonsillitis
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Hello? Is that Mr. Smith? Hello? Hello? Is that Mr. Smith? Yeah. Mr. Smith, my name is Sean I am one of the urgent care practitioners from the doctors out of hours service. I am ringing back about your call today. Oh hello. Hello there, Mr. Smith. Before we go any further can you just confirm your full name and date of birth, so I have got the right notes in front of me, please. My name is Mark Smith. Yeah. Date of birth, 15th of May, 1960. So I have got your details in front of me, Mr. Smith. So I understand you have rung the service today and I can see from the notes here they are on, you have got a problem with your throat, is that right? Yeah, I have got a really sore throat. It hurts when I swallow. Well, how long has it been like this for... Sorry? What day is it today? It is Wednesday today. Three days, three days, my dose, yeah. Three days. Okay, that is fine. So you have had this for three days now. Any other symptoms at all with this? I do not feel very well. In what way? Sorry. I just feel my joints ache. Aching joints. Okay. Any pain at all, anywhere? Just in, me throat. It hurts to swallow, I can't... I can drink a little bit, but I cannot eat anything. Any drooling at all? Where you are not able to swallow or speak? No. Okay, that is fine. You have been taking anything for the pain? Just Paracetamol. And has that been helping at all? Little bit takes the edge off it, but it hurts when I swallow. Okay, no worries. Any nausea or vomiting at all? No. If you press under your jawline where your jaw goes toward your neck, have you got any underneath there at all? Yeah. So you have got some pain under there. Yes, really, it is swollen. Alright. Okay. On the one side or both? Both sides. Okay then, so you might have some enlarged glands there in your neck as well. Are you able to look into a mirror for me? Now? Yeah, what I need you to do is go and look in the mirror, open your mouth wide, look in the mirror and see if you can see any white spots on your tonsils. Hang on. Thank you. Oh yeah. Okay. Yeah, there is like two like bubble things and they have got white spots on them. Okay, have you got the cough at all? No. No cough? No. Okay. What medical problems do you suffer from, Mr. Smith? What do you mean? Any other medical history that I need to be aware of? No. Do you suffer from anything? No. Nothing at all? Do you take any medications at all? For anything? Just Paracetamol. Okay. And that is just what you buy over the counter? Yeah. Okay, super. Any allergies at all to anything? I have got hay fever. Oh okay, you do not take any medications for your allergies at the moment? No. Okay, who do you live with at your home address? I live on my own. And are you normally mobile able to get around? Oh yeah. Do you have any support at all at home? What? What do you mean? Anybody come in to help you with day-to-day tasks? No, no, no. Okay. Any family at all? Local? No, no, I was an only child, I was. Okay. Alright, okay, so from what we are discussing at the moment, Mr. Smith and you have told me that you have looked in the mirror, and you have got these white spots on your tonsils and the absence of a cough and the pain when you are swallowing and that sort of swelling in your throat under your jawline, I would suggest that possibly you have got acute tonsillitis. Have you ever had tonsillitis before? I had that when I was a kid, a couple of times. Right, okay. Based on the observations that we are discussing at the moment, I think it would be appropriate to treat you with a course of antibiotics. You say you have got no allergies at all? No, no, there is none. Okay. Nothing at all? Only hay fever. Just hay fever. But no medications that you cannot take? No. Okay, so I am going to give you a course of an antibiotic, which is a penicillin-based antibiotics... I have had that before. Oh, super. And I am going to give you this for 10 days. Okay? Okay. I am going to support sort this prescription out now. Which pharmacy do you normally use? It is Boots in the square. Okay. Okay. And so I will get this prescription sent across to there. It will be ready within the next hour for collection. What I would say to you, it is very important that you take the full course for the 10 days as directed on the prescription, you need to take this medication up to an hour prior to food or two hours after food, if you do not, then the absorption rate can be interrupted and it will not work as effectively as we would like it to. I would also say carry on taking regular paracetamol. Okay? Two Paracetamol every four to six hours. No more than eight within a 24-hour period. Carry on drinking plenty of fluids, because if you are feeling unwell, lethargic, possibly got a temperature, you may become slightly dehydrated. So make sure you are drinking plenty. And what would say else, things that you need to be mindful of that would suggest your condition is worsening is, if you get a severe throat pain or the inability to swallow, if you start drooling or you cannot breathe correctly, it will suggest that the swelling is increasing and you need to be seen quite urgently. If that happens, Mr. Smith, you need to ring 999 straight away, do you understand? Okay. Okay. For an ambulance, is that? For an ambulance, yeah. We need to get you seen in a hospital straight away, because your airway may be threatened. We are gonna treat you with the antibiotics, it might take a couple of days before these to take effect. So do not worry if you do not get any immediate relief, give it at least two to three days, if you are not getting any relief after two to three days, then contact your doctor for a follow-up review. Okay? Okay. Just be mindful that antibiotics, sometimes the penicillin ones can cause a little bit of loose stool and vomiting, that is a normal side effect, but make sure you are taking the regular paracetamol, take the penicillin antibiotics as directed for the full 10-day course even if you start feeling better and drink plenty. If you have got any concerns at all, you speak to your own doctor for a follow-up review or you can ring back to 111 and we will have another discussion. Is that okay for you? Do you understand that, Mr. Smith? Okay, so I have got to take all these tablets? All the 10-day course. And I am better in three days. Even if you are feeling better in three days, you need to still take the full course, do not stop when you start feeling better. Oh, alright. Alright then, and if there is any problems when you start taking the medications, any new rash, any new shortness of breath, then you need to stop taking them and ring and get some medical advice. It might be that we need to look at an alternative antibiotic for you, do you understand that as well? Okay, yeah, that sounds good. Thank you. That is great. Okay, and I am going to close this call now, if there is any other problems you can ring us back. Thanks for your call. Mr. Smith. Thank you. Thank you now. Bye-bye. Bye. Bye-bye.
Telephone Consultation for Sore Throat: Guidance and Treatment
Introduction
Initial Contact: Mr. Smith, a patient, contacts the out-of-hours service with throat concerns.
Verification of Patient Details
Confirmation: Urgent care practitioner verifies Mr. Smith's identity and reason for calling.
Symptoms Assessment
Presenting Symptoms: Mr. Smith reports severe throat pain exacerbated by swallowing, along with joint ache and swollen glands under his jawline.
Medical History and Current Condition
Medical Background: No significant medical history except hay fever, no current medications other than paracetamol.
Diagnosis and Treatment Plan
Possible Diagnosis: Suspected acute tonsillitis based on symptoms and visual inspection.
Treatment Plan: Prescribing a 10-day course of penicillin-based antibiotics.
Guidance for Mr. Smith
- Medication Instructions: Take antibiotics as prescribed, spaced from meals for optimal absorption.
- Supportive Care: Continue using paracetamol for pain relief, ensure adequate fluid intake.
- Monitoring: Watch for worsening symptoms such as severe throat pain, difficulty swallowing, or breathing problems.
- Emergency Protocol: In case of emergency (severe symptoms), dial 999 immediately.
- Follow-up: If symptoms persist after 2-3 days or worsen, contact GP for review.
Conclusion of Call
Closure: End of consultation with instructions reiterated and patient understanding confirmed.
