Medical Subspecialty Referral Triage: An Ignored Teachable Skill

Abstract

Central triage systems are becoming increasingly common to minimize wait times. Outpatient referrals must then be triaged based on urgency. Although triage is a well-described skill in emergency medicine, there is currently no curriculum to teach outpatient triage to medical sub-specialty residents. Our endocrinology sub-specialty program has included supervised referral triage as a mandatory component and we have assessed its efficacy. Six common endocrinology referrals were transcribed. Four endocrinology sub-specialty trainees were asked to assign a visit priority to each case and answer questions to outline their decision making. The survey was repeated after the trainees completed at least 1 supervised triage session with an experienced endocrinologist. A panel of 4 staff endocrinologists completed the same survey as the “expert” panel. There was a high rate of agreement in the most urgent cases between trainees and experts, and within each group, but significant variability with less acute referrals. Patients at risk for deterioration were consistently identified by both groups. A lack of consistent triage criteria and resource stewardship was identified as the cause of variability in assigning priority to non-urgent cases. Both groups agreed that this is an educational intervention best delivered in a one-on-one setting with current referral cases. They also agreed that triaging outpatient referrals is a clinical skill that should be taught prior to independent practice. Our study highlights the need for an objective-driven educational curriculum to address this gap.