THE DEVELOPMENT AND UTILIZATION OF TRIAGE PATHWAYS IN OUTPATIENT GASTROINTESTINAL CARE

Abstract

The Division of Gastroenterology and Nutrition at our institution receives approximately 20 urgent/emergent patient referrals from community physicians on a daily basis. Outpatient GI care is provided at 10 sites located in the community. In an effort to triage severity of illness and to educate the staff in the community practices, pathways were developed recognizing that staff with varying levels of expertise and background accept and facilitate these calls. The goals of the project were: Acquire and review appropriate/specific patient history information including history growth data, previous testing; decrease the number of staff phone calls to acquire patient information; provide MD offices with testing suggestions/rationale prior to the visit; and provide consistent pathways for outpatient GI staff regarding triage, treatment, medications. Methods: We conducted an e-mail survey among the outpatient nurses, PNPs, physicians and clinical coordinators to identify common urgent referral diagnoses. The results identified gastroesophageal reflux, rectal bleeding, and failure to thrive as the three most common referral diagnoses. Triage pathways were devised and included triage questions, “red flags” that would warrant Emergency Department referrals, treatment goals and clinical reference data for clinicians. The triage pathways were reviewed by nurse/physician teams and the outpatient staff prior to use. Pathways were implemented in the outpatient network and were utilized by 4 RNs and 2 non-nursing clinic coordinators. Results: Pathways were evaluated at 3 intervals. Verbal feedback was solicited from staff at 2 and 4 months. A written evaluation at 6 months included a scale 1-5 with 5 being the most beneficial. Overall usefulness of the triage sheets was rated as 4-5. Evaluators identified decreased time spent in acquiring information and utilization as a resource as being most valuable. Conclusions: The goals of the project were met. The acquisition of information, and as a reference guide in providing patient care. This project facilitated collaboration between physicians, nurses and outpatient clinic coordinators. Staff found the triage pathways to be valuable and recommended the development of additional triage pathways for GI complaints such as abdominal pain, constipation and screening for celiac disease.