Triaging on site

RE: Triaging on site

Anthony Todd — Mon, 03 Dec 2018 22:45:58 GMT

[quote user="Julie Innes"]Really?? Not sure I'd be best chuffed if I was waiting politely for my appointment (on time) somewhere and someone "waved their arm" at me in order to see someone who had just wandered in. I think you would definitely lose me as a client for that- you are telling me that my time is not important.[/quote]

Sorry, I was not clear....

Wave you arm at the 8 waiting [probably stony faced] and address the walk-in by saying "sorry etc." to the walk-in.......

RE: Triaging on site

Julie Innes — Mon, 03 Dec 2018 13:26:40 GMT

[quote user="Anthony Todd"]Well.obviously you wave your arm at the 8 waiting and say "sorry" not very seriously, but I'll/we'll see you as soon as we can, it's not an emergency is it?"[/quote]

Really?? Not sure I'd be best chuffed if I was waiting politely for my appointment (on time) somewhere and someone "waved their arm" at me in order to see someone who had just wandered in. I think you would definitely lose me as a client for that- you are telling me that my time is not important.

RE: Triaging on site

Anthony Todd — Mon, 03 Dec 2018 11:15:33 GMT

[quote user="Julie Innes"]I disagree. What about the following 8 clients who now have to wait [/quote]

Well.obviously you wave your arm at the 8 waiting and say "sorry" not very seriously, but I'll/we'll see you as soon as we can, it's not an emergency is it?"

Trouble is you have to use a bit of common sense and courtesy.

Again, a case of an unnecessary "rule" that upsets a lot of people, loses clients and never works, IMHE.

And they really aren't that common?

We tried blocking off appointments but all that happened was that the emergencies never appeared, too many appointments were blocked off and the vets had to work later to catch up.

[IMHE]

RE: Triaging on site

Julie Innes — Mon, 03 Dec 2018 08:56:36 GMT

[quote user="Anthony Todd"]

Lost revenue and usually a lost client, or new client, for ever.

They will tell 8 people at least, so research said [I understood] because [and they always paraphrase] "the vet refused to see me!".

I stopped lecturing late or "drop-ins" after one gave me such a sad and horrible series of reasons...

99 times out of 98 it really wouldn't be so catastrophic if the vet just saw them; client grateful, and for life, revenue for someone, and much less stress and aggro for vet and staff.

PS Don't think a refusal will "educate" clients; it never does, late or drop-ins are often that, making them wait is usually not educational, or met with "Oh, the other vet always fitted me in", usually using a christian

[/quote]

I disagree. What about the following 8 clients who now have to wait (and who possibly have other commitments/ appointments, or only 10 mins left on their parking ticket?) Why is the person who just wandered in more important (unless the animal is obviously in distress, in which case people will be understanding, as will I) If you see people as and when they turn up you risk upsetting lots of other (well-behaved) clients!

And as for them being eternally grateful and becoming a loyal client...In my experience that is not how these people work!

RE: Triaging on site

Anthony Todd — Sun, 02 Dec 2018 02:24:45 GMT

[quote user="David Mills"]True. If all they're getting is a jab of penstrep and dex [/quote]

Can't believe you, always up to date or beyond, and so tolerant, is still using penstrep?

Some of us used to be able to fix animals even without a blood or even a "workup", might take us 9 or 10 revisits, I admit.

[hated the gym, myself; too busy vetting]

RE: Triaging on site

David Mills — Sat, 01 Dec 2018 22:42:51 GMT

[quote user="Anthony Todd"]99 times out of 98 it really wouldn't be so catastrophic if the vet just saw them; client grateful, and for life, revenue for someone, and much less stress and aggro for vet and staff.[/quote]

True. If all they're getting is a jab of penstrep and dex

RE: Triaging on site

Clive Ansell — Sat, 01 Dec 2018 20:13:05 GMT

[quote user="Sarah Keir"]Clive, as a locum, do you follow the practice protocol on these or are you allowed to use your head and follow your above advice?[/quote]

usually follow practice protocol. That usually dictates though that the vet on the floor makes the call as to whether they are seen or not. Animals that are not ill at all, vaccinations, nails etc will usually be turned away by reception unless very quiet. I will usually make them wait a while, and won't inconvenience another client that has made an appointment and is on time

It is a fine line to tread between not rewarding bad behaviour, not upsetting a good or potentially good client, not turning away an animal that really does need attention, and not turning away the boss mans revenue. If in doubt, I just see them. Emergencies would always be seen of course.

We could have a parallel discussion about late comers, they are a b****y nuisance too. Instinct would tell me to make them rebook, but of course we usually get on and see them (eventually). I will turn them away if at the end of the day.

And another parallel discussion about clients who persistently don't keep appointments.

RE: Triaging on site

Anthony Todd — Sat, 01 Dec 2018 14:05:37 GMT

[quote user="Anthony Dennison"]However at a quieter branch the little voice in the back of my mind says 'turning this person away is lost revenue' so I generally end up seeing them. Even if they do wait 10 minutes whilst I peruse the forum here... [/quote]

Lost revenue and usually a lost client, or new client, for ever.

They will tell 8 people at least, so research said [I understood] because [and they always paraphrase] "the vet refused to see me!".

I stopped lecturing late or "drop-ins" after one gave me such a sad and horrible series of reasons...

99 times out of 98 it really wouldn't be so catastrophic if the vet just saw them; client grateful, and for life, revenue for someone, and much less stress and aggro for vet and staff.

RE: Triaging on site

Sarah Keir — Sat, 01 Dec 2018 14:04:40 GMT

[quote user="Clive Ansell"]

[quote user="bob lehner"]

However, we do have a professional obligation to protect animal welfare ' Veterinary surgeons must make animal health and welfare their first consideration when attending to animals', so if an owner arrives and demands an appointment it seems to me that someone with sufficient knowledge must determine whether it is 'an emergency,' where animal welfare is significantly compromised and it should be seen by the VS quickly - or 'not an emergency', when it can be turned away/offered a later appointment.

So It seems that triage is needed in some shape or form - be it by a competent RVN or a VS.

[/quote]

I think most of us are already doing that, certainly do in all the practices I work.

Things like vaccinations and nails that just turn up, would be dealt with by reception, and offered the next available appointment.

Anything else a vet or an RVN would be consulted by reception. Emergencies and genuinely very sick (Most will not be) animals would be seen of course. However, when many clients are informed it could involve a considerable wait (if very busy I will stack them for 1 -2 hours) and usually a surcharge, cases miraculously improve quickly (better than any medicine I know)

Non emergencies like medication checks, ears, diarrhoea would be told to make an appointment.

It is easy to say, "just fit them in", but if fully booked it places unfair stress on the working vets, and short changes other fee paying clients that may get their consultation times cut short

All in all they are a damned nuisance.

[/quote]

Clive, as a locum, do you follow the practice protocol on these or are you allowed to use your head and follow your above advice?

RE: Triaging on site

Anthony Todd — Sat, 01 Dec 2018 07:27:37 GMT

[quote user="Glen McIntosh"]Thats about the same as what you would pay for a private urgent care consultation with a doctor in London.[/quote]

Yep, the local SPIRE private lot charged £100 consult and £100 for 0.5ml of Depomed [in the same bottle as the vet one and multiuse.....??] for a ganglion injection in a finger tendon.

Dr. said it was his "bread and butter" and whole visit was 5-10 minutes.

[Next one just went away with no treatment.]

RE: Triaging on site

Anthony Dennison — Sat, 01 Dec 2018 00:03:32 GMT

We have the issue of branch practices booking in appointments at the main hospital as an emergency without being triaged... receptionists worry that they have no vet so just book them in with us, adding to our workload. I'd say 80% of the time it's not as bad as initially made out and could have waited for a branch appointment. Especially as some clients travel up to an hour to the hospital!

I spend 2 days a week at a quieter branch, and often have people turning up with no appointment 'oh is the vet in?'. I'm often not doing anything, so will sigh loudly, come out to the waiting room and say something along the lines of 'we work with an appointment based system here - you're very lucky that I'm not operating at the moment as I usually am, so this once I will squeeze you in'.

If I'm operating they get booked in for afternoon consults. However at a quieter branch the little voice in the back of my mind says 'turning this person away is lost revenue' so I generally end up seeing them. Even if they do wait 10 minutes whilst I peruse the forum here...

RE: Triaging on site

Glen McIntosh — Fri, 30 Nov 2018 10:53:24 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Glen McIntosh"]We charge the equivalent of GBP100 for a walk in consultation[/quote]

Jeez.

[/quote]

Not really.

Thats about the same as what you would pay for a private urgent care consultation with a doctor in London.

The demand is definately there, nobody else wants to see these cases. Some of them are truly urgent, many of them are not. But you really can’t tell until you see them. The fee pays for the staff to deal with these cases that would otherwise be turned away.

RE: Triaging on site

Martin Atkinson — Fri, 30 Nov 2018 09:13:41 GMT

[quote user="Glen McIntosh"] We charge the equivalent of GBP100 for a walk in consultation (or any non scheduled “emergency” - even if they call us first) if they want to be seen without an appointment. [/quote]This doesn't always work if they're insured, they don't care what it costs. I guess you'd get the money to compensate but the odd occasion we've tried a similar tactic I have warned them then that when I complete the claim I won't include the emergency surcharge if its not really an emergency.

[quote user="Julie Innes"] Its amazing how many people phone at 8.30 with something "urgent" but want the last appointment we have! Because that is a really good time to see a dog that has had haemorrhagic diarrhoea for 3 days.... A lot of people who would prefer to wait til later can actually come earlier. [/quote]Sounds depressingly familiar!

I try to keep the latest appointments free so there is space for genuine urgent cases rather than those who just want one for convenience otherwise, especially on Saturday morning as they want a lie in and all want the latest appointment. Personally I don't understand this I always want the earliest appointment anywhere so i can get on with my day.

RE: Triaging on site

Julie Innes — Fri, 30 Nov 2018 08:43:50 GMT

[quote user="Clive Ansell"]How many practices have a contingency or back up plan, or leave some slack in the system, when working out their diaries?[/quote]

We start the day with several "Keep free" appointments. And we don't give away evening appointments until the afternoon (people are told to call back, an idea I nicked from my GP practice!) Its amazing how many people phone at 8.30 with something "urgent" but want the last appointment we have! Because that is a really good time to see a dog that has had haemorrhagic diarrhoea for 3 days.... A lot of people who would prefer to wait til later can actually come earlier. Filling up the earlier appointments first means we have some slots not filled by boosters for the dog that the owner comes home from work to find in a pool of vomit/ having eaten a box of chocolates, etc

RE: Triaging on site

Evelyn Barbour-Hill — Thu, 29 Nov 2018 21:57:42 GMT

[quote user="Glen McIntosh"]We charge the equivalent of GBP100 for a walk in consultation[/quote]

Jeez.

RE: Triaging on site

Glen McIntosh — Thu, 29 Nov 2018 21:03:43 GMT

[quote user="David Mills"]

I'm more in favour of putting barriers (the extra cost or supplement is an idea I like) in place to dissuade these people - obviously not for the seriously unwell or emergency - and make it fairer for those that do book and turn up on time.

[/quote] Yes, that’s what we do. We charge the equivalent of GBP100 for a walk in consultation (or any non scheduled “emergency” - even if they call us first) if they want to be seen without an appointment. I guess it’s the equivalent of a human “Urgent care” clinic. You pay more but you get seen without having to wait for an appointment. They have to be pretty motivated to use that option, so it will put off some of those trying to jump the queue. But you need to have sufficient staff or gaps in appointment lists to deal with demand, and you do need to triage these cases carefully both on the phone or on site, since some of them may have to wait to be seen. But we are a 40 vet combined GP and specialist referral clinic, and we get a lot of referred cases rolling up that have been told by their usual vets to just go straight to our clinic and walk in, no phone call, no referral letter. So that kind of skews it a bit.

RE: Triaging on site

Beats — Thu, 29 Nov 2018 20:36:08 GMT

One can always offer to see the walk-in without an appointment - advising that sometimes an appointment doesn't turn up and hopefully if they hang around the vet will be able to fit them in within the next 6 hours or so, but if more urgent cases turn up then they may have to wait longer... and it's always a risk that the clinic might close before they get seen and would have to come back to start waiting again tomorrow morning in that case... or they could book an appointment.

I equally don't think it is wrong for reception to turn them away - that is still a triage though?

I find skin cases (like obesity cases or non-obstructive FLUTD cases etc) can take ages personally, so if I have a skin case appear I don't have time for I give them some flea control (+dex if needed on welfare grounds) and re-schedule for a more suitable time; i would be delighted if the receptionist told the clients on the phone that 99% of the time the vet would be giving them flea control to start with and if they would like to get some before bothering the vet that would be just great - indeed a self-service Bravecto-dispensing machine at the reception-desk would save me a lot of time and effort.

One charity clinic I locumed in had an excellent system of ensuring eligibility for their "discounted" service [a separate thread - discounted from what? - the prices were similar to what other clinics I had worked in charged...]. Their solution appeared to be waiting times that only the unemployed would be able to cope with - 2 hours was not unusual.

RE: Triaging on site

David Mills — Thu, 29 Nov 2018 17:05:47 GMT

[quote user="Clive Ansell"]Most places I work will block off a few appointments for emergencies, walk ins and reporting results etc. [/quote]

The issue I have with this is that it is fine for emergencies (not common day-to-day) but it potentially adds reward for the walk ins by building availability into the diary for those who don't do like most other people, and book in advance. There is also the risk of appointments not being filled to accommodate the fickle owners who turn up and expect to be seen, so you lose doubly. I'm more in favour of putting barriers (the extra cost or supplement is an idea I like) in place to dissuade these people - obviously not for the seriously unwell or emergency - and make it fairer for those that do book and turn up on time.

RE: Triaging on site

Martin Atkinson — Thu, 29 Nov 2018 16:45:22 GMT

[quote user="bob lehner"]Of course - the receptionist can/will field the initial dialogue - but they are not competent to make a clinical decision. [/quote]Our 'receptionist' is an RVN or a competent very experienced trainee, we don't have a separate receptionist. They can triage most things and if in doubt will pop their head into the consult or ops and ask me. TBH we are rarely busy enough that I could not do a quick triage within 10-15 minutes unless I'm up to my elbows in an operation and we could probably see them almost as quickly. My issue is not that I don't have time but as Clive has highlighted, casuals and pseudo-emergencies are more often than not a pain in the backside, high maintenance and also poor/none payers.

RE: Triaging on site

Clive Ansell — Thu, 29 Nov 2018 16:17:27 GMT

How many practices have a contingency or back up plan, or leave some slack in the system, when working out their diaries?

For example where I am working at the moment it is usually busy and fully booked working to 10 minute slots. Sometimes there is a problem in that an evening surgery will be fully booked in advance with vaccinations, AG's and routine appointments, the usual bilge. If someone then telephones or just turns up with a sick animal or an emergency it is difficult to deal with.

Most places I work will block off a few appointments for emergencies, walk ins and reporting results etc.

RE: Triaging on site

Clive Ansell — Thu, 29 Nov 2018 13:47:45 GMT

[quote user="bob lehner"]

But - for example I had one turn up last week during my (short) lunch break -'Dog a bit lame behind' - receptionist booked it in without asking.

I swore fluently - but then found the poor animal had the most monumental ripe abscess over its gluteals T. 40.6 and pretty damn sick.... def. needed seeing. Turning it ways without triage would have been very BAD.

[/quote]

Yes, I would have seen that too. Not an emergency, so next free appointment slot, or could sit and wait if fully booked. Would have finished my lunch though!

I had one last week; there was no vet on premises, and I had finished a half day so was out cycling. I received a call from the practice, someone had wondered in with a dog that "couldn't breath" and because they couldn't contact the duty vet, they called me. Even though off duty, I raced back to the practice to be met with a young healthy dog running around wagging its tail, noad on c/e. It had got stressed at the groomers and was panting, but was fine. Brief triage consult and supplement fee for day OOH was met by surprise. BL***y woman then started banging on about its nails, but she had to rebook for that.

RE: Triaging on site

bob lehner — Thu, 29 Nov 2018 13:01:37 GMT

I agree - unscheduled walk-ins are a pain.

But - for example I had one turn up last week during my (short) lunch break -'Dog a bit lame behind' - receptionist booked it in without asking.

RE: Triaging on site

Julie Innes — Thu, 29 Nov 2018 12:06:19 GMT

I wasn't aware there was any need to see them if they were on the premises! When people grumble about our "emergency appointment" charge, we explain that it is to compensate for the inconvenience to everyone else- especially clients who have made an appointment and turned up on time, who may have the price of their consultation reduced to compensate for their extra wait. In that way we try to reward the good clients by penalising the bad! Very few people do it twice!

RE: Triaging on site

David Mills — Thu, 29 Nov 2018 12:02:13 GMT

[quote user="bob lehner"]

Of course - the receptionist can/will field the initial dialogue - but they are not competent to make a clinical decision.

You'd have no defence anywhere if they got it hopelessly wrong...!

[/quote]

Yes, my issue is the differential between being physically at the practice or on the phone. I don't see a difference between the two, the receptionist can only act on the information given by the owner.

The background is that we get a fair number of clients who just turn up without an appointment, sometimes because (they say) they can't get through on the phone, or were passing. We don't run open surgeries, only appointments.

My issue with it when fully booked, like Michael says, is that it potentially rewards bad behaviour, and disadvantages the several for the few. Whilst emergencies are always accommodated, routine walk ins are a pain. If they're seen, then it means vets will normally end up staying late, or missing breaks, which is further unfair. If they have to be triaged, then you may as well just see them - there is little time differential between the two, unless a nurse can do it (not always possible). I don't see why, ethically, they must be seen just because they're on the premises.

RE: Triaging on site

Clive Ansell — Thu, 29 Nov 2018 11:59:52 GMT

[quote user="bob lehner"]

So It seems that triage is needed in some shape or form - be it by a competent RVN or a VS.

[/quote]

I think most of us are already doing that, certainly do in all the practices I work.

Things like vaccinations and nails that just turn up, would be dealt with by reception, and offered the next available appointment.

Non emergencies like medication checks, ears, diarrhoea would be told to make an appointment.

It is easy to say, "just fit them in", but if fully booked it places unfair stress on the working vets, and short changes other fee paying clients that may get their consultation times cut short

All in all they are a damned nuisance.