Train, test, and trust: A recipe for triage success

Does this scene sound familiar? You’re a veterinarian with a packed schedule plus two emergencies and a handful of drop-offs.  You’re already running behind trying to divide yourself between appointments, reviewing lab work and specialist referrals, and approving prescription refills.  You are trying to stay on top of everything, but your train of thought keeps getting interrupted by questions from well-meaning team members.  

Client A is on the phone and isn’t sure if her cat is urinating.  Client B stopped by to say he has noticed that his dog’s knee is suddenly swollen.  Client C emailed the practice to report that their dog has been eating less but is not sure for how long. The team members fielding these questions are coming to you to ask how to respond to each concern.  Do these pets need to be seen today? Should any of them be referred to an emergency clinic? Can the owners do anything at home first? The time spent answering these questions just further slows down the flow of the day. Clients are also stuck waiting longer for answers while team members go track down a doctor.   

You wish that your team could answer more of these questions without having to ask you every time while still giving clients guidance that aligns with your practice style. Your team needs to learn to triage.  

Training to triage 

Deriving from the French word meaning “to sort,” triage in medical scenarios refers to the practice of determining which cases are in the most urgent need of your attention so that you can determine which pets need to come in right away and which ones can wait a little longer, be monitored at home, or be referred elsewhere.   

Debbie Boone, BS, CVPM, Co-Founder and Vice President of the North American Association of Veterinary Receptionists (NAAVR), has a long history of training customer service representatives (CSRs) to triage cases when clients call the practice with a concern.  She stresses the importance of thorough training and using algorithms to help CSRs know how to respond to clients when they call asking for guidance. “When I was training my CSRs, one of the things that they had to learn was called top common telephone questions and the answers…according to my doctors and what we wanted to have happen in those calls,” she said.   

And the secret to ensuring this training was successful? A quiz followed by a raise. 

Boone gave her team one month to study the practice’s triage algorithms and then required each team member to pass a 50-question multiple-choice quiz with a score of 90% or higher. If they didn’t pass that quiz, Boone gave them another month to study and then required team members to take an essay-style quiz, something Boone said, “nobody wanted to do,” resulting in high motivation to pass the multiple-choice quiz.   

Once a team member had passed the quiz, their hard work and improved confidence and communication skills were rewarded with a raise.  And they were entrusted to make triage decisions autonomously so that every member of the team could make the most efficient use of their time and skills. Or as Boone put it, “train to your list, test on your training, and then turn your team loose.” 

How to create triage algorithms 

Boone recalls how tedious it can be to create triage algorithms, but she didn’t feel like it was necessary to reinvent the wheel.  She started by asking her team which complaints they were most commonly asked about by clients.  Then she would do her own research and consult with the veterinarians in the practice.   

She would start assembling material for her practice’s triage manual based on this feedback, commenting that it was “not pretty.”  

“I did not rewrite everything,” she said.  “I would tear articles out of a magazine and make copies of it and build training manuals. I would copy things out of books that I got from my doctors, copy things out of books that I got from my manufacturers.” 

“They don’t have to be beautiful,” she added. “They just have to be accurate.”  

However, in the digital age, Boone says she would now take a different approach using artificial intelligence. She would ask ChatGPT to create a protocol of questions CSRs should ask a client who is concerned that their cat is urinating inappropriately or not at all, “then go back in there and tweak them according to what our doctors want those CSRs to say,” she explained.  

Communication pearls for CSRs  

Boone has some helpful communication advice for those who are just learning to triage.  

• Don’t diagnose, even if the client pushes you to do so.  Especially when you tend to see a lot of the same types of cases repeatedly, it can be easy to assume you know what the condition is based on the description the client is giving.  And your assumption may very well be accurate.  But the goal of triage is to determine how, when, and where the patient should be attended to.   

• Ask discerning questions. “How can you get the client to tell you a story?” Boone prompts. When clients contact the clinic, they may not volunteer all the relevant information or know how to describe what they are seeing with their pet.  Asking good follow-up questions can help you dig deeper and know how to best direct the client.  Many of the specific questions will be guided by the initial complaint. But when in doubt, asking open-ended questions can invite the client to give you more useful information.  

• When in doubt, recommend an exam.  “You call for a reason, we know you’re concerned, what harm does it do to look? Let’s get you some peace of mind,” Boone said, describing the philosophy she takes when discussing a client’s concerns with them.  That doesn’t always mean the pet needs to come in immediately or even be seen at your practice if that’s not the best option for everyone involved. 

According to Boone, empowering your CSRs to triage your patients is a win-win. “It’s going to save the medical team hours and hours of time answering questions that could be answered at the front desk and the other outcome of that is you’re going to have much more satisfied clients because they’re not placed on hold having to sit there and wait and stressing out about getting an answer to a question,” she said. 

If you are looking for more guidance to get started with your team, check out this list of resources curated by Boone to help level up your team’s triaging confidence.  

Training resources recommended by Debbie Boone: 

NAAVR website 

Hospitality in Healthcare book 

Veterinary Hospital Managers Association Client Service Certificate 

atDove Client Services Onboarding Guide 

Ignite Veterinary Receptionist of Excellence Certificate 

Communication Solutions for Veterinarians Training Modules 

Photo credit: DenGuy/iStock via Getty Images  

Disclaimer: The views expressed, and topics discussed, in any NEWStat column or article are intended to inform, educate, or entertain, and do not represent an official position by the American Animal Hospital Association (AAHA) or its Board of Directors.