Title: Assessing appropriate triaging for domiciliary referrals: A clinical audit
Abstract:
Background: When patients are referred for a Domiciliary visit within the Cwm Taf Health Board they are triaged by clinicians or admin staff. They are then categorised according to time urgency. This system has been created in order for patients with the greatest needs to be prioritised and seen within an appropriate time frame.
Aim: This Audit aims to assess whether the current system is effective in correctly categorising these patients and to improve the flow of patients through the Domiciliary referral process so that those in most urgent need are prioritised, whilst conforming whether local guidelines are being followed.
Standard: Local Cwm Taf Morgannwg University Health Board Guidelines – Categories for Domiciliary Visits.
Process: A retrospective audit of new patient assessment and emergency appointment documentation in 190 Domiciliary patients seen by all clinicians within Cwm Taf region over a three-month period. Data retrieved from SOE to include: Initial triage category upon referral, origin of referral (FDS, self, telephone) and the correct category on presentation.
Results: Overall, 45 (24%) of patients had a discrepancy in their triage category to category on presentation, with 35 (78%) patients being in a higher category than triaged (less urgent issue on presentation). 36 (80%) were triaged by admin staff and all originated from self- referrals or telephone triaged referrals with none being referred through the FDS system.
Discussion and action plan: The audit demonstrated errors in the triaging system resulting in incorrect categorising of patients therefore incorrect time-frames for assessment. Issues with the telephone and self- referral process and discrepancies between triaging carried out by clinicians and admin staff. Recommendations of more comprehensive triaging under a new self-referral and telephone triaging form, increase in staff training, proposal of a new categorisation system for better prioritisation of patients. Changes have been implemented of recommendations stated, currently waiting to re-gather data of second cycle for audit completion which should be achieved within the next month.
