Standard Work: Triage

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Standard Work: Triage Triage: Triage staff will ask specific questions to understand what the client has presented for, quickly determine what services the client should receive, and schedule an appointment in Lifelink. Determine clinic capacity each day. Count alternating 30 and 45 minutes appointments for each clinician working that day. Inform front desk staff of number of clients to accept. Clients will be called individually by number, ensuring they come back alone. Triage patients with yellow numbers (pre-scheduled appointments/treatments/ec), orange numbers (Mike-CTRS appointments), &/or green numbers (Testing Together CTRS appointments) from registration/triage waiting area first, by appointment time. Front Desk Clerk and Triage will monitor Lifelink schedule for No Shows. Patients are instructed to arrive 30 minutes prior (check in time) to provider Lifelink time to allow for registration and phlebotomy. Patient will be allowed 10 minutes grace period before they are marked as a No Show. Triage, communicate with Front Desk Clerk and Back Office Staff regarding patient status, change of schedule, late patients, etc. Triage makes the final decision to No Show or Attend a patient. In regards to late patients, Triage and Front Desk Clerk should always consult with the nurse who the patient is scheduled to see. It is important that Triage & Front Staff to attend daily huddle for updates, changes, communication. Attempt to rotate scheduling of male/female, high/low complexity patients on clinician schedule. If Triage is complete, see walk-in treatments (should NOT be waiting more than 1 hour in clinic), express visits, complete individual work assignments, and/or assist others with Front Office duties, or phlebotomy if backed-up). Rule of thumb, during down time, if you triage a treatment or express visit, you should see the treatment or express visit. If patient arrived for Scheduled Appointment: 1. Log into HealthDoc 2. Log into LifeLink (Note: Do not leave computer unattended) 3. Call patients by yellow/orange/green numbers in order of appointment time into triage room. 4. Write date and log number at top of registration form and initial the witness section. 5. Inform patient that this is the number that they will be called by. For example, You are number 162 today; listen for this number to be called. 6. Verify ID including address. If address does not match registration form, obtain proof of address.

7. Go to LifeLink 8. Locate patient under Resource Appointments- Group- STDALL 9. Once you have located patient in LifeLink, write down time of appointment and clinician to see patient on the registration form. 10. Click and review Comment section in LifeLink for that patient. a. Verify the following: i. Is the patient having any symptoms? If so, what are the symptoms? 1) O Onset 2) L Location 3) D Duration 4) C Characteristics 5) A Aggravating factors 6) R Relieving factors 7) T Treatment ii. Is the patient having sex with men, women, or both? iii. Is their partner with them today? iv. Does the patient have Medicaid or Health Insurance? If so, mark at top of registration page, even if they declined to use insurance v. Labs ordered b. If there are no labs indicated from the Comment section in LifeLink: i. Check the summary chart in HealthDoc for previous tests/results, and previous notes. ii. Determine needed labs according to criteria (SEE LAB CRITERIA) 11. Perform vital signs (Blood pressure, pulse, respirations). Repeat if BP: >= 180/120, P: >= 120/minute, &/or R: >=30/minute; inform nurse and document. If patient is having HTN symptoms (SEE VITALS SIGN PROCEDURE), call attending. Take temperature if patient is complaining of UTI symptoms (dysuria, frequency, & urgency), PID (abdominal pain), Epididymitis (testicular pain). If patient has fever of 38C or 100.4F, CONSULT WITH NURSE PRIOR TO SCHEDULING! 12. If HIV test declined or does not meet criteria, have patient sign Decline HIV test section on registration form 13. Assure patient signed Consent for Services 14. Write on registration form: a. In upper right hand corner write- sexual preference (MSM, WSM, etc.), & partner # (if partner testing in clinic) b. Circle if NV, FU, EXP, TC, CC, VSR, CTS, Choices, EC Only c. Circle lab tests ordered d. Fee code, Medicaid, or other Health Insurance, if applicable 15. Change patient status in LifeLink to Patient Arrived (Gray), if not already done by Front Desk Clerk 16. Have patient sit in registration waiting area 17. Place on communication board-by registration: a. Patient number b. Time of appointment

c. B if blood If patient arrived for a Same Day Appointment: 1. Log into HealthDoc 2. Log into LifeLink (Note: Do not leave computer unattended) 3. Check off patient number on left hand side of communication board 4. Call patients in numeric order into triage room (paper numbers). 5. Write date and patient number at top of registration form and initial the witness section. 6. Inform patient that this is the number that they will be called by. For example, You are number 2 today; listen for this number to be called. 7. Verify ID including address. If address does not match registration form, obtain proof of address. 8. Search for patient in HealthDoc and LifeLink. b. Have you been to the clinic before? i. If YES - 1) Review chartable comment from last patient visit 2) Review Summary Chart for last lab results (Last HIV test, untreated CT/GC, adequately treated syphilis, outcome if +UHcg) 3) Review if patient is a Teen or Continuity client and if they need an annual exam. (patient may know) ii. If NO Check HealthDoc anyway! Sometimes patients forget they were seen here, or they were probably tested in an outreach clinic (Rehya, HeyDenver, etc). If you re not able to find patient, ask for previous names (maiden, marriage). Switch first and last name (sometimes patients are registered under last name as the first name and vise versa). For patients with out of country ID, sometimes the month and day of birth are switched 9. Triage patient by asking the following: ALL CLIENTS c. What symptoms are you experiencing today? i. O Onset ii. L Location iii. D Duration iv. C Characteristics v. A Aggravating factors vi. R Relieving factors vii. T Treatment d. When is the last time you had sex? e. When was your last HIV test? f. Do you have sex with men, women, both? g. Have you had sex recently with someone that has an STD? h. Is your partner(s) here with you today? FEMALE CLIENTS - i. When was the first day of your last period? Have you missed your period?

j. Do you think you might be pregnant? k. When was the last time you had unprotected sex? l. Have any of your male partners had other male partners? m. Are you currently using a method of birth control? n. Do you receive your method of birth control from this clinic? o. Do you need birth control today? i. If not currently using a method of birth control and states they don t need a method, find out why (hysterectomy, vasectomy, BTL, pregnant). ii. If interested in birth control, provide birth control information sheet that lists all the methods. ALL CLIENTS p. Is there anything else you would like to discuss with your clinician? i. Do you have Health Insurance or Medicaid? If so, mark at top of registration page, even if they declined to use insurance 10. Determine labs to be ordered according to criteria (SEE LAB CRITERIA). 11. Perform vital signs (Blood pressure, pulse, respirations). Repeat if BP: >= 180/120, P: >= 120/minute, &/or R: >=30/minute; inform nurse and document. If patient is having HTN symptoms (SEE VITALS SIGN PROCEDURE), call attending. Take temperature if patient is complaining of UTI symptoms (dysuria, frequency, & urgency), PID (abdominal pain), Epididymitis (testicular pain). If patient has fever of 38C or 100.4F, CONSULT WITH NURSE PRIOR TO SCHEDULING! 12. If HIV test declined or does not meet criteria, have patient sign Decline HIV test on registration form 13. Assure patient signed Consent for Services 14. Write on registration form: a. In upper right hand corner write- sexual preference (MSM, WSM, etc.), & partner # (if partner testing in clinic) b. Circle if NV, EXP, FU, TC, CC, VST, CTS, Choices, EC Only c. Circle lab tests ordered d. Fee Code, Medicaid or other Health Insurance, if applicable 15. Go to LifeLink 16. Go to Integrated Booking Space 17. Click on New 18. Search for patient by: a. MR# or SSN and/or b. Demographic information including but not limited to: partial last name, partial first name, date of birth 19. Identify the correct patient. If patient not in LifeLink, create patient. a. Creating a patient in LifeLink i. Add new patient ii. Complete First name, Last name, Birthdate, Gender, Marital status, Address, Phone Number iii. Click Save 20. Schedule appointment

a. Enter Comments (should include: patient number, sexuality, symptoms, labs to be ordered b. Pick activity depending on type of visit (STD 15, STD 30, etc.) c. Click Find d. Change View to see all available providers e. Select an appointment time f. Select g. Save h. Close post note 21. If patient s appointment is 2 hours or less from time it is being made or is NOT leaving clinic, patient will continue on to next steps: a. Locate patient under Resource Appointments- Group- STDALL b. Change patient status in LifeLink to Patient Arrived (Gray) c. Have patient sit in registration/triage waiting area for registration d. Place on communication board-by registration: i. Patient number ii. Time of appointment iii. B if blood ordered 22. If patient s appointment is greater than 2 hours from time it is being made, and patient plans to leave, advise patient to return to the clinic 30 minutes before scheduled appointment time, AND check-in with the front desk. If the patient plans to stay in clinic and wait for appointment time, proceed as mentioned on #21. 23. When the patient returns, the Front Desk Clerk will ask to see registration form. (Note: these patients will not be given a yellow/orange/green number.) a. Locate patient under Resource Appointments- Group- STDALL b. Change patient status in LifeLink to Patient Arrived (Gray) c. Have patient sit in registration/triage waiting area for registration 24. Triage: a. Place on communication board-by registration: i. Patient number ii. Time of appointment iii. B if blood ordered If patient is a CTS Appointment: 1. The front desk clerk identifies patient as CTS. a. Give patient orange/green 200 range number b. Page Mike c. Decipher if patient is anonymous or not. i. If anonymous no registration form just orange number is given ii. If not anonymous give registration form, given orange/green number, and send to registration/triage waiting area. 2. Triage calls patient by number in order of appointment time into Triage room. a. If anonymous give patient anonymous form and review with them. i. See Anonymous HIV Scheduling document (G:\APPS\STD\COMMON\Standard of Work_Front Office\SCHEDULING\Anonymous appointments)

b. If not anonymous Continue following above process for scheduled or same day appointment. Lab Criteria: 1. HIV* heterosexual: 1x per year (4 week grace period); MSM/MSMW: every 3 months (2 week grace period); contact to HIV 2. HCV** Born 1945 1965, injection drug use; received blood, blood products, or tissue transplant prior to 1992; received a blood transfusion outside the United States; sexual partner of someone infected with HCV; intranasal drug use with shared supplies; and/or needle sharing, other percutaneous exposure, incarceration, born to a Hepatitis C infected mother, long-term hemodialysis 3. RPR ALL MSM, previous history of syphilis, Females who have had gay or bisexual male partners, all pregnant women 4. RPR, STAT RPR, and TPPA All contacts to syphilis, complaints of rash/sores (verify with Team Lead if needed) 5. Urine Hcg (clean catch***) - LMP is > 30 days ago ( missed period ), needs EC/BC, IUD or Implanon is scheduled for that day, pelvic pain (even if they ve had a tubal), concerns with pregnancy regardless of BC method 6. Urine Dip (clean catch***) patient c/o dysuria, urinary urgency, AND frequency, and/or dysuria for females only (case by case), ask Team Lead *If the patient insists on having an HIV test early, they have the option of paying $50. **If returning to clinic with prior negative HCV test, risk was > 6mo and no continued risk, no further testing recommended. If client returning within same year and new risk behavior occurred in the past 6 months, encourage client to re-test 6 months after the last exposure (no fee). ***Instruct patient on clean catch: With towelette, wipe from front to back, separate labia, use 2 nd towelette to wipe from front to back again, urinate in toilet first, then collected the rest of urine in the cup (mid-stream). If patients have had a positive GC/CT test in the last 3 months, they may be given a yellow number and treated. If a positive GC/CT result is longer than 3 months ago, the patient will need to be retested and return to the clinic for treatment. When giving results over the phone, ensure that patients with a positive GC/CT in the last 3 months return to the clinic for treatment and those that have not been tested within three months, return for testing. See Lab Criteria or LAB CRITERIA by visit type (G:\APPS\STD\COMMON\Standard of Work_Front Office\TRIAGE\lab) Service Types: NV (New Visit) = Any new problem. FU (Follow-up) = Follow-up of existing problem (within last 3 months) EXP (Express) = A new visit where the patient presents asymptomatic

TC (Teen Clinic) = Any female 18 years old or younger requesting birth control, and has enrolled at first visit of the calendar year CC (Continuity Clinic) = Any female 19 years old or greater; qualify if at high risk for unintended pregnancy (generally enrolled at first visit of the calendar year - see FP Qualifiers tab in HealthDoc Form, must have 6 or more predictors OR nurse will note in Service Comments) VSR (Vice Squad Referral) = court ordered STD testing CTRS (Counseling Testing and Referral Services) = asymptomatic patients needing HIV/STD testing, couples Testing Together, patients with high risk behaviors, anonymous HIV testing, & patients requesting PrEP/PEP; (appointments with Mike in Lifelink schedule), sometimes Roberto or Alex will request this type of registration CHOICES = Any female up to the age of 44 who is not using effective contraception and drinking alcohol at unhealthy levels (4 or more drinks/day or 8 or more drinks/week) EC ONLY (Emergency Contraception Only) = Female requesting emergency contraception ONLY at risk for unintended pregnancy within 5 days (or 120 hours) of unprotected intercourse Appointment Times: See Appointment times (G:\APPS\STD\COMMON\Standard of Work_Front Office\SCHEDULING) Fee Codes: See Fee Codes (G:\APPS\STD\COMMON\Standard of Work_Front Office\REGISTRATION)

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