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Office Triage with a BOOKED schedule

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HayMA HayMA (New) New

I am a new medical assistant and got hired on at my extern site which happened to be a cardiovascular clinic. As you would expect, we have patients call all day with angina and other MI symptoms. This may sound rediculous, but I find triage to be the most challenging task of my daily duties!! We have one doctor in the office that sees approximately 17 patients a day (that's without a lunch hour and working anywhere from 30 minutes to an hour past closing) whom is COMPLETELY overbooked for the next 3 months, we also have a brand new nurse practitioner who is expected to see up to 10 patients a day and is also overbooked (with 12-13 patients everyday) for the next month. When someone calls with angina, dyspnea, syncope and etc, I of course advise them to call 911 but as I'm sure you all know, only about 50% of patients will agree to this, so my question is what am I supposed to do?! I have worked them in for the day or the next recently and made quite a few coworkers a little irritated. How would you triage in this situation??!

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

Do you not have an office nurse that can triage? In most states it is very much out of the scope of practice for an MA to triage patients over the phone, even with a triage order set or flow sheet. In many states telephone triage is exclusively within the domain of an RN, APN or physician (in many states even licensed LPN's cannot do phone triage). There is so much more to just scheduling a patient calling with chest pain and assuming its angina. The liability you are assuming as a MA doing phone triage is tremendous.

Can you take a message and consult with the MD or APN before relaying any advice or directive to the patient on the phone?

Check with your state medical board or whichever entity oversees MA's as most states you cannot do telephone triage only relay messages between provider and patient.

Unfortunately as far as clinical staff goes, we have one LPN, one "stress lab LPN" and myself. I just did a little research and found that a medical assistant is indeed not supposed to "independently triage", which is confusing because we did train on triage some in school and the person whom worked the position before me didn't even have any medical training, just experience.

I definitely will be taking a message and consulting the doctor before I ever advise a patient again, especially if they refuse an ER visit!

Thanks for the quick response, I think I'll be discussing this with my office manager tomorrow as well. I knew this was overwhelming for a reason.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

It was overwhelming because it was beyond your scope and education. Small offices like to hire people that want to be helpful but do not know what they don't know. Now you know better.

Maybe be proactive create a "triage questionnaire" for the questions & information the doctor or APN always ask you such as med list, last visit to the office. next appointment, last lab tests (and results if recent), last date of stress test, chest xray, ECG, did they take anything (nitro, aspirin, other meds, and did they work) etc. so that when you present the question you can have your sheet ready with the answers. That can always be added to the medical record as back up...

(Hint there is a big difference for a patient with chest pain and a history of angina who didn't bother to take his meds and a patient with angina history who has crushing chest pain and no relief from 3 NTG!) Find out if you can do a 3 way call with 911 if needed when you talk to your office manager. Some patients need you to call for them...

That all helps so much! You have no idea how much I appreciate your courteous response!

Been there,done that, ASN, RN

Has 33 years experience.

This is NOT cardiac nursing. You are a new medical assistant in an office setting, that has thrown you and the patients under a bus.

You can only advise them to call 911. As far as scheduling them for a next day visit. ..will they still be around to do so? Their lives are literally in your hands. Neither you or the patients deserve this .

BuckyBadgerRN, ASN, RN

Specializes in HH, Peds, Rehab, Clinical. Has 4 years experience.

Wow. I am scared for you and the patients on the other end of the phone. SO out of your scope =(

canned_bread

Specializes in Cath lab, acute, community. Has 11 years experience.

My first thing is I am concerned that you have the responsibility of triage. If you give the wrong advice, it falls onto you and your business. Legally, I just wouldn't think it would be allowed.

That aside, sometimes the best you can do is say to the patient "you need to go to a hospital, if someone cannot drive you, call 911". Or simply say "call 911, this is a potentially acute situation even if you don't think it is and we can't help you right now". It is then up to the person as to whether they follow your advice or not. You should pick the light ones that are okay, and you are sure can wait.

The fact that you are struggling with the triaging is also an indicator that perhaps this isn't safe for you to do, you shouldn't be stressing like this. :) I really think you should speak to your manager and explain that you are worried about potential legal ramifications or harming someone, and ask what they would suggest or think. People really trust what you would say, after all.