Triage tools during Covid-19

Veterinary nurses and receptionists are often on the ‘front line’ when it comes to triaging patients over the phone in practice. However currently, due to Covid-19, many practice teams are working with less team members and some may be adjusting specific roles as a result.

Veterinary nurses are urged to refer to the BVA and RCVS guidance when assessing the need to see patients in practice. 

The British Small Animal Veterinary Association (BSAVA) have released some extremely helpful triage tools for front line veterinary teams to help navigate emergencies during these times.

·          BSAVA TRIAGE TOOLKIT

·          BSAVA TRIAGE TOOLKIT GUIDANCE NOTES

What is defined as an emergency?

“An emergency is an illness or injury that poses an acute threat to life.”

Alongside emergencies, we do also have other conditions which pose a serious welfare risk to the animal if not dealt with relatively urgently.

Examples include;

·          Dyspnoea / airway obstruction

·          Collapse

·          Seizures

·          Patients involved in road traffic accidents

·          Ataxia

·          Acute haemorrhage from orifices

·          Abdominal distension

·          Intoxications (chocolate, rat bait, slug bait, mouldy food waste, Xylitol, bulbs, batteries etc)

·          Foreign body ingestion (socks, pieces of toys, stones etc!)

·          Acute vomiting & diarrhoea (especially in young, old or those with pre-existing comorbidities)

·          Vaginal discharge > Pyometra

·          Dystocia

·          Dysuria, stranguria or anuria (especially in male cats)

·          Anorexic animals

·          Acute lameness

·          Dogs with paraphimosis

·          Fight / bite wounds (due to infection risk)

·          Skin wounds / soft tissue trauma

·          Burns

·          Drowning / water toxicity

·          Gut stasis (rabbits)

·          Head tilt (rabbits)

·          Patients with acute pain of unknown origin

·          Bee / wasp stings / anaphylactic reactions

·          Fading puppy / kittens

·          Heat stroke

When an owner phones, it is important to remain calm. Key bits of information to obtain straight away include;

·          Their name

·          Their pets name

·          Contact number (in case they get cut off!)

This also enables us to read the clinical history for anything of significance.

Ask them when the problem started and when their pet was last normal – how far from ‘normal’ are they right now?

Consider the use of smart phones as this may be useful. You could ask the owner to send you a photo or video of what is happening to help you gauge the severity of the situation. Once you have obtained the history and signalment from the owner, touch base with your Vet to ascertain the most appropriate time for them to arrive depending on the nature of the emergency.

Before you end the phone call ensure you double check with the owner which practice branch they should travel to, as their usual branch may be closed.

At this point it is worth informing the owners briefly of the social distancing requirements currently in place.

·          Advise them that you will be taking their pet away from them to triage & assess inside the practice.

·          It will depend on your practices specific protocol as to at what point the consent form is signed, some practices will do this pre-triage and others once the assessment has taken place.

·          For canine patients, ask the owners to leave them in the car, but to ring the practice upon arrival. Once prepared and donning your PPE, collect the patient from the car using a clean practice lead (carry with a colleague/stretcher if non-ambulatory) whilst the owner keeps their distance.

·          With feline or small furry patients, ask the owner to ring to let you know they have arrived and request they leave the pet carrier at the front door.

·          To minimise client contact card payments can be taken over the phone either before or after the consultation. Cash payments are best avoided.

Prior to the patient arriving, prepare for the emergency to the best of your ability by gathering equipment and materials you feel this patient may need. Usually the minimum to prepare is;

•               IV catheter kit

•               Breathing system & mask to provide oxygen

•               Comfortable bed

•               Patient monitoring forms

•               Patient monitoring equipment

•               IV fluid therapy set, drip pump & bag of fluids

•               +/- Patient warming devices

•               +/- Minimum database blood tubes (PCV, TP, Electrolytes, Glucose & Urea)

•               Prime & turn on diagnostic laboratory machines / diagnostic imaging equipment

If your nurse initiative prompts you that it may well be a surgical emergency (such as a gastric dilatation & volvulus), prepare the surgical environment & equipment.

Once you have collected the patient from the owner, they should remain outside whilst the full assessment takes place.

The BVA has issued advice on how owners should take precautions when handling or transporting their animals when owners are self-isolating due to having symptoms of Covid-19;

·          Restrict contact with pets as a precautionary animal health measure until more information is known about the virus.

·          If your pet requires care, wash your hands before and after any interaction with them and wear a face mask if possible.

·          Keep cats indoors if possible and try to arrange for someone else to exercise dogs, taking care to restrict any contact with the person walking your dog and making sure they practice good hygiene. This is to reduce the likelihood of your pet spreading the disease through environmental contamination on their fur – there is no evidence that pet animals play a role in the spread of the disease.

·          If your pet shows clinical signs of Covid-19, please do not take it to the vet but call the practice for advice.

·          If your pet requires emergency treatment, call the practice for further advice.

·          Do not take your pet to the surgery unless the vet instructs you to.

·          You may need to arrange for someone else to transport your pet for treatment.

Owners can also be signposted to up to date advice from the BVA here

Article written by Lou Northway CertVNECC NCert(Anaesth) RVN.

Further reading, references & other useful resources:

Aldridge, P. & O'Dwyer, L., 2013. Triage & assessment of the veterinary patient. In: Practical emergency & critical care for Veterinary Nurses. Chichester: John Wiley & Sons, pp. 1-8.

TVM UK toxin triage sheet

Triage tools for Veterinary Teams

Guidance notes for the triage tool kit

RCVS Code of professional conduct : 3. 24-hour emergency first aid and pain relief

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