Reverse triage in COVID surge planning: a case study of an allied health supported clinical care pathway in an acute hospital setting
Toni Dianne Withiel
A * , Rachel Blance-Palmer A D , Cassandra Plant B , Genevieve Juj A , Carly Louise McConnell A , Melissa Kate Rixon A , Mark Putland C , Nicola Walsham C and Marlena Klaic D
A Allied Health, Royal Melbourne Hospital, Melbourne, Vic., Australia.
B Allied Health, Royal Darwin Hospital, Darwin, NT, Australia.
C Department of Emergency Medicine, Royal Melbourne Hospital, Vic., Australia.
D Melbourne School of Health Sciences, University of Melbourne, Melbourne, Vic., Australia.
Australian Health Review 47(4) 456-462 https://doi.org/10.1071/AH22084
Submitted: 1 April 2022 Accepted: 25 April 2023 Published: 15 May 2023
Abstract
This case study describes the development and outcomes of a new integrated and multidisciplinary care pathway. Spearheaded by allied health, the ‘COVID community navigator team’, applied established principles of reverse triage to create additional surge capacity.
A retrospective cohort study examined workflow patterns using electronic medical records of patients who received navigator input at the Royal Melbourne Hospital between 20 September 2021 and 20 December 2021.
There were 437 eligible patient encounters identified. On average patients stayed 4.15 h in the emergency departments (ED) (s.d. = 4.31) and 9.5 h (s.d. = 10.9) in the short stay unit. Most patients were discharged into a ‘low risk pathway’ with community general practitioner follow up. Of discharged patients, only 38 re-presented to the ED with symptoms related to their initial COVID-19 diagnosis (34.9% of total re-admissions). Of these re-admissions, more than half did not require admission to a ward.
The findings presented here provide support for the clinical utility of a multidisciplinary reverse triage approach in surge planning for anticipated presentation peaks.
Keywords: allied health, case study, clinical pathways, clinical services, COVID-19, health services research, models of care, triage.
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