eTriage: A new patient check-in and triage tool for UHB’s Emergency Departments

Why do we need digital check in when receptionists are here to do that?

eTriage does check patients in, but the main reason we are incorporating the tool into our emergency departments is because it will help triage patients quickly, taking pressure off our nursing and medical teams. The tool will provide a provisional priority score for patients based on their symptoms, which will be checked and verified by the triage nurse. The tool provides clinical teams with background information that also helps when it is a patient’s time to be seen. These sorts of tools are used widely in the NHS, from GP surgeries through to acute care providers.

There are, however, a number of patients who will not be able to use the tool, for example pregnant women, patients with language barriers, patients who have a visual impairment, patients with certain learning difficulties and patients who are not familiar with using touch screen devices. All of these patients will need to go through the usual process of being checked in by a receptionist, along with patients whose details cannot be found on the NHS Spine.

Will we get lots of questions about how to use the tool? What if we don’t know how to answer them?

When eTriage goes live in your emergency department, the eTriage project team will be on-hand in the department to help with any issues. You will also have details of the team displayed in your staff areas should you need to contact them after the initial go-live period. Any recurring queries will be addressed – this could include further training, improved signage, or changes to the tool, depending on the need.

Isn’t this just another Ask A&E? These tools never seem to work in the long term.

eTriage is different from ask A&E because it is used as an aid in clinical decision making to identify the highest and lowest acuity patients. Ask A&E was used to inform patients of the best place to get care, and to advise on whether A&E was right for them. The system is also integrated with our existing clinical systems (PAS and PICS). eTriage is already used in a number of NHS Emergency Departments in the UK and has been proven to have positive outcomes to date.

Will Solihull, Heartlands and Good Hope ED get eTriage?

Yes, eTriage will go live at QE in April. Once the system is live and teams in ED at QEHB are comfortable, we will look focus on Solihull, Heartlands and Good Hope. Please be assured we will give teams advance notice and will ensure plenty of time for training and testing. We are doing a phased approach to ensure we can properly support you on the ground for the first few weeks after going live.

How many iPads will there be at QEHB?

To begin with we will trial having four iPads in the main ED waiting room at QEHB, and four in the EDAA waiting room at QEHB. We have the potential to increase this to six, however based on the data we have on numbers coming through these areas and the time it will take to use eTriage, we believe this will be sufficient. We will review this once we are live with the tool.

Will eTriage be available in other languages?

eTriage is only currently available in English. The eTriage team is working on making it available in other languages and a pilot is currently underway in Wales (with Welsh language displayed). The challenge is ensuring free text information can be accurately translated for our clinicians.

I work on reception in ED. Is my job at risk?

No, you are an absolutely integral part of ED. Whilst eTriage will lighten your load in terms of volumes of patients you need to manually check in; there are still cohorts of patients that won’t be able to use the tool. We hope that e-Triage will help to improve your experience at work by taking some of the pressure off and allowing you to focus on other tasks, for example ensuring patients have the right emergency contact details.

People coming to ED struggle to fill out forms – how will this be any different?

Most healthcare settings now have some element of digital information gathering – even if it’s just checking in for an outpatient appointment. Patients may find the tool easier than filling out a form as it will ask specific questions, some of which they can just answer ‘yes’ and ‘no’ to. There will of course always be people who cannot, or do not want to, use a digital device, but feedback from other trusts that have eTriage in their EDs is that 85% of patients are happy to use it.

How does eTriage work out the priority score?

eTriage uses the Manchester Triage System, an NHS approved and one of Europe’s most-used systems.

How will we know if there is a safeguarding issue?

You should continue to follow existing processes to check for safeguarding issues. For example, triage nurses will be able to identify any concerns when they triage the patient. Receptionists will still have visibility of who is registering for the purposes of CPIS checks for paediatric patients.

Will patients be able to see what information others are inputting to the iPads? Is it a confidentiality risk?

The iPads are spaced apart to minimise the risk of any ‘over-the-shoulder’ unintentional data sharing. Additionally, there is a timeout on the system to protect confidentiality if a patient leaves the kiosk. The system is expected to promote better confidentiality and privacy than the current method of verbal communication at registration. If you spot anything concerning, please raise with your manager.

What will happen to patients who self-discharge?

The usual process will apply.

Once a patient has booked in on eTriage, how are the wristbands and CAS cards printed?

CAS cards are no longer printed, following a recent change in January 2024. Wristbands should be printed as normal and given to the triage nurse. PRTM will tell you once a patient has registered on eTriage

If patients update their details on eTriage and it doesn’t update it on the spine, how will they know to go to reception to ensure the spine is updated?

If a patient enters details which match with the spine, then the spine is correct, and they won’t need to go to reception. If their details do not match the spine, eTriage will immediately tell them to go to reception. In this case, follow the normal process for updating the patient’s details.

If NOK is updated on eTriage does it remove the old NOK so they are not contacted by mistake?

No; emergency contact information provided on eTriage does not automatically update in Oceano. When you complete the patient’s registration in PICS, you should also manually check that their emergency contact information in Oceano matches what was entered on eTriage and update it if not. You shouldn’t remove the old NOK, as the question asked by eTriage is related to emergency contact.

What happens if a patient has an issue with more than one body part? Would they have to go through eTriage again?

No; they will answer the questions with their first issue, then there is an opportunity at the end of the questions to add anything they haven’t previously mentioned.

What do overseas patients do as they won’t have a postcode?

eTriage won’t be able to find a match, so it will tell the patient to go to reception to register in the normal way.

How are staff going to explain to patients why people who arrived after them are being seen first? This could make patients angry

We will support with clear messaging in the department around patient priority and this will be reinforced by clinical colleagues. ED has always prioritised the most unwell patients - so this is nothing new – but we appreciate people will be upset if they feel others are being seen before them. There will also be security present in the department (as normal).