Resources developed to aid telephone triage of colic cases in horses

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Flank watching is a classic sign of colic.
Flank watching is a classic sign of colic. © University of Nottingham

Authors of a British study which explored the telephone triage of colic cases went on to develop resources to help veterinary clinic staff with the incoming calls.

Katie Lightfoot and her colleagues at the University of Nottingham noted that telephone triage is an integral part of modern patient care in human medicine, and a key component of veterinary practice care systems.

However, they found there was no published research on telephone triage within the veterinary profession.

The study team set out to investigate current approaches to telephone triage of horses with suspected colic in veterinary practices and to develop new resources to support decision-making.

An online survey was developed targeting veterinary staff at practices who took telephone calls from horse owners during normal working hours.

In all, the responses of 116 people were used in the final analysis. Half were veterinary surgeons, a quarter were members of client care teams, 18% were management staff, and 4% were veterinary nurses.

The flow chart which forms part of the colic telephone triage resources.
The flow chart which forms part of the colic telephone triage resources.

Management and client care staff felt less confident giving owner advice and recognising critical colic indicators compared to veterinary surgeons and nurses, the researchers reported.

Those employed within a client care role took significantly more calls associated with colic when compared to those employed in a clinical role.

Contradictory advice was noted on several occasions, the study team reported.

“Advice would frequently not be given to owners, with ten participants, all undertaking a client care role within practice, stating that this was not their responsibility.”

Evidence-based materials were developed by the researchers to provide current information about equine colic and support decision-making by those routinely taking telephone calls from horse owners. They took into account the systems used in human telephone triage and factored in how the staff at clinics handled colic-related calls.

The resources included an information pack, a recording form to document information during telephone calls, and a decision-making flow chart.

Four client care teams working within East Midlands veterinary practices were recruited to employ the resources and provided feedback.

They were interviewed before the resources were rolled out, and again six months later.

“The new resources received positive feedback; the decision flow chart and information on critical indicators were identified as most useful,” the researchers reported.

“After resource implementation, there was an increase in confidence in recognising critical cases and giving owners advice.”

Discussing their findings, the study team said the results show that the telephone triage of colic cases, and the identification of potentially critical cases, is currently unstandardised within British equine practices.

“Information that could potentially impact delays in treatment, such as the insurance status of the horse and access to equine transportation, were rarely queried during an initial telephone call with an owner.

“Though client care [staff], rather than clinically trained employees, managed the majority of telephone calls within practice, some reported that they felt unconfident providing advice to owners and identifying potentially critical cases.”

The survey that kicked off the study revealed that while 62% of those employed in a client care role felt they were very important in the triage of calls, a further 30% suggested that this was not their responsibility.

“It is reasonable to suggest that client care teams may inadvertently perform some degree of telephone triage, despite role uncertainty,” the authors said.

“These results highlight the need for industry stakeholders to recognise the complex, and often unsupported, role that client care teams perform in veterinary practice”

Being the first point of emergency contact for animal owners can often be challenging for client care personnel, they said.

“Therefore, more should be done to ensure these team members are sufficiently supported during times of uncertainty, through the implementation of formal training and standardised protocols.”

The study team said that while the resources were viewed positively by the client care teams that tried them, factors such as computerised booking systems, owner familiarity and practice protocols were potential barriers to implementation.

The resources developed in the study have been made freely available through the British Equine Veterinary Association website, so they can be used in their current form, or adapted by veterinary practices to suit their individual requirements.

The study team comprised Lightfoot, John Burford, Gary England, Mark Bowen and Sarah Freeman, all with the School of Veterinary Medicine and Science at the University of Nottingham.

Lightfoot KL, Burford JH, England GCW, Bowen IM, Freeman SL (2020) Mixed methods investigation of the use of telephone triage within UK veterinary practices for horses with abdominal pain: A Participatory action research study. PLoS ONE 15(9): e0238874. https://doi.org/10.1371/journal.pone.0238874

The study, published under a Creative Commons License, can be read here.

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