Katie Pedwell and Rob Carmichael

1. TELEPHONE TRIAGE –
WHY IS MY EYE RED?
KATIE PEDWELL & ROB CARMICHAEL
UNIVERSITY HOSPITALS OF BIRMINGHAM NHS FOUNDATION TRUST

2. TELEPHONE TRIAGE
• Definition
• Principles
• Risks
• Audit
• Scenarios – What would you do ?

3. DEFINITION
‘Prioritising clients health problems according to their urgency, educating and advising clients and
making safe, effective and appropriate decisions’
Pygall (2017)

4. PRINCIPLES
Accessible to expert advice
Convenient, patient’s can ring from work or home Interpret symptoms and answers to
carefully structured questions to determine the severity of the condition
Opportunity for patient education and empowerment
Recommend patients to an appropriate level of health care or self-management or other
health professionals/levels of care

5. PRINCIPLES
• Cost saving to patient and service avoids need for hospital review appointments
• Efficient use of resources, managing workload
• Managing compliance to long term conditions
• Clarity over when, where and by whom to be seen
• Patient should be satisfied with the outcome

6. RISKS
• Training and competency ability to ask the right questions
• Accuracy of information obtained
• Poor communication – patients may not see the relevance of the questions or language
barrier /hard of hearing
• Confirm understanding
• Documentation – good record keeping

7. REDUCE RISK
• Local departmental protocols and guidelines
• Clinical supervision
• Proforma for recording calls and outcomes
• Audit

8. PRESENTING COMPLAINTS
• Red eye
• Visual disturbance
• Pain
• Trauma
• Reduced vision

9. OPD TRIAGE
25%
35%
13%
27%
Number of Patients
Medication
post Surgery
Ref to A&E
Appt

10. SCENARIOS

11. ADA
• 78 year old female
• On a ‘relaxing’ holiday with
her family
• Phones local eye casualty unit
as her eye is red and sore…
• That’s all you’ve got!
green for routine review
yellow for rapid review (i.e. rapid access clinics)
red for immediate review

12. ANTERIOR SCLERITIS
• First onset?
• Duration of pain?
• Nature of pain?
• Past medical history?
• Family medical history?
• New systemic symptoms?
• Clinic review to exclude underlying disease
– but how soon?

13. MICKEY
• 28 y/o male
• Normally fit and well
• “Work hard, play hard – know what I
mean?”
• Brother’s stag do about 12 weeks ago.
green for routine review
yellow for rapid review (i.e. rapid access clinics)
red for immediate review

14. CHLAMYDIAL
CONJUNCTIVITIS
• Preauricular lymph enlargement
• Sexual history
• Male  urethritis
• Female  vaginal discharge
• Clinic r/v required: needs slit lamp
examination for evidence of follicles,
conjunctival sample for confirmation.
• 2’ uveitis if left untreated - when do
you see?
This Photo by Unknown Author is licensed under CC BY-SA

15. KALPANA
• 55 y/o female
• Already known to clinic –
BRVO
• Being treated with anti-
VEGF
• Anti-hypertensives
• Apixaban
green for routine review
yellow for rapid review (i.e. rapid access clinics)
red for immediate review

16. SUB
CONJUNCTIVAL
HAEMORRHAGE
• Medications
• Medical history
• Valsalva’s manoeuvre
• No pain.
• No drop inVA.
• Foreign body sensation –
chemosis?
• Review?

17. CLINT
• 87 y/o male
• Resides in care home
• Previous CVA – has dysphasia
• Care home staff have called as
concerned about some ‘nasty
stickiness’ around the eyes
• POH – Glaucoma,
pseudophakia
• Can you “make his day?”*
• *Sorry…
green for routine review
yellow for rapid review (i.e. rapid access clinics)
red for immediate review

18. ENTROPION
• FB sensation
• Redness and pain
• Epiphora
• Mucous discharge and eyelid crusting
• 3rd party history – tread carefully.
• Ascertain behaviours from 3rd party if
patient unable to articulate.
• Poor and vague history  oculoplastics
review. How soon? This Photo by Unknown Author is licensed under CC BY

19. COULD BE WORSE…IT COULD BE THE RARELY SPOTTED “OH MY
LIFE WHAT ON EARTH ARETHEY DOING?!” AUTO-INDUCED
POSTERIOR SEGMENT ENTROPION

20. AL
• 45 y/o male.
• Discharged previous day following day case
orthopaedic surgery under GA
• Eye increasingly sore overnight.
This Photo by Unknown Author is licensed under CC BY-SA-NC
green for routine review
yellow for rapid review (i.e. rapid access clinics)
red for immediate review

21. CORNEAL ABRASION
• Acute onset
• Significant pain
• Swollen upper lid
• Consider environment
• Prompt review to assess cornea and
commence treatment

22. ESME
• 39 y/o female
• No PMH
• Distressed when she phones
your department and talks to
you
green for routine review
yellow for rapid review (i.e. rapid access clinics)
red for immediate review

23. ACUTE ANGLE CLOSURE GLAUCOMA
• Pain – severity? Rapidity?
• Vision – cloudy?
• Visual symptoms – halos?
• Red eye?
• When do you see?

24. BOB
• 54 y/o male.
• Relatively new to the department –
recently diagnosed with glaucoma.
• “Don’t feel like there’s anything
wrong!”
• Initially commenced on latanoprost –
IOP control not optimal.
• Started new drops 2 days ago.
• Also has blepharitis
green for routine review
yellow for rapid review (i.e. rapid access clinics)
red for immediate review

25. ALLERGIC REACTION
• Consider conjunctivitis type symptoms –
swelling of lids; erythema; epiphora;
irritation.
• Onset?
• Environment?
• Change in agent?
• Urgency of review – variable, depending
upon cause of reaction.
• When would you bring Bob back?

26. CONCLUSION
‘Processes undertaken by experts tend to look easy – experts make it so’
Marsden (2008)