Episode 6 – Partner’s Triage Process with Dr. Rachael Boyd

Dr. Rachael Boyd is Partner’s Lead Emergency Veterinarian in our Richmond location. She has been practicing ER medicine with a focus on Trauma Medicine for more than 10 years. In this podcast, Dr. Boyd gives us an in-depth explanation on Partner’s Triage Process—an order of treatment that dictates how patients are prioritized in an ER setting.

All emergency hospitals, both human and veterinary, follow this same approach to make sure all patients get the level of care they need as quickly as possible.

What You’ll Learn…

What is Partner’s Triage Process and how it works.
What the different triage levels are and what they mean.
How our triage system benefits pets who come through our hospital.
How the triage process affects wait times and what you as an owner can expect.

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Narrator:

Welcome back to “Did You Know,” a podcast by Partner Veterinary. In this series, we will explore all things veterinary medicine and all things Partner. In each episode, we will answer some of the most common questions we are asked—from HR to emergencies and everything in between. If it happens at Partner, we’ll cover it.

Speaking of emergencies, in this episode, we hear from Dr. Rachel Boyd, Partner’s lead emergency veterinarian in our Richmond location. Dr. Boyd gives us an in-depth explanation of Partner’s triage process—the order of treatment that dictates how patients are prioritized in our ER.

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Dr. Boyd:

“I’m Dr. Rachel Boyd. I’m a 2015 graduate of the Virginia-Maryland Regional College of Veterinary Medicine. I’ve been practicing ER medicine exclusively since graduating, so about 10 years now. I have a focus in trauma medicine, and I currently am the lead emergency veterinarian at Partner. That entails basically advocating for my DVM team, making sure that we can communicate and work well with the specialists who are at our hospital, and that we all have the resources to work appropriately with our team that supports us and our patients every day.”

Jen Mellace:

“Thank you so much for joining us, Dr. Boyd. Partner has a triage process at the hospital. Can you explain what the triage process is and how it works?”

Dr. Boyd:

“Yeah, so triage, in its most basic form, is completing a brief assessment of the patient in front of you in order to determine how urgently they need to be evaluated fully and receive treatment and intervention. At Partner, our triage process is performed by our ER team. When they go in, they collect a history on the patient because often, history is actually half of the equation for us. Then they’ll assess a patient’s vital signs, which includes heart rate, breathing rate, and the effort they’re using to breathe, the patient’s temperature, and some perfusion parameters like how strong their pulses are and how good their capillary refill time is. All patients have those vitals assessed with their history, and then they’re able to determine how urgently that patient needs to be seen by the medical team.”

Jen Mellace:

“What are the different levels of our triage process, and what do they mean?”

Dr. Boyd:

“Here in Richmond, we have five levels of triage assessment. They are labeled in order of how those patients need to be seen. Our triage level one is for patients that need to be seen first by the medical team, whereas our triage level five are the patients that need to be seen last by the medical team.”

“Triage score one patients are the most severe—they are really at an imminent risk of death. These patients are usually struggling to breathe; they may require CPR or some stabilization measures like getting their blood pressure up. These are the most critical patients who often present to our hospital limp, unable to lift their head.”

“Level two triage patients are patients whose condition requires pretty urgent intervention or could decline really rapidly. We often consider patients who’ve been bitten by snakes as level two, because snake bite patients can be stable initially but can decompensate very quickly. Patients who have been hit by a car sometimes can be level two, depending on the strength of the impact. Allergic reactions or toxin ingestions can be considered level twos as well, depending on how the patient presents to the ER.”

“Level three patients are sick but for whom the next few hours are not going to change the course of their illness. A patient who’s been vomiting pretty profoundly all day, they’re mildly dehydrated—they probably need some fluid therapy and medical intervention, but if they have to wait in the waiting room for six, sometimes eight hours, it won’t cost them their life.”

“Level four are patients who really have no immediate risk to life or limb in the immediate 24, sometimes even 48-hour period. Level five are patients who can be seen probably within the next several days, whether by us, by their primary vet, or by an urgent care veterinarian.”

Jen Mellace:

“That’s really helpful, going through the chart and giving examples of each. Is the triage process something other veterinary emergency hospitals employ?”

Dr. Boyd:

“I think to some extent, almost all ERs use a form of triage. They’re going to get the history on a patient—for example, a male cat who hasn’t urinated in a long time or is straining, they’re going to know that’s likely to be a cat with a urethral obstruction, and that’s going to move them to the beginning of their priority list. The difference at Partner is just that we have it very clearly defined. Not all ER facilities are going to have quite as strict of a protocol for which patients fall into which triage level, which types of vital changes and parameters qualify them for which triage level. Those triage levels being so clearly defined help our medical team make sure that we’re providing patient care to the patients who need it most first.”

Jen Mellace:

“How is this beneficial to the pets we care for?”

Dr. Boyd:

“One of the things that everyone has experienced probably in the last several years is that ER departments can become very overwhelmed with the amount of sick pets here in our country in general, but Richmond, particularly where our hospital is, faces that a lot. They may have to close their doors to receiving additional patients, and patients may have to drive several hours to receive care. Our priority is to try and assess where our patients are in their triage acuity so that we can make sure the patients who can’t make a drive or who can’t wait for any further care can receive the care they need. Unfortunately, that means some patients will have to wait a very long time to get care if they have an ear infection or a urinary tract infection, but what it does mean is that we try and prevent pets from suffering or even passing away in transportation to a hospital that’s much farther from us—because that happens every day right now in this country due to ERs just not being able to handle the volume of sick pets.”

Jen Mellace:

“That’s one of my questions—how does this affect wait times for people? Because we do have patients or clients who come into the hospital and end up waiting a long time, which is hard for people to have to wait, but it makes sense that if your pet is not as urgent as others, you might have to wait. How do you explain this, and how can people understand when they come in how they’re going to be put through the triage process and what they can expect?”

Dr. Boyd:

“We try to be really clear with people once they’ve been assessed and we’ve looked at their pets’ vitals where they fall on the triage acuity scoring system so they can have a better idea of the prioritization of their patient. Sometimes people worry that means ‘Okay, my pet is a four or five, that means they’re not important’—and that’s not true at all. We want to get those pets taken care of; we want to get them the pain control, the antibiotics, whatever treatment it is that they need, but we can’t sacrifice the life or well-being of another pet in order to do that.”

“We’re fortunate that our hospital is in a pretty busy area of Richmond, so we often will encourage clients who have a more stable pet—they can sometimes go home for a little bit if they live nearby, they can go to a local restaurant, and we’re happy to watch their pet in the back. We want to make the waiting experience as comfortable as we can, because it can be very long, but we have to make sure that for the pets who need us right away, we have the availability and staff to help them.”

Jen Mellace:

“What would you say is the most important thing clients should know and understand about our triage process?”

Dr. Boyd:

“Understanding where you are in it can be really important because we do have an excellent set of urgent care veterinarians in Richmond that may be opening shortly. If you come in, get your vitals assessed, and we say you’re a four or five and our wait is going to be eight hours, it may make more sense to go to a different urgent care vet where you can be seen a little bit faster. We won’t begrudge anyone for that because if we’re on that extended period of a wait, our staff is focusing on the pets that need the emergency room treatment that we can provide that urgent care can’t.”

“The other thing clients should recognize is that your triage acuity score can change. If you come in and your pet is assessed at a three, and you feel during the time that you’ve been waiting that your pet has declined, that they’re more lethargic, that they’re just not doing well—something’s not sitting right with you—please alert our team. We can actually change your triage acuity score based on changes to their vital signs or how they’re doing in our hospital. Keeping that line of communication open with your medical team is a really important part of triage.”

Jen Mellace:

“That was really helpful. Thank you so much for taking the time to go through this with us, Dr. Boyd.”

Dr. Boyd:

“Absolutely.”

Narrator:

Thank you for listening to “Did You Know.” Is there something about Partner that you want to know? Email us at [email protected]. Who knows? We might turn your question into an entire episode! You can now find us wherever you listen to all of your other favorite podcasts. Subscribe now!

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