Agree you have to practice with caution. And the well being of the patient needs to come first. I may be digressing from the discussion but I believe its worth kicking the tires on this. The front office needs to develop the skill to discern between a complaint that can be life threatening from one that is not. From my perspective the "RED FLAG LIST" ain't that long and should be both memorized by the front office staff and posted in the front office. Also the policy should not IMHO be one that captures every penny owed. Having such a rigid policy will lead to problems. There should be flexibility based on each individual case. This being said I believe the majority of those who owe are not Red Flag Cases. Also when a patient can not be seen for what ever reason. You should not turn the patient away but offer an alternative such as presenting to the ER/Urgent care, or a discounted cash clinic with caveat being that if it is a red flag issue you inform the patient that their symptoms may represent a life threatening condition and they should present to ER immediately and offer them to call 911 on their behalf. If the patient is an established patient the office should follow up to insure patient has presented to ER. So for instance when a patient calls to schedule all "Red Flag Issues" are not scheduled but referred to ER right there and then. So if a patient wants to schedule for chest pain, acute neurological symptoms, acute headaches, new onset abdominal pelvic pain and yes fevers in children which can't be seen that day, we refer those and all other Red Flag issues to ER.
Maybe we are saying the same thing, but a receptionist or any other front staff cannot be trained to do triage. Even if they are triage capable, the triage cases should follow the same route --> to the triage nurse working with the doctor who work together to make those decisions.
Our flow is that when a patient calls the office, the patient is always allowed an appointment either that day or at a subsequent day if they desire. This is a definite for any patient up to 11 am (in other words I do not want someone calling at 8:30 am and being told we can't see them. We also see any baby up to six months if a parent deems it necessary. Most of the time the parent will know if they want an appointment, but if it is questionable either they or our receptionist will message the triage specialist, CMA, who then gets back to the patient. Anything she advises the patient is sent to me for final approval. Or she sends it to me for direction. The triage nurse, as she is referred to, can make triage decisions, but the patient can still ask for an appointment. Obviously, if we can't fit them in, we refer them to the ED or give them instructions with advice to go directly to the ED or page me if the patient gets worse.
There is absolutely no way our receptionist is going to keep that patient who did not need to be seen away from the window based on her experience level. Plus, we do not want several people doing triage. Not to knock or belittle any other speciality, it is more difficult to triage the little ones. And, parents expect way more, trust me.
