Practice response to threats
When someone with a clinically significant transmissible microbial infection (eg a relevant respiratory, skin or gastrointestinal infection) has visited the practice, appropriate infection prevention and control measures (standard and transmission-based precautions) must be implemented to prevent the spread of disease (see 5. Levels of precautions).
Reception and triage
Practice staff must receive training to recognise symptoms and signs of potentially infectious disease and to respond appropriately. The practice’s infection prevention and control program coordinator is responsible for providing or arranging education and training for each staff member, as appropriate to their role.
It is critical to involve reception staff in identifying risks of microbial transmission and train them to alert the designated person on duty (eg a primary care nurse or GP) immediately.
Triage in general practices and other office- and community-based practices includes:
- routine triage
- questions asked when the patient indicates signs or symptoms consistent with an infectious disease
- questions asked of patients when the practice suspects a localised outbreak of an infectious disease (eg measles) or when the practice is part of a response to a pandemic (eg providing a GP respiratory clinic).
Staff must know how and when to use standard and transmission-based precautions (see 5. Levels of precaution) to protect themselves and other patients, especially in the event of a disease outbreak. Staff must also receive training in how best to explain to patients why precautions are being taken and to reassure patients that precautions are for everyone’s benefit.
Patient privacy must be considered and respected when asking questions while booking an appointment. However, a few non-intrusive questions can elicit information that is very useful in planning for the patient’s arrival and care within the practice.
When booking patient appointments, reception staff can ask a general question about the reason for the consultation. If a patient indicates that they have a fever, a rash, a cough, diarrhoea or an infectious disease, it is appropriate to ask more questions. The receptionist could explain that the reason for asking is to help the doctors provide the right care.
If the patient does not offer information about possible infection, the receptionist should ask a series of routine questions, after explaining the reason. Practices may wish to develop a script or question sheet for the clerical staff to use for this purpose. For example:
Would you mind if I asked a few more questions to help our doctors?
- Do you have a fever?
- Do you have a cough?
- Do you have a rash?
- Do you have diarrhoea or vomiting?
- Have you been overseas recently? (if so, where?)
- Have you recently had contact with someone who has an infectious disease?
The answers could be recorded and passed on to the doctor (without delay, if necessary based on risk).
Prioritisation of patients: a guide to urgency for non-clinical staff (POPGUNS) is a widely used triage process in general practices. POPGUNS has been adapted by Primary Health Networks into clear fact sheets for staff use and can be located on PHN websites (for example, Adelaide PHN’s POPGUNS Triage Process).
⚠ Reception staff training should ensure that care is not delayed for patients with potentially life-threatening conditions such as meningococcal disease or acute asthma exacerbations.
Triage during an infectious disease outbreak
The practice must plan for and establish policies to be implemented in the event that a localised outbreak of an infectious disease occurs, or when the practice is part of a response to a suspected or known epidemic/pandemic (eg avian influenza). In a pandemic, such as COVID-19, policy will be guided by continually updated local and national guidelines provided by health authorities and supported by advice from RACGP.
All staff must be trained in and familiar with these policies, and continue to receive updates as the policies change over time.
During an infectious disease outbreak, triage at reception will include specific questions, for example:
Our doctors have asked us to ask all patients a few questions.
Have you been exposed to anyone with chicken pox or shingles in the past 3 weeks?
Have you recently returned from overseas?
If infection risk is identified, staff must take appropriate precautions by following established protocols according to the type and degree of risk (eg arranging a telehealth consultation or pre-consultation phone call from a doctor, or by implementing transmission-based precautions when the patient attends) (see Transmission-based precautions).
When booking an appointment for a patient with a potentially infectious disease, consider offering a telehealth consultation, or a time when there are fewer patients present (eg at the end of a session). During a disease outbreak (including pandemics), consider booking such patients to a designated doctor in a designated separate room – preferably with separate entrance/exit to the main surgery.
During respiratory outbreaks, respiratory clinics are set up in each state and territory. These clinics are specifically staffed, equipped and designed to provide care for patients with significant communicable respiratory infections. Ensure staff have details of the locations of these clinics and encourage patients to attend them in preference to attending the practice.
Consider having a properly protected staff member triaging patients as they arrive at the practice and before they enter. This staff member’s role is to explain to patients the precautions being taken and only permit entry those who meet entry criteria (eg those will wear a mask and agree to segregation, preferably in a designated room with a separate entrance/exit), and when the healthcare worker is ready to see them. Risk may be reduced by consulting outdoors.
During an outbreak, practices may set up extra protocols to prevent contact between patients, such as asking patients to wait in their car or outside before being called into their consultation, to avoid mingling in the waiting area and further protect patients and reception staff. Practices may be supported to provide enhanced telehealth options, and health authorities may set up special services (eg COVID-19 virtual hospitals), to avoid the need for patients to visit general practices.
Communication of infection prevention and control information to patients
Practices could consider:
- posting a sign at the entrance to the practice and another at reception, informing patients of any significant infections that are currently circulating and asking them to tell the receptionist if they have symptoms of a possible infection
- recording a telephone message for patients on hold, asking them to let the receptionist know if they think they may have an infectious disease, and advising that they may be asked questions about their symptoms
- displaying information about infection prevention (eg current local infection outbreaks) on the front door, practice notice board, the practice website, or information sheets
- displaying posters on prevention of infectious disease transmission in waiting areas.
These strategies can be adjusted according to current risk.
Practices must consider how to communicate infection prevention and control information to patients from culturally and linguistic diverse backgrounds, or those with a communication impairment. This could include the use of interpreters or translated information.