Training activity information
Details
Triage incoming referrals
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Prioritisation and escalation
- Clinical urgency based on symptoms associated with cerebrovascular disease
- Managing inappropriate referrals
- The stroke and TIA patient pathway
- Alternative imaging investigations for cerebrovascular disease
- Advantages and disadvantages of CTA, MRA and angiography
- Clinical presentation of cerebrovascular disease
- Local and national guidelines
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to effectively planning and preparing to undertake upper limb nerve conduction studies, specifically the expectations for reviewing and triaging referrals for extracranial cerebrovascular scans.
- Consider how the learning outcomes apply, specifically in relation to reviewing and triaging referrals for extracranial cerebrovascular scans, and appraising the impact of research evidence on national guidelines.
- Discuss with your training officer to gain clarity of what is expected of you in relation to expectations for equipment setup, patient flow logistics, and integrating necessary safety protocols, specifically the expectations for effective referral triage.
What is your prior experience of this activity?
- Think about what you already know about planning medical procedures or preparing clinical rooms, specifically triaging referrals.
- Consider possible challenges you might face during the activity, such as logistical issues with moving NCS equipment, ensuring necessary resources (e.g., limb temperature monitors) are available, or understanding procedural requirements, specifically ambiguous referral information, urgent cases.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if the complexity of the planned study requires specialised equipment or protocols not covered in routine procedure, or if unclear guidelines necessitate clarification regarding urgency assignment.
- Acknowledge how you feel about triaging referrals received.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as planning complex clinical procedures, specifically critical review of clinical data, drawing upon previous experiences of the activity.
- Identify the specific insights you hope to gain into the detailed requirements for upper limb NCS planning, including patient flow, equipment setup, and integrating safety protocols, specifically effective referral triage.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of similar planning or preparation activities, specifically triaging referrals.
- Identify important information you need to consider before embarking on the activity, such as reviewing the anatomy of upper limb nerves (median, ulnar, radial) and the procedures for motor/sensory nerve conduction studies, as this knowledge is foundational for planning, specifically specific guidelines.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst reviewing the incoming referrals?
- Are you encountering situations such as:
- Conflicting information where the urgency marked on the referral contradicts the stated clinical symptoms (e.g., highly symptomatic Transient Ischemic Attack (TIA) marked as routine)?
- An unusual or ambiguous referral that felt surprising or different from what you anticipated, complicating the assessment of clinical priority?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding appropriately to the situation when encountering an unusual or ambiguous referral? Are you adapting or changing your approach to seeking additional information or escalating the referral?
- Consider the steps you are taking in the moment, such as:
- Immediately documenting the ambiguity and contacting the referrer to obtain clarification on the urgency status.
- Halting the triage process to consult departmental guidelines regarding urgent extracranial cerebrovascular criteria.
- How are you feeling in that moment? For instance, are you finding it difficult to adapt to the unexpected nature of the referral? Is it affecting your confidence in accurately triaging the referral?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully re-prioritising the patient’s appointment time based on verbal clinical clarification? Or are you needing support because the ambiguous clinical details require senior sign-off before a high-risk triage category can be assigned?
- What are you learning as a result of the unexpected development? For example, are you mastering a more efficient technique for vetting the completeness of a referral form? Or gaining insight into the critical factors that define urgent vs. routine extracranial referrals?
On action
What happened?
- Begin by summarising the key steps you took when reviewing and triaging incoming referrals for extracranial cerebrovascular scans.
- Consider specific events, actions, or interactions which felt important, such as how you ensured the clinical details matched the urgency rating or how you initiated contact with the referrer to clarify ambiguous information.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately elevating the priority of a routine referral when the clinical symptoms suggested acute limb ischaemia, complicating the initial triage decision.
- How did you feel during this experience, e.g., did you feel stressed by the logistical challenge or confident in your knowledge of triage guidelines?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding referral triage. What strengths did you demonstrate, e.g., meticulous attention to detail in cross-referencing clinical symptoms against procedural expectations?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific departmental criteria for escalating critical extracranial referrals?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in triaging referrals?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding escalating a referral due to ambiguous clinical details, and how you reacted to this.
- Acknowledge any changes in your own feelings now that you are looking back on the experience.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving the efficiency and documentation of your triage decisions.
- What will you do differently next time you approach referral triage, for instance, by proactively structuring a template for documenting conversations with referrers to clarify conflicting information?
- Do you need to practise any aspect of the activity further, such as reviewing the common presentations of cerebrovascular disease or key learning outcomes related to managing risk in test preparation?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of triaging extracranial cerebrovascular referrals since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent urgent case required immediate clinical escalation due to acute TIA symptoms forced you to re-evaluate the diligence of your initial pre-planning risk assessment checklist during your first attempt at this training activity.
- Considering what you understand about clinical urgency criteria, risk management, and national TIA guidelines now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your referral triage process based on further learning and experiences? For example, how you proactively reviewed and integrated the departmental guidelines for communicating with referrers about missing clinical information based on further learning.
- Has discussing unexpected delays due to poor clinical history on the referral form or the impact of inappropriate triage on patient flow with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a time when incorrect urgency classification caused a delay refined your understanding of the critical nature of pre-activity clinical verification during planning.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent triage experiences, contributed to your overall confidence and competence in reviewing and triaging referrals for extracranial cerebrovascular scans, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in rapidly ensuring all required clinical information is vetted now enables you to confidently discuss urgent management pathways during a CBD assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to triage incoming referrals? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice immediately when ambiguous clinical details suggest a potential dissection that requires senior sign-off before scheduling, recognising this falls outside routine triage scope.
- Looking holistically at your training journey, how has this initial triage incoming referrals experience, revisited with your current perspective, contributed to your development in meeting the objectives related to reviewing and triaging referrals? For example, how this foundational experience has supported your development in recognising and communicating clinical urgency.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Review and triage referrals for extracranial cerebrovascular scans. |
| # 7 |
Outcome
Appraise the impact of research evidence on national guidelines. |
| # 9 |
Outcome
Summarise surgical and endovascular interventions performed for carotid disease. |
| # 10 |
Outcome
Describe the potential risks and benefits associated with intervention. |