The default triage rule in most practices is first-in-first-out. It is fair-feeling and indefensible. The first person on the list is rarely the person who should be admitted next. Triage is a clinical-and-operational decision; treating it as a queue empties it of the judgement it requires.
Clinical urgency
Some referrals carry safeguarding or developmental urgency that cannot wait. Children in early-intervention windows where a six-month delay is materially worse than a three-month one. Adults with regression risk. These come first, full stop. Document why, so the rest of the team understands.
Capacity to engage
If a family is in housing crisis, a fortnightly therapy session is unlikely to land. Bringing them in too early can damage the relationship and burn a clinician's caseload slot for low yield. Prioritise referrals who have the bandwidth to actually use the service. Park the others gently — confirm interest in two months.
Geographic fit
Two referrals with similar urgency: prefer the one inside your existing cluster. The one inside the cluster will get four sessions in the time the outlier gets three, and your clinician finishes the day less drained. This is operational, not clinical, and the trade-off should be visible.
Discipline match
Take the referrals you can serve well. A referral for paediatric speech therapy when your only speech path is on parental leave is a referral that should be redirected, not held. Be honest with referrers about your real capacity by discipline.
Plan timing
For NDIS-funded participants, plan timing matters. A participant with three months left on their plan and untouched therapy budget has a different urgency to one whose plan was just renewed. Build it into your triage decision explicitly, not implicitly.
Document the call
Whatever criterion you use, write it down on the client record. 'Admitted ahead of the queue because of paediatric urgency window' is two seconds of documentation that pays back the next time someone questions the order.