RT Journal Article
SR Electronic
T1 Telephone triage systems in UK general practice: analysis of consultation duration during the index day in a pragmatic randomised controlled trial
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e214
OP e218
DO 10.3399/bjgp16X684001
VO 66
IS 644
A1 Tim A Holt
A1 Emily Fletcher
A1 Fiona Warren
A1 Suzanne Richards
A1 Chris Salisbury
A1 Raff Calitri
A1 Colin Green
A1 Rod Taylor
A1 David A Richards
A1 Anna Varley
A1 John Campbell
YR 2016
UL http://bjgp.org/content/66/644/e214.abstract
AB Background Telephone triage is an increasingly common means of handling requests for same-day appointments in general practice.Aim To determine whether telephone triage (GP-led or nurse-led) reduces clinician–patient contact time on the day of the request (the index day), compared with usual care.Design and setting A total of 42 practices in England recruited to the ESTEEM trial.Method Duration of initial contact (following the appointment request) was measured for all ESTEEM trial patients consenting to case notes review, and that of a sample of subsequent face-to-face consultations, to produce composite estimates of overall clinician time during the index day.Results Data were available from 16 711 initial clinician–patient contacts, plus 1290 GP, and 176 nurse face-to-face consultations. The mean (standard deviation) duration of initial contacts in each arm was: GP triage 4.0 (2.8) minutes; nurse triage 6.6 (3.8) minutes; and usual care 9.5 (5.0) minutes. Estimated overall contact duration (including subsequent contacts on the same day) was 10.3 minutes for GP triage, 14.8 minutes for nurse triage, and 9.6 minutes for usual care. In nurse triage, more than half the duration of clinician contact (7.7 minutes) was with a GP. This was less than the 9.0 minutes of GP time used in GP triage.Conclusion Telephone triage is not associated with a reduction in overall clinician contact time during the index day. Nurse-led triage is associated with a reduction in GP contact time but with an overall increase in clinician contact time. Individual practices may wish to interpret the findings in the context of the available skill mix of clinicians.