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Phone triage 'not most efficient use' of practice nurse time

Patients who receive telephone consultations from their GP or practice nurse are more likely to need care in the month after their phone call than those who see a clinician face-to-face, a UK study suggests.

Researchers found that people who requested a same-day appointment but were instead offered telephone triage from a GP were 33% more likely to seek help in the 28 days after the phone call.

“Our study suggests that introducing triage may not represent the most efficient use of doctor or nurse time”

John Campbell

Telephone triage has become increasingly popular in general practice as demand for appointments to see GPs has soared, with patients called by a doctor or nurse who can either deal with the problem over the phone, or decide as and when a patient needs to be seen.

But researchers found that such consultations may not be the most efficient use of a clinician’s time.

Their study, published in The Lancet, found they did not reduce workload and instead saw it “redistributed” from face-to-face consultations to telephone consultations.

It involved 42 practices in England, which either offered their patients usual care, telephone triage with a GP or a nurse-led computer supported consultation. Almost 21,000 patients who were seeking same-day appointments were included in the study.

The study authors, led by researchers from Exeter University, found GP phone triage was associated with patients being 33% more likely to need care in the 28 days following the phone call, compared with standard care, and nurse triage was associated with a 48% increase.

They also found that GP triage was associated with a 38% increased rate of workload for family doctors, the rate of face-to-face contacts reduced by 39%.

Meanwhile, the costs of care were similar across all methods studied, they found.

University of Exeter medical school

John Campbell

“Up to now, it has been widely thought that introducing a triage system might be an efficient way of providing same-day access to healthcare advice,” said lead author Professor John Campbell, from the University of Exeter’s medical school.

“However, our study suggests that introducing triage may not represent the most efficient use of doctor or nurse time,” he said. “Patients who receive over-the-phone support are more likely to seek follow-up advice, meaning that the workload is only redistributed, whilst the costs are the same.”

He added: “Practices thinking about introducing triage might benefit from looking at our findings carefully, and considering whether introducing triage is really likely to be of benefit to their patients, or to the primary care practice team.”

The ESTEEM trial – one of the first robust investigations in its field – was funded by the National Institute for Health Research.

 

Readers' comments (1)

What problems can 'phone triage' present? Have your say in the comments box below

  • I agree. I have worked in general practice in small and large practices, and often wondered why I was wasting time discussing stuff on the telephone that I would then have to discuss in the consulting room an hour and a half later. I would have been best to have a walk in and wait service.

    But people dont want that do they? They dont want to come into a waiting room and actually wait. Especially with other people. Years ago this used to work. But everybody wants everything NOW. Often the problems were not new, but had been festering for days and even weeks but due to going on holiday/flying tomorrow/just want to get it sorted now as been going on for a while etc etc.
    The public have to play their part. The blame should not be constantly heaped onto the shoulders of the GP, most of whom I know work exceedingly hard and impossible hours, and I am amazed that there are still doctors who actually want to be GP's.
    They have far more stamina than me. Because I dont want to be a nurse anymore!

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