Does telephone triage for general practice facilitate speedier access to clinicians? Jane Warner questions recent research
Classic Westerns often involve scenes pitting gunslinger against sheriff, usually on a hot, dusty square, surrounded by tense locals.
Silence is punctuated by the shattering of glass as a banjo-playing buzzard has just been thrown backwards out of the saloon. The clock chimes, and whoever has the fastest finger on the trigger generally gets to ride off into the sunset.
Similarly, when patients request on-the-day appointments in GP surgeries, the moment the clock chimes for 8:30 am, it is often the patient with the fastest finger on the phone who gets to ride off into the waiting room for an appointment.
“It is often the patient with the fastest finger on the phone who gets to ride off into the waiting room”
Leaving aside “please try again later” messages, this system can work well, provided there is sufficient capacity and flexibility in service provision.
But what if there are limitations on capacity? It might follow that Patient A, who has mastered the art of speed-dial, despite his cold, will receive a GP appointment, but very poorly Patient B will probably endure auditory telephonic battering by the 1812 Overture before being told that appointments have been filled for the day.
Ideally, patients should have access to appointments at a convenient time and with the clinician of their choice, but as yet Pinky, Perky and Peppa have not been granted a pilot’s license.
In many GP practices, demand for on-the-day appointments is increasing, whilst capacity remains static.
Surely, telephone triage is a valuable tool? When successfully implemented each patient should be directed to, and receive, appropriate clinical input.
“Demand for on-the-day appointments is increasing, whilst capacity remains static”
It cannot be emphasised too strongly that telephone triage is not a soft option or a way to reduce patient demand; conversely, a good triage system can facilitate speedier access to a clinician than might otherwise happen.
It is therefore somewhat perturbing to read the latest research by Campbell et al (2014) which casts doubt on the effectiveness of telephone triage under some circumstances. What is this research actually telling us? It compares GP-led telephone triage, nurse–led computer supported (my italics) triage with usual care.
What emerges seems to be that GP triage was associated with a 33% increase in the mean number of contacts per person over 28 days compared with the usual care. For nurses undertaking computer supported triage, the figure is a worrying 48%.
Perhaps some of these follow up appointments were a necessary part of the normal “safety netting” process? Further input might also be warranted due to the intrinsic nature of many illnesses, which as every clinician knows, may start with vague prodromal symptoms but worsen over time. In addition, it might be interesting to compare nurse–led computer supported triage with triage undertaken by experienced nurse practitioners and its impact for general practice workload.
This research does acknowledge that telephone triage for same-day consultation requests might be useful in aiding the delivery of primary care, but that the implications of implementing such a system must be considered before doing so.
Cambell JL et al (2014) ‘Telephone triage for the management of same-day consultation requests in general practice (the ESTEEM trial): a cluster-randomised controlled trial and cost-consequence analysis’. The Lancet, Early Online publication (14) 61058-8 4 Aug