Triage in Practice - A Random is Ed Control

8/3/2019 Triage in Practice - A Random is Ed Control

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Does practice based nurse telephone triage using computerised decision support for same daypatient requests reduce practice costs and GP time required for these patients? A randomisedtrial.

Authors:Mark Vorster BSc MB BS (Lon) FRCS (Eng) MRCGPGeneral Practitioner

KnebworthHertfordshire

David Stott BA D.Phil MScStatisticianHealth Research and Development Support UnitUniversity of Hertfordshire

Address for correspondence:Dr Mark VorsterAddress: Regal Chambers, 50 Bancroft, Hitchin, Herts SG5 1LLTel 01462 453232 Fax 01462 631536Email: [email protected]

Key Messages:What is already known on this topic:Telephone triage performed by nurses in primary care is effective with a high level of patientsatisfactionIt has not been shown to be cost effective for GPs to perform telephone triage for patients requestingsame day attentionWhat this study adds:Nurse telephone triage using computerised decision support for patients requesting same dayattention reduces the amount of GP time needed for these patients and is cost effective for a UKgeneral practice

Word count (main article) = 1860

ABSTRACT

ObjectivesTo compare the effect of nurse telephone triage using computerised decision support versus usualreceptionist handling of patient requests in terms of GP and nurse time and costs.DesignRandomised trial with a cost analysis from the perspective of the practice. Patients requesting anappointment the same day were randomised to receive nurse telephone triage or usual care.SettingOne mixed urban/semi-rural general practice in the South East of EnglandSubjects383 patients were eligible for randomisation, of which 374 agreed to be randomised. InterventionsNurse telephone triage involved a practice nurse carrying out a telephone consultation using decisionsupport software. Usual care involved the receptionist granting the patient's request.Main outcome measures

Number, length and costs of appointments with the general practitioner and practice nurse,prescription costs, number of appointments with other primary health care professionals over a 28 dayperiod following first contact.ResultsThere was a significant reduction in GP time per patient from a mean (S.D) of 13.03 (13.19) minutes inthe control group to 7.36 (10.27) minutes in the triaged group.There were significantly reduced costs per patient in the triaged group compared to the usual caregroup of 8.70 per patient (95% C.I. -14.15 to -3.17).

Conclusion


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It was cost effective for this practice to have a nurse telephone triage service using computeriseddecision support for same day patient requests. Nurse telephone triage reduced the amount of GPtime needed for these patients.

INTRODUCTION:The availability of clinical time is an important quality and clinical governance issue. Methods toincrease the clinical time available within present economic constraints need to be found (1,2). There

is a recognised and increasing need for reassurance regarding health issues amongst the public (3),and nurses are known to be particularly effective at this, with high levels of patient satisfaction (4, 5,6). However, there is a debate about whether nurses should compliment rather than substitute for GPs(GPs) (7), and. substituting nurses for doctors is not necessarily cheaper (8, 9, 10,11).

Use of the telephone as a means of organising clinical workload is becoming increasingly widespreadbut where should telephone consultation take place? Patients prefer talking about their problems toprofessionals whom they know, and ready access to patients' medical records and local knowledge isprobably advantageous (12, 13, 14, 15). It is probably not cost effective for GPs to provide an initialtelephone 'sieve', (16, 17, 18). Nurses have been found to be effective at triaging out of hours (19),and in hours in primary care (20, 21). A study in three practices in York where nurses were supportedby management protocols found that triage resulted in reduced GP time but did not reduce costs (11).

Nurse telephone triage guided by computer decision support software (CDS) has been shown to beuseful in primary care (22). It can also act as a medicolegal safeguard through the use of protocolsand by facilitating call documentation and audit (23).

We decided that a study to assess the cost effectiveness for a UK practice of nurse telephone triageusing CDS 'in hours' to assess same day' requests would be a useful addition to the above debate.

METHODSubjectsThe study took place at one mixed urban/semi-rural general practice in Hertfordshire,(List size12,700, 6 Partners, IDM deprivation score minimal at 6.5)Patients were recruited between August and November 1999. All consecutive patients phoning thesurgery between the hours of 9 and 11am each Monday and Friday and requesting a same dayappointment were asked to take part in the study by the receptionists.

Interventions

Receptionists recorded the patient request and obtained verbal consent. If consent was obtained,each patient was asked to wait on the telephone to receive the result of randomisation. Patientsallocated to the triage nurse group were usually telephoned back by the nurse. Nurse telephone triageinvolved a practice nurse using TAS decision support software (24).This would assist the nurse indeciding what course of action should be followed and also provided a record of the encounter. Usualcare involved the receptionist granting the patient's request.

ObjectivesAn analysis was conducted from the perspective of the practice to compare the costs per patient ofnurse telephone triage with usual receptionist handling of patients requesting a same dayappointment. As part of this analysis a comparison was also made of the amount of GP time taken.

OutcomesData were collected on timing of consultations with the GP and the practice nurse, which included the

timing of the initial consultation and all contacts within the subsequent 28 days relating to the initialpresenting problem. The software automatically logged nurse telephone consultation times. Doctorsand nurses recorded times of all other contacts. Out of hours contacts were timed via the GP co-opreports. Contacts with services not directly funded by the practice were recorded but not costed.Prescription costs for each patient were totalled for the initial contact and for the subsequent 28 days.

Sample SizeFigures for consultation times were obtained from a pilot study in June 1999. We were looking for aneffect size of 25%, a significance level of 5% with a power of 80%. The estimated N was 400 patientsbut we were only able to achieve a total of 374.


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RandomisationRandomisation was by means of envelopes containing a block randomisation (three triage and threeusual care). An independent researcher at the University of Hertfordshire generated the randomblocks and placed them in consecutively numbered sealed opaque envelopes.A member of practice staff physically separated from the reception area opened the next numbered,sealed envelope to allocate each patient to nurse triage or usual care. A computer search was made

prior to randomisation to ensure that they were maintained in the same arm of the study if they hadbeen previously recruited.

BlindingThe receptionists used a standard phrase to explain the nature of the study to each potentialparticipant: We are studying different ways of handling urgent calls---this may include speaking to thenurse on the telephone and answering an anonymous questionnaire. Are you willing to take part?Patients were then randomised unless they declined to take part.The doctors or nurses seeing patients were not aware prior to a consultation into which arm of thestudy a patient had been entered, (but this may have become apparent during the consultation).

Statistical methodsThe data was collected an Office 97 Excel spreadsheet. The data was transferred to SPSS foranalysis. Cost effectiveness analysis was done using Unit Costs of Health and Social Care 1998PSSRU (25). Given the non-normality of the cost and time data, additional calculation of bootstrapconfidence limits for the difference in mean costs and mean total time was undertaken using STATA(26).

Results:The diagram summarises participant flow through the study.


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Excluded (n = 9)

Refused to participate (n = 9)

Randomised (n = 374)

Assessed for eligibility (n =383)

TRIAGED

Allocated to intervention (n = 191)

Provision recorded (n = 189)

Attended (n = 189)

CONTROL

Allocated to intervention (n = 183)

Provision recorded (n = 182)

Attended (n = 179)

Incomplete timing record (n = 54)

Discontinued intervention (n = 0)

Analysed (n = 135/189 for timings, 189/189 forre-contact)


Analysed (n = 141/179 for timings, 179/179 for

re-contact)



Discontinued intervention (n = 0)


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There were no significant differences between triage and control group participants according to sex,

age or initial request (Table 1). Requests were dominated by calls for a GP emergency appointment.

Effectively 9 out of 10 requests in both groups were for either a GP emergency appointment or GP

home visit.

The difference between triage and control groups in terms of primary outcomes are summarised in

Tables 2 and 3. The differences between the two groups with respect to the provision that was made

at initial contact are marked. While the pattern of provision among the control group is a close

reflection of the requests, the triage group experienced a much greater involvement of practice nurse

provision either in the form of telephone advice or nurse emergency appointment.

The difference is particularly evident among the subset of patients who initially requested a GP

emergency appointment. Only 49/152 (32.2%) of this subset received a GP emergency appointment

among the triage group compared with 135/138 (97.7%) of the controls (see Table 4)

Overall about a third of the patients had a re-contact during the 28-day follow-up period though the

slightly higher rate among the triage group was not significant. Among the triage group 27.5% had a

GP re-contact compared with 29.1% among the control.

There were a small number of contacts with personnel or services not funded by the practice as

shown in Table 5.

The average total time per patient, when initial and any subsequent contacts were combined, was

around 14 minutes for both groups. However the relative share of GP and nurse time is markedly

different. Among the triage group the mean (S.D.) values were 7.36 (10.27) for GP time and 6.68(3.35) for nurse time. Comparable figures for the control group were 13.03 (13.19) for GP time and

0.83 (2.99) for nurse time.

The effect of this transfer of GP to nurse time among the triage group led to a significant reduction in

time cost per patient of 7.39 (95% C.I. -12.47 to -2.93). Drugs costs were lower among the triage

group though of borderline significance. The reduction in costs per patient of combined time and

drugs costs was 8.70 (95% C.I. -14.15 to -3.17).

The cost results are based on those patients for whom a fully recorded set of time data was available.

There were no significant differences between those with a full time record and those with an

incomplete record (Table 6). The slightly higher proportion of females among those with incomplete

data is not likely to have biased the cost difference in favour of the triage group- the mean (S.D.) cost

was higher among females (n = 162) at 24.45 (26.34) compared with males (n = 113) at 20.13

(17.65).

Discussion:


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Our results show that nurse telephone triage using CDS 'in hours' can operate cost effectively within ageneral practice.

The ultimate management of the patients shows that triage had a significant effect in lessening theneed for face to face contacts with a general practitioner. This produced the main effect in terms ofreduction in cost per patient.

The re-contact rates in the 28 days following the initial contact were not significantly different betweenthe two arms of the study. One previous study showed a similar effect (21), but another study showedan increased rate of re-contact following nurse triage (11).

Software costs were not included. If capital costs were included the actual cost effectiveness woulddepend on the number of patients triaged; increasing numbers would increase cost effectiveness. Inour case the costs of the software had been reimbursed as part of a bid for a Health Authority qualityinitiative. Patient, doctor and nurse views of triage the service were obtained and will be reportedelsewhere.

What are the possible shortcomings of this study?It was conducted in a single centre in which the main author of the study was working. Only one nursedid the telephone triage. Due to organisational issues the triage could only operate for a restricted timeduring the week, (albeit the two busiest periods). Recordings of some times were made manually bythe doctors and nurses. Timings of contacts analysed related to the initial presenting problem, and it ispossible that some subsequent contacts could have been misinterpreted for inclusion or exclusion.However, these effects would have applied to both arms of the study.

Patient costs were not taken into account, but it seems likely that if anything patient costs would beless in the triaged group, as they were less likely to have to attend the surgery.

We have not included the costs for services (eg. Community nurses) not directly reimbursed by thepractice (but this amounted to a minimal number of contacts).

Various factors contributed to the delay in publication. Many of these reflect the difficulty of carryingout research at the coalface in primary care. Amongst these factors were time pressures on workingGPs and nurses, changes in academic support provision , and some problems with tidying the dataeg. excluding double counting.

Conclusion:In this study we found it to be cost effective to operate a nurse telephone triage service for patientsrequesting same day management guided by decision support software within daytime UK generalpractice.

Nurse telephone triage affected the ultimate management of patients towards less face to face contactwith a general practitioner without affecting the rate of patient re-contact.

The implications of this research are significant for primary care. With ever increasing demands, newmodels for practise will have to be found. In the real world of cost constraints, these systems will haveto be effective but also economical. This may be particularly apt within the framework of any new GPcontract. Any new systems should ideally be introduced to compliment the well established benefits oftraditional, personal, general practice.


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Contributors:General advice and support:Sue Le Masurier + Karin Friedli (Former Managers, HertNet), ShelleyHutton (Former Statistician, HertNet), Duncan Barron (Methodologist HertNet)Advice on economic evaluation: Gareth Harper (CRIPACC, University of Hertfordshire)Advice on statistical analysis:Julie Barber (see ref 26)Data inputting:Christine VorsterWith thanks to:Carol Clapham (Practice Nurse) and the patients, staff and doctors at Knebworth

Surgery

Guarantor:Mark Vorster (Author)

Ethical approval:Hertfordshire Ethics Committee

Funding organisation:HertNet(Both authors declare independence from funder)

Conflict of interest:Mark Vorster has been a Clinical Consultant for Plain Software (which markets TAS) since March2000David Stott declares that the answer to the questions on your competing interest statement are all Noand nothing to declare

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BMJ 2000; 320: 1053

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Nursing Research 1995 44 (6): pp 332-339

5. Shum C, Humphreys A, Wheeler D, Cochrane M, Skoda S, Clement S. Nurse management of

patients with minor illnesses in general practice: multicentre randomised controlled trial BMJ 2000;

320: 1038-1043

6. Kinnersley P, Anderson A, Parry K, Clement J, Archard L, Turton P, Stainthorpe A, Fraser A, Butler

C, Rogers C. Randomised controlled trial of nurse practitioner versus general practitioner care for

patients requesting 'same day' consultations in primary care BMJ 2000; 320: 1043-1048

7. Koperski M, Nurse practitioners in general practice-an inevitable progression? Br J Gen Pract 1997;

47: 696-698

8. NHS Executive South Thames. Evaluation of nurse practitioner pilot projects. SETRHA London:

Touche Ross 1994


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9. Richardson G, Maynard A. Fewer doctors? More nurses? A review of the knowledge base of

doctor-nurse substitution Discussion paper 135 York: University of York 1995

10. Venning P, Durie A, Roland M, Roberts C, Leeses B. Randomised controlled trial comparing cost

effectiveness of general practitioners and nurse practitioners in primary care BMJ 2000; 320: 1048-53

11. Richards D, et al Nurse telephone triage for same day appointments in general practice: multiple

interrupted time series trial of effect on workload and costs BMJ 2002; 325: 1214 (23 November)

12. Glasper A. Telephone triage: a step forward for nursing practice? (Editorial) Br J Nurs. 1993; 2 (2):

108-9

13. Hallam L, Use of the telephone by practice nurses (Report to the Dept of Health)

Manchester: Centre for Primary Care Research, University of Manchester 1992

14. Marsh GN, Dawes ML. Establishing a minor illness clinic in a busy general practice BMJ 1995;

310: 778-80

15. Florin D, Rosen R. (Editorial) Evaluating NHS Direct BMJ 319 3 July 1999 pp55-6

16. Stuart A, Rogers S, Modell M. Evaluation of a direct doctor-patient telephone advice line in general

practice Br J Gen Pract 2000; 50: 305-306

17. Jiwa M, Mathers N, Campbell M. The effect of GP telephone triage on numbers seeking same day

appointments Br J Gen Pract 2002; 52: 390-391

18 McKinstry B, Walker J, Campbell C. et al Telephone consultations to manage requests for same

day appointments: a randomised controlled trial in two practices. Br J Gen Pract 2002, 52: 306-10

19. Lattimer V, George S, Thompson F, Thomas E, Mullee M, Turnbull J. et al Safety and

effectiveness of nurse telephone consultation in out of hours primary care: Randomised controlled trial

BMJ 1998; 317: 1054-9

20. Gallagher M. Telephone triage of acute illness in general practice: outcomes of care Br J Gen

Pract 1998; 48: 1141-1145

21. Jones K, Gilbert P, Little J, Wilkinson K. Nurse triage for housecall requests in a Tyneside general

practice: patients' views and effect on doctor workload. Br J Gen Pract 1998; 48: 1303-6

22. Crouch R, Dale J, Patel A. et al Ringing the changes: developing, piloting and evaluating a

telephone advice system in Accident and Emergency and general practice settings. London: Dept of

General Practice and Primary Care, King's College School of Medicine and Dentistry 1996


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23. Coleman A. Where do I stand? Legal implications of telephone triage J Clin Nurs Vol 6 (3) May

1997 227-231

24. TAS (Telephone Advice System) Version 5.0--Plain Software company (http://www.plain.co.uk)

25. Netten A, Curtlis L. Unit costs of health and social care. Canterbury: University of Kent at

Canterbury, Personal Social services Research Unit 1998

26. Barber JA, Thompson SG. Analysis of cost data in randomised controlled trials: An application of

the non-parametric bootstrap. Statistics in Medicine 2000; 19: 3219-3236


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PAPER SECTIONAnd topic Item Description

Reportedon page

#

TITLE &ABSTRACT

1 How participants were allocated to interventions (e.g.,"random allocation", "randomized", or "randomlyassigned").

1

INTRODUCTIONBackground 2 Scientific background and explanation of rationale.

2

METHODSParticipants

3Eligibility criteria for participants and the settings andlocations where the data were collected.

2

Interventions 4Precise details of the interventions intended for eachgroup and how and when they were actuallyadministered.

2

Objectives 5 Specific objectives and hypotheses. 2

Outcomes 6

Clearly defined primary and secondary outcomemeasures and, when applicable, any methods used toenhance the quality of measurements (e.g., multipleobservations, training of assessors).

2

Sample size 7How sample size was determined and, whenapplicable, explanation of any interim analyses andstopping rules.

2

Randomization --Sequencegeneration

8Method used to generate the random allocationsequence, including details of any restriction (e.g.,blocking, stratification).

3

Randomization --Allocation

concealment

9

Method used to implement the random allocationsequence (e.g., numbered containers or centraltelephone), clarifying whether the sequence was

concealed until interventions were assigned.

3

Randomization --Implementation

10Who generated the allocation sequence, who enrolledparticipants, and who assigned participants to theirgroups.

3

Blinding (masking) 11

Whether or not participants, those administering theinterventions, and those assessing the outcomes wereblinded to group assignment. When relevant, how thesuccess of blinding was evaluated.

3

Statistical methods 12Statistical methods used to compare groups forprimary outcome(s); Methods for additional analyses,such as subgroup analyses and adjusted analyses.

3

RESULTS

Participant flow13

Flow of participants through each stage (a diagram isstrongly recommended). Specifically, for each groupreport the numbers of participants randomly assigned,receiving intended treatment, completing the studyprotocol, and analyzed for the primary outcome.Describe protocol deviations from study as planned,together with reasons.

4

Recruitment 14 Dates defining the periods of recruitment and follow- 2


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up.

Baseline data15

Baseline demographic and clinical characteristics ofeach group.

Table 1

Numbers analyzed 16

Number of participants (denominator) in each groupincluded in each analysis and whether the analysis

was by "intention-to-treat" . State the results inabsolute numbers when feasible (e.g., 10/20, not50%).

4

Outcomes andestimation

17For each primary and secondary outcome, a summaryof results for each group, and the estimated effect sizeand its precision (e.g., 95% confidence interval).

Table

2+3

Ancillary analyses 18

Address multiplicity by reporting any other analysesperformed, including subgroup analyses and adjustedanalyses, indicating those pre-specified and thoseexploratory.

Tables 4-

6

Adverse events 19All important adverse events or side effects in each

intervention group.

DISCUSSIONInterpretation

20

Interpretation of the results, taking into account studyhypotheses, sources of potential bias or imprecisionand the dangers associated with multiplicity ofanalyses and outcomes.

6

Generalizability 21 Generalizability (external validity) of the trial findings. 6

Overall evidence 22General interpretation of the results in the context ofcurrent evidence.

6

C h e c k l i s t s f o r h e a l t h e c o n o m i c s p a p e r s

S t u d y d e s i g n

( 1 ) T h e r e s e a r c h q u e s t i o n i s s t a t e d P 1

( 2 ) T h e e c o n o m i c i m p o r t a n c e o f t h e r e s e a r c h q u e s t i o n i s s t a t e d P 2

( 3 ) T h e v i e w p o i n t ( s ) o f t h e a n a l y s i s a r e c l e a r l y s t a t e d a n d j u s t i f i e d P 2

( 4 ) T h e r a t i o n a l e f o r c h o o s i n g t h e a l t e r n a t i v e p r o g r a m m e s o r i n t e r v e n t i o n s c o m p a r e d i s

s t a t e d P 2

( 5 ) T h e a l t e r n a t i v e s b e i n g c o m p a r e d a r e c l e a r l y d e s c r i b e d P 2

( 6 ) T h e f o r m o f e c o n o m i c e v a l u a t i o n u s e d i s s t a t e d P 2

( 7 ) T h e c h o i c e o f f o r m o f e c o n o m i c e v a l u a t i o n i s j u s t i f i e d i n r e l a t i o n t o t h e q u e s t i o n s

a d d r e s s e d P 2

D a t a c o l l e c t i o n

( 8 ) T h e s o u r c e ( s ) o f e f f e c t i v e n e s s e s t i m a t e s u s e d a r e s t a t e d P 2

( 9 ) D e t a i l s o f t h e d e s i g n a n d r e s u l t s o f e f f e c t i v e n e s s s t u d y a r e g i v e n ( i f b a s e d o n a s i n g l e

s t u d y ) P 2 - 5

( 1 0 ) D e t a i l s o f t h e m e t h o d o f s y n t h e s i s o r m e t a - a n a l y s i s o f e s t i m a t e s a r e g i v e n ( i f b a s e d

o n a n o v e r v i e w o f a n u m b e r o f e f f e c t i v e n e s s s t u d i e s ) N / A

( 1 1 ) T h e p r i m a r y o u t c o m e m e a s u r e ( s ) f o r t h e e c o n o m i c e v a l u a t i o n a r e c l e a r l y s t a t e d P 2

( 1 2 ) M e t h o d s t o v a l u e h e a l t h s t a t e s a n d o t h e r b e n e f i t s a r e s t a t e d N / A

( 1 3 ) D e t a i l s o f t h e s u b j e c t s f r o m w h o m v a l u a t i o n s w e r e o b t a i n e d a r e g i v e n P 2


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( 1 4 ) P r o d u c t i v i t y c h a n g e s ( i f i n c l u d e d ) a r e r e p o r t e d s e p a r a t e l y N / A

( 1 5 ) T h e r e l e v a n c e o f p r o d u c t i v i t y c h a n g e s t o t h e s t u d y q u e s t i o n i s d i s c u s s e d N / A

( 1 6 ) Q u a n t i t i e s o f r e s o u r c e s a r e r e p o r t e d s e p a r a t e l y f r o m t h e i r u n i t c o s t s T a b l e 3

( 1 7 ) M e t h o d s f o r t h e e s t i m a t i o n o f q u a n t i t i e s a n d u n i t c o s t s a r e d e s c r i b e d P 2 , 3

( 1 8 ) C u r r e n c y a n d p r i c e d a t a a r e r e c o r d e d T a b l e 3

( 1 9 ) D e t a i l s o f c u r r e n c y o f p r i c e a d j u s t m e n t s f o r i n f l a t i o n o r c u r r e n c y c o n v e r s i o n a r e

g i v e n N / A

( 2 0 ) D e t a i l s o f a n y m o d e l u s e d a r e g i v e n N / A

( 2 1 ) T h e c h o i c e o f m o d e l u s e d a n d t h e k e y p a r a m e t e r s o n w h i c h i t i s b a s e d a r e j u s t i f i e d

N / A

A n a l y s i s a n d i n t e r p r e t a t i o n o f r e s u l t s

( 2 2 ) T i m e h o r i z o n o f c o s t s a n d b e n e f i t s i s s t a t e d P 3

( 2 3 ) T h e d i s c o u n t r a t e ( s ) i s s t a t e d N / A

( 2 4 ) T h e c h o i c e o f r a t e ( s ) i s j u s t i f i e d P 3

( 2 5 ) A n e x p l a n a t i o n i s g i v e n i f c o s t s o r b e n e f i t s a r e n o t d i s c o u n t e d N / A

( 2 6 ) D e t a i l s o f s t a t i s t i c a l t e s t s a n d c o n f i d e n c e i n t e r v a l s a r e g i v e n f o r s t o c h a s t i c d a t a P 3 +

T a b l e 3

( 2 7 ) T h e a p p r o a c h t o s e n s i t i v i t y a n a l y s i s i s g i v e n N / A

( 2 8 ) T h e c h o i c e o f v a r i a b l e s f o r s e n s i t i v i t y a n a l y s i s i s j u s t i f i e d N / A

( 2 9 ) T h e r a n g e s o v e r w h i c h t h e v a r i a b l e s a r e v a r i e d a r e s t a t e d N / A

( 3 0 ) R e l e v a n t a l t e r n a t i v e s a r e c o m p a r e d P 2

( 3 1 ) I n c r e m e n t a l a n a l y s i s i s r e p o r t e d N / A

( 3 2 ) M a j o r o u t c o m e s a r e p r e s e n t e d i n a d i s a g g r e g a t e d a s w e l l a s a g g r e g a t e d f o r m T a b l e

3

( 3 3 ) T h e a n s w e r t o t h e s t u d y q u e s t i o n i s g i v e n P 6

( 3 4 ) C o n c l u s i o n s f o l l o w f r o m t h e d a t a r e p o r t e d P 6

( 3 5 ) C o n c l u s i o n s a r e a c c o m p a n i e d b y t h e a p p r o p r i a t e c a v e a t s P 6


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Table 1 Baseline Characteristics

CharacteristicsTriage(n = 189)

Control(n = 182)

n (%) n (%) sign.

Age1

and Gender

Female 112 (59.30 %) 115 (63.2%) 0.503*

Age 65 and over 41 (21.9) 39 (21.4%) >0.999*

Age: mean (S.D.) 39.15 (27.43) 39.97 (27.65) 0.774**

Request at first contact

GP emergency appointment 152 (80.4%) 138 (75.8 %) )

GP home visit 25 (13.2%) 25 (13.7%) ) 0.343*

Other 12 (6.3% 19 (10.4%) )1. Data on age for triage group based on n = 187.* Yates chi-square test; ** unpaired t test

Table 2 Provision and re-contact.

Provision and re-contactTriage(n = 189)

Control(n = 182)

n (%) n (%) sign. *

Provision

GP emergency appointment 54 (28.6%) 139 (76.4%) )

GP home visit 9 (4.8%) 24 (13.2%) )

GP routine appointment 22 (11.6%) 5 (2.7%) )

Nurse emergency appointment 36 (19.0%) 3 (1.6%) )


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Table 4 Provision according to initial request

TriageRequests

ControlRequests

ProvisionGP

emergency GP home OtherGP

emergency GP home Other

appt visit requests appt visit requestsGP emergency appt 49 4 1 135 2 2

GP home visit 2 7 1 22 1

GP routine appointment 19 2 1 1 4

Nurse emergency appt. 32 1 3 3

Nurse telephone advice 46 4 6 1 4

Other provision 4 7 1 1 5

Total 152 25 12 138 25 19

Table 5 Contacts with other services (all contacts within 28 days)Triage Control

Other Service Contacts (n = 189) (n = 182)

Midwife/Health Visitor 5 0

Community Nurse 5 1

Accident and Emergency 5 0

Hospital Admission 1 2

Total 16 3

Table 6 Baseline characteristics of participants according to completeness of time record

Baseline characteristics Complete record Incomplete record sign.

Gender: female 162/275 (58.9%) 63/93 (67.7%) 0.165*

Age group 65 and over 212/274 (77.4%) 74/92 (80.4%) 0.639*

Age: mean (S.D.) 39.23 (27.56) 40.50 (27.48) 0.703**

Requested GP emergency app. 213/275 (77.5%) 76/93 (81.7%) 0.471** Yates chi-square test; ** unpaired t test

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Triage in Practice - A Random is Ed Control