Acceptability of emergency department triage nurse's advice for patients to attend general practice: A cross‐sectional survey

Abstract

Objectives: Demand for ED care is increasing at a rate higher than population growth. Strategies to attenuate ED demands include diverting low-acuity general practice-type ED attendees to alternate primary healthcare settings. The present study assessed the ED attendees' receptiveness to accept triage nurse's face-to-face advice to explore alternate options for medical care and what factors influence the level of acceptance. Methods: The ED attendees of four major public hospital EDs in Brisbane were surveyed between August and October 2018, using a questionnaire informed by Health Belief Model's cues to action. Results: Of the 514 valid responses, 81% of respondents were very likely/ likely to accept the triage nurse's advice to see a general practitioner. Selfperceived urgency of presenting condition/s (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78-0.97), not having confidence in general practitioner (OR 0.37, 95% CI 0.21-0.66) and having a medical record at the hospital (OR 0.60, 95% CI 0.36-0.99) were negatively associated with the likelihood of accepting the advice. For every point increase in perceived seriousness, the odds of accepting the advice decreased by 16% (95% CI 6-25%). Conclusion: Most of the participants believed that EDs were for emergent care and they attended the ED because they perceived their presenting condition/s to be serious and/or urgent. The acceptability of face-to-face advice by triage nurse to seek help in general practice was influenced by perceived threats of the illness, and the underlying beliefs about availability, accessibility, suitability and affordability of the service.

Potential role of general practice in reducing emergency department demand: A qualitative study

“…Previous studies suggest telephone triage may reduce patient workload for EDs 27 . However, some patients still decide to present to the ED contrary to telephone advice 12,28 . Furthermore, phone triage commonly includes advice to present to the ED if the symptoms persist or worsen.…”

“…While not inappropriate from a safety net perspective, this may potentially undermine confidence, thus some patients may present anyway since self-perceived urgency has been demonstrated as a major factor for presenting to the ED. 11,12 Suggested ED policy changes include further patient streaming, 'GP areas' (depending on local patient requirement and demographics), and more salaried GPs and other subacute doctors working within ED. There is a niche market for those in the workforce who are not on specialised training programmes (or experienced ED consultants who are looking to transition to retirement), and who can be utilised as highly-skilled staff working independently in acute care.…”

“…With a population of over 900 000, this geographical area is serviced by four major public hospitals and a wide range of primary care providers, including general practitioner (GP) clinics, GP co‐operatives, a medical hub and allied health services. Further details about the study context have been published elsewhere 5,12 …”

“…Further details about the study context have been published elsewhere. 5,12 Using purposive sampling approach, the research team prepared a list of positions and stakeholders within the health system who could inform the project objectives. The list identified around 30 positions and 100 individuals including directors, chairs, CEOs, practitioners and providers (e.g.…”

“…Our research on the expanded role of PHC as a suitable alternative to the ED for acute care explored the factors influencing the growth in demand for emergency healthcare 2,5,10–13 . One of the research outcomes was the potential to divert demand to PHC, but that would require significant re‐engineering of PHC to meet patient needs 14 .…”