Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs

Abstract

Objective To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care.

Effects of computerized decision support systems on nursing performance and patient outcomes: a systematic review

“…23 In triage of same day appointment requests, CDSS use led to a decrease in GP appointments (risk difference 0.23, 95% CI 0.20 -0.26, p = 0.00). 25 In out-of-hours telephone triage, there was a reduction in adverse events in the intervention group, with a significant difference in two of the four measures. 23 The upper 95% confidence interval for the number of deaths within 7 days of contact with the service in the intervention arm was well within the limits of equivalence (risk difference 0.00, 95% CI 0.00 -0.00, p=0.48).…”

“…23,25 Characteristics of these studies are given in Table 6 and the results are reported in Table 7.…”

“…The two studies of triage for first contact care suggest CDSS to be beneficial in terms of performance, with significantly decreased GP workload when nurses used CDSS. One study suggests CDSS to be detrimental to patient outcomes, 25 while one study suggests CDSS to be beneficial in terms of some patient outcomes.…”

“…In triage of same day appointment requests, there was a significant difference in all three patient outcome measures (number of out of hours consultations, number of accident and emergency visits, and number of return consultations), all favouring the control group. 25 In summary, three RCTs comparing nurses using CDSS with doctors for anticoagulation management found no significant difference in terms of patient outcomes, suggesting that CDSS may help nurses to manage anticoagulation as effectively as doctors. However, these studies were underpowered to detect important adverse consequences of poor anticoagulation management such as death.…”

Analysis of users and reasons for use of a physician-on-call service in an Italian local health unit

“…Recently, several countries proposed changes to primary care organization (1,2).Thus, there has been an increase in the use of telephone consultations (3)(4)(5). Telephone consultations can reduce both the emergency care visits and the number of visits overtime for general practitioners (GPs) (3)(4)(5).Moreover, the availability of telephone consultations in primary care could effectively reduce costs (6).In the literature, there is evidence that telephone consultations guarantee patient safety (7)(8)(9) and user satisfaction (3,10).…”