The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

Abstract

BackgroundNurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings.ObjectiveTo investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition.DesignQuestionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage.Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse.Settings15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK.Participants45 nurse practitioners and practice nurse trained in the use of clinical decision support software.MethodsWe investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling.ResultsValid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more likely to recommend patients for follow-up (OR 3.17, 95% CI 1.18–5.55).ConclusionNurse characteristics were associated with disposition of triage calls to within practice follow-up. Nurse practitioners or those who reported feeling ‘more prepared’ for the role were more likely to manage the call definitively. Practices considering nurse triage should ensure that nurses transitioning into new roles feel adequately prepared. While standardised training is necessary, it may not be sufficient to ensure successful implementation.

Triage Decision-Making Levels of Healthcare Professionals Working in Emergency Departments

“…Healthcare professionals' characteristics such as the amount of experience and level of qualification may also influence triage outcomes (23). In the present study, it was determined that the critical thinking subscale score was high in paramedics, medical vocational high school graduates, and healthcare professionals with emergency care certificates.…”

“…These results are thought to be associated with the fact that paramedics are high school graduates and that they have received extensive knowledge on triage during their education. However, confidence may be a factor that influences decision-making (23,26). Therefore, the findings from the present study may also be associated with the fact that paramedics feel more confident in decision-making and are prepared to undertake triage.…”

What happens to patient experience when you want to see a doctor and you get to speak to a nurse? Observational study using data from the English General Practice Patient Survey

“… 23 Staff transitioning in to new roles in patient care or in patient triage need to feel adequately prepared, and standardised training may be necessary, but insufficient, to ensure success. 24 New models of care should consider the possible intended and unintended consequences for patient experience of multidisciplinary teams, particularly given the policy emphasis on enabling patient choice. Monitoring should include any potential adverse effects on patient confidence and trust in health professionals.…”

Modeling the effects of telephone nursing on healthcare utilization

“…According to [28] a clinically significant reduction in workload could be achieved if all nurses reached a proportion of patients managed by self-care of at least 65%, assuming that referral to self-care was appropriate. A result in our study was that cost savings based only on the patient's first action undertaken after consultation is estimated to be 3.3% but could be up to almost four times higher if compliance to the nurse's recommendations was higher.…”