title: 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.
  
  
  METHODS
  Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months.
  
  
  METHODS
  Three primary care sites in York.
  
  
  METHODS
  4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial.
  
  
  METHODS
  Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care.
  
  
  RESULTS
  The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference pound 1.48 more per patient for triage (95% confidence interval -0.19 to 3.15).
  
  
  CONCLUSIONS
  Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments.
authors.affiliation: School of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester. David.Richards@man.ac.uk
authors.forename: David A
authors.initials: DA
authors.lastname: Richards
authors.forename: Joan
authors.initials: J
authors.lastname: Meakins
authors.forename: Jane
authors.initials: J
authors.lastname: Tawfik
authors.forename: Lesley
authors.initials: L
authors.lastname: Godfrey
authors.forename: Evelyn
authors.initials: E
authors.lastname: Dutton
authors.forename: Gerald
authors.initials: G
authors.lastname: Richardson
authors.forename: Daphne
authors.initials: D
authors.lastname: Russell
mesh_terms: D001071:Appointments and Schedules; D003365:Costs and Cost Analysis; D004471:Economics, Nursing; D004739:England; D005194:Family Practice / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D009732:Nursing Care / Q000458:organization & administration*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D013689:Telephone; D013997:Time Factors; D014218:Triage / Q000191:economics / Q000458:organization & administration*; D016526:Workload