title: Receptionist rECognition and rEferral of Patients with Stroke (RECEPTS): unannounced simulated patient telephone call study in primary care.
abstract: BACKGROUND
  Stroke is a leading cause of morbidity and mortality. Timely recognition and referral are essential for treatment.
  
  
  OBJECTIVE
  To examine the ability of receptionists in general practices to recognise symptoms of stroke and direct patients to emergency care.
  
  
  METHODS
  Unannounced simulated patient telephone calls and prospective cross-sectional survey study in general practices in the Birmingham and Solihull area.
  
  
  METHODS
  A total of 52 general practices participated in a total of 520 simulated telephone calls, with 183 receptionists completing questionnaires. Logistic regression analyses were used to examine likelihood of referral for immediate care by ease of vignette recognition and number of common stroke symptoms present.
  
  
  RESULTS
  General practice receptionists correctly referred 69% of simulated calls for immediate care. Calls classed as 'difficult' to recognise were less likely to be immediately referred. Compared with 'easy' calls: 'difficult' calls odds ratio (OR) 0.15, 95% confidence interval (CI) = 0.08 to 0.26; 'moderate' calls OR 0.55, 95% CI = 0.32 to 0.92. Similarly, calls including one or two 'FAST' symptoms were less likely to be referred immediately (compared with three FAST symptoms: one symptom OR 0.30, 95% CI = 0.13 to 0.72; two symptoms OR 0.35, 95% CI = 0.15 to 0.83).
  
  
  CONCLUSIONS
  General practice receptionists refer patients with stroke for immediate care when they present with several symptoms; however, they are less likely to refer patients presenting with only one symptom or less common symptoms of stroke. Optimum management of acute stroke in primary care requires interventions that improve receptionists' knowledge of lesser-known stroke symptoms.
authors.affiliation: NHS Lanarkshire, Kirklands, Bothwell.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Mellor
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: James P
authors.initials: JP
authors.lastname: Sheppard
authors.affiliation: Primary Care Clinical Sciences;
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bates
authors.affiliation: Primary Care Clinical Research & Trials Unit, University of Birmingham, Birmingham.
authors.forename: George
authors.initials: G
authors.lastname: Bouliotis
authors.affiliation: Primary Care Clinical Sciences;
authors.forename: Janet
authors.initials: J
authors.lastname: Jones
authors.affiliation: Northfield Health Centre (Tudor Practice), Birmingham.
authors.forename: Satinder
authors.initials: S
authors.lastname: Singh
authors.affiliation: Primary Care Clinical Sciences;
authors.forename: John
authors.initials: J
authors.lastname: Skelton
authors.affiliation: Primary Care Clinical Sciences;
authors.forename: Connie
authors.initials: C
authors.lastname: Wiskin
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D008496:Medical Receptionists / Q000458:organization & administration*; D009017:Morbidity / Q000639:trends; D016544:Patient Simulation; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration*; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013689:Telephone; D006113:United Kingdom / Q000453:epidemiology
keywords: general practice; health services administration; medical receptionists; patient simulation; questionnaires; stroke