title: Telephone triage systems in UK general practice: analysis of consultation duration during the index day in a pragmatic randomised controlled trial.
abstract: BACKGROUND
  Telephone triage is an increasingly common means of handling requests for same-day appointments in general practice.
  
  
  OBJECTIVE
  To determine whether telephone triage (GP-led or nurse-led) reduces clinician-patient contact time on the day of the request (the index day), compared with usual care.
  
  
  METHODS
  A total of 42 practices in England recruited to the ESTEEM trial.
  
  
  METHODS
  Duration of initial contact (following the appointment request) was measured for all ESTEEM trial patients consenting to case notes review, and that of a sample of subsequent face-to-face consultations, to produce composite estimates of overall clinician time during the index day.
  
  
  RESULTS
  Data were available from 16,711 initial clinician-patient contacts, plus 1290 GP, and 176 nurse face-to-face consultations. The mean (standard deviation) duration of initial contacts in each arm was: GP triage 4.0 (2.8) minutes; nurse triage 6.6 (3.8) minutes; and usual care 9.5 (5.0) minutes. Estimated overall contact duration (including subsequent contacts on the same day) was 10.3 minutes for GP triage, 14.8 minutes for nurse triage, and 9.6 minutes for usual care. In nurse triage, more than half the duration of clinician contact (7.7 minutes) was with a GP. This was less than the 9.0 minutes of GP time used in GP triage.
  
  
  CONCLUSIONS
  Telephone triage is not associated with a reduction in overall clinician contact time during the index day. Nurse-led triage is associated with a reduction in GP contact time but with an overall increase in clinician contact time. Individual practices may wish to interpret the findings in the context of the available skill mix of clinicians.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford.
authors.forename: Tim A
authors.initials: TA
authors.lastname: Holt
authors.affiliation: Exeter Medical School, University of Exeter, Exeter.
authors.forename: Emily
authors.initials: E
authors.lastname: Fletcher
authors.affiliation: Exeter Medical School, University of Exeter, Exeter.
authors.forename: Fiona
authors.initials: F
authors.lastname: Warren
authors.affiliation: Exeter Medical School, University of Exeter, Exeter.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Richards
authors.affiliation: University of Bristol, Bristol.
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
authors.affiliation: Exeter Medical School, University of Exeter, Exeter.
authors.forename: Raff
authors.initials: R
authors.lastname: Calitri
authors.affiliation: Exeter Medical School, University of Exeter, Exeter.
authors.forename: Colin
authors.initials: C
authors.lastname: Green
authors.affiliation: Exeter Medical School, University of Exeter, Exeter.
authors.forename: Rod
authors.initials: R
authors.lastname: Taylor
authors.affiliation: Exeter Medical School, University of Exeter, Exeter.
authors.forename: David A
authors.initials: DA
authors.lastname: Richards
authors.affiliation: Faculty of Medicine and Health Sciences, University of East Anglia, Norwich.
authors.forename: Anna
authors.initials: A
authors.lastname: Varley
authors.affiliation: Exeter Medical School, University of Exeter, Exeter.
authors.forename: John
authors.initials: J
authors.lastname: Campbell
mesh_terms: D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D009726:Nurses; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011320:Primary Health Care; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D012196:Review Literature as Topic; D013689:Telephone; D014218:Triage / Q000379:methods / Q000592:standards; D006113:United Kingdom / Q000453:epidemiology
keywords: delivery of healthcare; general practice; telephone/economics; triage; workload