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Abstracto

Evaluating a service improvement intervention in GP out-of-hours: impact of 'expert triage model'

Gemma Eccles

Background and objective Cardiff and Vale out-of-hours
service (Wales, UK) adopted the ‘expert triage’ service model in
April 2013. The purpose of the model was to train and support
General Practitioners (GPs) to provide high quality triage in
terms of process and outcomes. The aim of this study was to
analyse effects on triage outcomes and to examine patient and
GP experiences of the ‘expert triage’ service model.
Method Triage outcomes of telephone advice, primary care
centre appointments, home visits, and Accident & Emergency
referrals were analysed as a ‘run chart’; a graph used to depict
changes across time. Telephone interviews were conducted with
samples of participating GPs and patients, which considered
patient understanding and use of triage information and GP
perception of the changes adopted by the new model. Interview
responses were coded and analysed thematically as themes and
subthemes.
Results Primary Care Centre appointments and referrals
to A&E departments declined after introduction of the
expert triage model. Patient understanding and use of triage
information was similar for previous model and expert triage
patients. There appeared to be greater intention to use in-hours
GP surgeries but more disagreement with the recommended
treatment pathway for expert triage patients. Expert triage GPs
perceived that there was improved triage quality, enhanced
capacity and fewer delays to assessment. Both patients’ and
expert triage GPs’ responses indicated awareness of the need
to improve patient knowledge and to enhance appropriate use
of the service.
Conclusions Triage outcomes and interview responses
provide a positive account of the ‘expert triage’ model, although
some limitations were apparent from patient responses. Further
improvements in this GP out-of-hours service may also be
possible from implementing suggestions from participants’
responses in light of their experiences.