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

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