Evaluation of POPGUNS: a tool to improve quality and safety of triage decisions by general practice receptionists

• Register: ISRCTN
• Last refreshed on: 24 October 2016
• Main ID: ISRCTN58234128
• Date of registration: 22/08/2016
• Prospective Registration: No
• Primary sponsor: Rural Clinical School, Medical School, Australian National University
• Public title: Evaluation of POPGUNS: a tool to improve quality and safety of triage decisions by general practice receptionists
• Scientific title: Cluster randomised trial of POPGUNS (Prioritisation of Patients: A Guide for Non-Clinical Staff) in general practice, assessing effect on safety and quality of triage decisions by general practice receptionists
• Date of first enrolment: 01/04/2011
• Target sample size: 24
• Recruitment status: Completed
• URL: http://isrctn.com/ISRCTN58234128
• Study type: Interventional
• Study design: Unblinded multi-centre pragmatic cluster-randomised trial (Other)

Countries of recruitment

Australia

Contacts

• Name: Christine Phillips

• Name: Sally Hall

Key inclusion & exclusion criteria

Inclusion criteria: Receptionist inclusion criteria:
1. General practice receptionists
2. Have not had any clinical training

Practice inclusion criteria:
must have more than 2 receptionists.
Exclusion criteria: General practice receptionists who have had clinical training.

Age minimum:
Age maximum:
Gender: Both

Health Condition(s) or Problem(s) studied

Prioritisation decisions by general practice receptionists
Not Applicable
Prioritisation decisions by general practice receptionists

Intervention(s)

Practices are randomly allocated to one of two groups.

Intervention group: Practices are provided with the POPGUNS decision protocol and the explanatory booklet. All intervention practices are visited by a member of the research team and provided with an education session outlining use of the protocol as recommended by the development team. This meeting targets all staff in the practice who might have input or reflections on the appointment process, or clinical responsibility. The protocol supports decisions about timely access to medical assessment and care, based on a description of the presenting problem. It does not propose that reception staff will make clinical decisions about diagnosis, care or treatment, but rather how quickly the patient needs to see someone who can do this.
The intervention consists of the use of POPGUNS by receptionists in response to requests for appointments. The tool guides them through a series of questions and then allocates them to a priority category.
There are four components to the POPGUNS decision support process:
1. A series of basic questions to ascertain the nature of the problem and any specific circumstances relating to the patient
2. Categorization of the urgency or seriousness of the problem, which determines the action to be taken
3. Follow up actions including documentation and communication
4. First aid advice which can be given in certain instances, at the discretion of the employing GPs

Control group: Practices are provided with a copy of the RACGP accreditation standard (RACGP 2007) for ‘scheduling care in opening hours’, which describes minimum arrangements practices should institute to accommodate requests for access to care, if they wish to achieve accreditation. As most practices in Australia are accredited [at least 66%, based on Practice Incentives Program statistics (Medicare Australia 2010)] this was viewed as a universally available outline of acceptable ‘usual practice’.

Participants are followed

Primary Outcome(s)

Triaging practice by receptionists is assessed by self-reported response to hypothetical but representative patient scenarios, reflecting a range of matched acuity (or urgency) levels measured at baseline and at 4 months.

Secondary Outcome(s)

1. Patient satisfaction is measured using the Patient Satisfaction Questionnaire (Access and General Satisfaction subscales) at 4 months
2. Intra-practice consistency in rating between receptionists within a practice is measured by comparing variation between ratings of urgency accorded to a scenario between receptionists at baseline and at 4 months
3. Confidence of reception staff in decision-making is measured using self-report on a Likert scale at baseline and 4 months

Secondary ID(s)

N/A

Source(s) of Monetary Support

Australian Rotary Health