Physiotherapist Experiences and Perceptions of Telephone Triage and Barriers faced when Triaging

Purpose

This study aims to identify Physiotherapist's perceptions and experiences of Telephone Triage, as well as identifying any barriers they may face when triaging.

Professional barriers to PTT have been suggested demonstrating clinician reluctance despite patient satisfaction. Little is known about the effect of the role change on the Physiotherapist, and the inability to physically examine the patient.

This research will help direct training and the working experience for Physiotherapists, improve current Triage structures and provide justification to organisations implementing the service. Understanding barriers to PTT will assist with service planning and change management.

It was felt beneficial for a patient to be initially triaged
over the telephone, rather than to wait to be seen face-to-face (91.38%).
Physiotherapists were confident when asking Red Flag questions
and how to manage any patient presenting with them (100%).
They felt able to accurately diagnose patients
over the telephone (84.48%)...
...and had a good understanding
of their symptoms (96.48%).

Approach

The mixed methods qualitative/quantitative study will focus on a population of Physiotherapists working for Nuffield Health (NH) who perform PTT.

A semi-structured focus group discussion was held with Physiotherapists to gather themes to aid in development of a survey. The survey was distributed via electronic portal to other Physiotherapists practicing Triage at NH. It consisted of two compulsory introduction questions, seven demographic questions, two Triage experience questions and 23 statements.

For consistency, most statements were framed positively, and Physiotherapists were asked to rate their agreement with each statement on a seven-point Likert scales ranging from strongly agree to strongly disagree. Levels of agreement with each statement were evaluated. This data was analysed to provide detail of Physiotherapist's experiences, perceptions and barriers faced when performing PTT.

Outcomes

Overall Physiotherapists had positive perceptions of PTT services. They felt able to accurately diagnose patients over the telephone (84.48%) and had a good understanding of their symptoms (96.48%).

It was felt beneficial for a patient to be initially triaged over the telephone, rather than to wait to be seen face-to-face (91.38%). Physiotherapists were confident when asking Red Flag questions and how to manage any patient presenting with them (100%).

Improvements in skills such as clinical reasoning were seen. Barriers faced by the Physiotherapists included time limitations for call-associated administration to be completed, dislike of losing physical contact, and patients have limited understanding of what Triage is prior to the call being held.

This study concluded PTT is acceptable to Physiotherapists working at NH. Overall Physiotherapists have positive perceptions of PTT services. Literature demonstrated clinician concerns about Triage including potential deskilling, compromised ability to diagnose over the telephone, and the lack of sensitivity and accuracy for complex cases. These were all disproved in this research.

Implications

The research shows Physiotherapists are supportive of PTT and can clearly see the benefits it provides for patients. To change a service, adaptability and buy-in from the staff is required.

This research could be used to introduce and demonstrate the positives of PTT. Additionally the barriers, such as administration time and educating the patient prior to the call can be improved.

The positive results of this survey should be encouraging to clinicians feeling negatively about PTT. However a similar standard of training and supervision is needed. Implemented nationally would improve patient outcomes, and improve confidence in the profession and PTT itself.

Fund acknowledgements

This work was unfunded. 

Additional notes

This work was presented at Physiotherapy UK 2019