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Title: Senior doctor triage and emergency department performance : a mixed methods study
Author: Abdulwahid, Maysam
ISNI:       0000 0004 7231 106X
Awarding Body: University of Sheffield
Current Institution: University of Sheffield
Date of Award: 2018
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Aim: Emergency department (ED) crowding has led many EDs to implement interventions such as senior doctor's involvement in the initial assessment of emergency patients or senior doctor triage (SDT). The aim of this study was to quantify and evaluate the SDT process in English EDs and supplement this with descriptions of various aspects of the SDT process. Methods: For the first phase of this mixed methods study, a national cross-sectional survey, and a retrospective secondary data analysis were used. This was followed by the qualitative component of the study; the semi-structured interviews. The survey was aimed at emergency consultants of all Type I EDs in England to identify those which implemented a form of SDT and then, the secondary routine ED performance data analysis study proceeded to test the theoretical assumption that EDs with SDT achieved superior ED performance using the relevant statistical tests. Subsequently, the qualitative study recruited a convenience sample of emergency health care professionals and ED managerial staff. Template analysis was followed in the qualitative study. Results: Responses were received for 119 out of the 171 surveyed EDs with 69.6% response rate. In about two-fifths of EDs (42.8%, 51/119), a form of SDT was utilized for either ambulance arrivals or walk-in patients or both. The most commonly used model was senior doctor and registered nurse triage. The retrospective routine ED data analysis study compared the ED performance of the two groups (with and without SDT) using routinely collected ED quality indicators for a one year period. It revealed that there was no statistically significant difference in ED performance across the two groups, but hospitals with SDT received a significantly higher number of patient attendances per year. In the interviews, participants identified that crowded EDs revert to a form of SDT at peak times when patient volume increases, and that this model was mainly used as a safety mechanism to recognise and treat the 'sick' patients in these circumstances. Participants had various understandings of the SDT process. The positive and negative aspects, barriers and facilitators to the application of the SDT process were described. Conclusion: SDT was a relatively popular practice in EDs across England but it did not impact ED performance indicators. This could partly be explained by the notion that SDT was implemented as part of a 'crisis management and patient safety' strategy in these hospitals, as was evidenced in the interviews. Future research should attempt to measure the impact of SDT on patient outcomes such as patient mortality and near-miss events, in addition, to its impact on ED targets. A process evaluation study that takes into account the local contextual factors is warranted.
Supervisor: Mason, Suzanne ; Turner, Janette Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available