Medical referrals: introducing a GP-priority clerking shift to ensure equitable patient care

Jennifer Holland; Yazeed Abed El-Khaleq

doi:10.7861/futurehosp.5-1-37

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Fig 1.
The current rotated hours for medical clerking junior doctors on weekdays. The grey square illustrates the shift which has been changed to a ‘GP priority’ clerking shift, when most GP-referred patients will arrive at the hospital.
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Fig 2.
Figures showing the time taken for (i) initial clerking and (ii) consultant post take. (a) Compares assessments between GP- and ED-referred patients for both audit cycles. (b) Compares assessments between audit cycles for both referral source. ED = Emergency Department

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Table 1.

Patient referral demographics between audit cycles

Patient demographics	Audit cycle one	Audit cycle two	p-value	95% CI
Total	85	85
Excluded *	9	3	0.072	–0.009 to 0.157
Complete missing data	(7)	(0)
Other referral source (clinic, hospital transfers)	(2)	(1)
Number suitable for analysis	76	82
Full data available	(64)	(74)
Incomplete data available
Initial clerking time only	(6)	(1)
Consultant review only	(6)	(7)
Referral source			0.293	–0.062 to 0.199
ED	61 (80.3%)	60 (73.2%)
GP	15 (19.7%)	22 (26.8%)
Day of referral			0.002	0.081 to 0.365
Weekday	41 (53.9%)	63 (76.8%)
Weekend	35 (46.1%)	19 (23.2%)
Time of referral			0.215	–0.0559 to 0.247
In hours	37 (48.7%)	48 (58.5%)
Out of hours	39 (51.3%)	34 (41.5%)

↵*Complete missing data: both initial clerking and consultant review times missingED = Emergency Department

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Table 2.

Time taken for initial clerking and consultant review, comparing ED and GP-referred patients for both audit cycles (average) time taken is displayed as median [lower quartile, upper quartile] or mean ± standard deviation)

		ED referrals	GP referrals	p-value	95% CI
Audit cycle one
Initial clerking	Within 4 hours	90.9% (n=50)	60.0% (n=9)	0.009	0.10 to 0.64
	Average time taken	1h47m [52min, 2h38 min]	3h6min ± 1h47min	0.023	+9min to +2h3min
Consultant review	In recommended time	87.5% (n=49)	50% (n=7)	0.005	0.12 to 0.62
	Average time taken	6h35min [2h54min, 10h29min]	10h36min [3h44min, 17h48min]	0.094	–1h6min to +7h54min
Audit cycle two
Initial clerking	Within 4 hours	84.9% (n=45)	95.5% (n=21)	0.573	–0.082 to 0.231
	Average time taken	1h30min [55min, 2h25min]	1h36min [49min, 2h13min]	0.800	–1h22min to +48min
Consultant review	In recommended time	88.3% (n=53)	90.5% (n=19)	0.573	–0.181 to 0.147
	Average time taken	4h48min [1h59min,12h27min]	3h21min [2h18min, 5h25min]	0.530	–33min to +4h23min

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Table 3.

Time taken for initial clerking and consultant review, comparing cycle one and two

		Audit cycle one	Audit cycle two	p-value	95% CI
Initial clerking	% seen in recommended time
	Total	84.7	88.0	0.517	–0.074 to +0.161
	ED	90.9	84.9	0.555	–0.074 to 0.188
	GP	60.0	95.5	0.011	+0.089 to +0.600
	Average time taken
	Total	2h5min [56min,3h4min]	1h30min [50min,2h15min]	0.107	–24min to +56min
	ED only	1h47min [52min,2h38min]	1h30min [55min,2h25min]	0.557	–31min to +40min
	GP only	3h6min ± 1h47min	1h36min [49min,2h13min]	0.017	–25min to +2h27min
Consultant review	% seen in recommended time
	Total	80.3	88.9	0.130	–0.023 to +0.217
	ED	87.5	88.3	0.223	–0.111 to +0.142
	GP	50.0	90.5	0.009	+0.083 to +0.639
	Average time taken
	Total	6h45min [3h11min,11h9min]	3h55min [2h17min,11h14min]	0.086	–31min to +3h9min
	ED	6h35min [2h55min,10h29min]	4h48min [1h59min,12h27min]	0.623	–1h54min to +1h49min
	GP	10h36min [3h44min,17h48min]	3h21min [2h19min,5h25min]	0.01	+1h59min to +9h46min