> arguably if you are going to put a 'Specialist' Doctor at the front
> door of
> A+E to do a job which a Band 5 Nurse can do if appropriately
> supported (
> triage + signposting)- it should be a GP ...
I don't think it really is something a Band 5 nurse can do regardless of support. You need someone who can make a rapid assessment (otherwise you won't get through the patients), manage uncertainty (deciding which patients with normal/ ish observations and no definite diagnosis need a fuller assessment there and then; which can contact their GP next working day; and which don't need to see a doctor), and deciding on sensible risk taking.
Tony Redmond published on it in the 1990s. He would send about a third of patients away from triage. That's probably way above what a Band 5 nurse could do.
Using a GP is one possibility. However it is worth noting that sensitivity of clinical examination by GPs for picking up serious disorders has been shown to be low in a number of studies (sensitivity of EPs may be similar, lower or higher, it just hasn't been studied as well). This is not a problem in a population with a low prevalence as negative predictive value is OK, but patients attending EDs are more likely to be sicker. The other side of this is that specific parts of examination are probably less important in decision making at triage than physician gestalt. Physician gestalt learned in one setting may not translate to another. So the question there is whether patients coming to triage are similar to patients attending their GP. If they are, you might find that using a consultant EP would mean overtriage (i.e. not as many patients been sent away as could be). If they aren't, then using a GP might result in under triage (so some patients are sent away who shouldn't be). It is an interesting question and one that might warrant a good quality study.
Matt Dunn
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