Exploring the complexity associated with out of hours calls to UK
general practice
Prof Jeremy Dale, HSRI, Warwick Medical School
Objectives
The overall objectives of the research will be to use routinely collected data from a computerised
decision support (CDS) that is in widespread NHS use
- To explore patterns of activity, decision-making and symptomatology associated with
general practice out of hours calls, and how these vary according to
o patient characteristics
o problem (symptoms presented)
o time (hour, day of week, month)
o place (location of the patient and the out-of hours service)
o nurse experience
The specific objectives of the mini-project are to undertake the first phase of this research by
o understanding the format of the CDS patient record database
o establishing a process to transfer data from the CDS patient record database to
a statistical package that can be used for in-depth analysis and modelling
o using appropriate statistical techniques, undertake exploratory analyses of the data
o engaging with end-users to understand the questions that they would like answered
Why it is interesting?
General practice out of hours care is provided by local/regional out of hours organisations, most of
which serve populations of about 0.25 - 1 million residents. The majority of these services use
nurses to assess the patients’ needs over the phone to determine the urgency and type of care that
is needed and to provide advice. Of these, the majority use computerised decision support (CDS)
to prompt this process, of which TAS Odyssey (the database that will be used in this study) is the
system that is most widely used. The evidence base for the needs of primary care patients out of
hours and how these are managed is quite weak, and it is only recently with the widespread use of
computerised decision support that the potential has arisen for analysing the data associated with
these calls. On average, about 150 out of hours calls occur per 1000 population pa (i.e. about 7.5
million for the population of England pa).
Background to be assimilated
This project will make use of a database drawn from the most widely used CDS for out of
hours calls, and will initially look at between 500000 and 1 million call records. For each record
the following data are available:
o anonymised identifier for assessing nurse & their organisation
o date, time, patient age, sex, postcode (first 4 characters), content of previous
calls and their outcome
o problem/symptoms presented, aspects of symptoms (such as duration, severity),
treatment tried
o length of call, triage recommendation, actual disposal
Techniques required
The mini-project will require understanding of database structure, and how to transfer data
from a patient record format to one that allows complex statistical analyses to be undertaken.
Prospective deliverables
A report scoping out the potential for statistical modelling of this data, and how such modelling
can be used to help inform service development and CDS development.
Relation to end/downstream users
This research will be of use to the NHS and out of hours service commissioners and providing
organisations. It may also lead to refinement of the CDS. JD is lead clinical advisor to the
company that produces the CDS. The student will be encouraged to liaise with the NHS out of
hours services to develop questions that are pertinent to their activities.
Prospects for this miniproject leading into a PhD project
There are numerous possibilities for developing this project into a PhD study.