An evaluation of Rapid Health’s Smart Triage at The Groves Medical Centre

Introduction

Rapid Health’s Smart Triage is an autonomous patient triaging system that aims to improve access for patients and enable better management of demand and capacity. In contrast to traditional online consultation and triage tools that only collect information and support humans in the triage process, Smart Triage is autonomous and fully automates the patient triage and navigation process from the initial contact with their GP practice. Whether requesting care online, by phone, or in person, patients are guided through a series of questions based on their concerns. The system then assesses their symptoms, clinically triages and directs the patient to the most suitable care and enables immediate self-booking into the right appointments. This streamlined process empowers patients to access care at their convenience while relieving the practice from direct involvement in each request. Unity Insights were commissioned by Health Innovation Kent Surrey Sussex and Rapid Health to independently evaluate the impact of Rapid Health’s Smart Triage from October 30th 2023 to February 29th 2024 at The Groves Medical Centre (South West London ICS).

Methods

Quantitative data from The Groves Medical Centre, Rapid Health, and NHS Digital were analysed through descriptive and statistical analyses. When comparing the pre- and post-implementation periods, only data from attended appointment slots could be used, as patient medical and admin request data was not available for the pre-implementation period.

Staff members were surveyed pre- and post-implementation. Patient perspectives were captured through a post-implementation survey, and through the Friends and Family survey before and after Rapid Health’s Smart Triage. All surveys were analysed through thematic analysis and frequency distributions. Patient and staff survey responses were likely to reflect opinions on the change impact of the new pathway, not just on the implementation of Rapid Health’s Smart Triage. Further, it cannot be guaranteed whether the same staff members completed both surveys.

Results

Does Rapid Health’s Smart Triage lead to improved access to care?

During the four months of implementation at The Groves Medical Centre, Rapid Health’s Smart Triage improved access to care by:

• Reducing wait times by 73% for appointments (patients received a pre-bookable appointment nine days faster on average).
• Increasing online care requests (from 12% to 82%) and delivering digital-first primary care. Care request volumes peaked at 8am in both periods, however each month the proportion of care requests at this time decreased by 16% following implementation.
• There was a 58% decrease in the average maximum telephone call concurrency by 15 calls following implementation. Call volumes peaked at 8am pre-implementation, however in the post-implementation period, call volumes at 8am were comparable to other times of day.
• Automating clinical triage and booking processes without staff or clinical intervention.
• Enabling equitable patient access across all access channels – online, telephone, and walk-ins; the demographics of patients completing requests was representative of the overall registered patient population.
• Online access was available 24/7 throughout the post-implementation period.

Does Rapid Health’s Smart Triage lead to better management of demand and capacity?

During the four months of implementation at The Groves Medical Centre, Rapid Health’s Smart Triage improved demand and capacity management by automating triage and appointment booking (with 91% of appointment requests made via Rapid Health’s Smart Triage allocated automatically), increasing face-to-face appointments (an increase from 53% to 85%), enhancing clinical capacity utilisation, reducing waiting times, and avoiding over triage to secondary care (0.12% of requests made via Rapid Health’s Smart Triage were signposted to A&E and resulted in the patient stating they planned to attend A&E). Further, there were no clinical incidents or significant events during the post-implementation period, underscoring the system’s safety and demonstrating that demand and capacity were managed appropriately.

Does Rapid Health’s Smart Triage lead to more sustainable staff working patterns?

During the four months of implementation at The Groves Medical Centre, Rapid Health’s Smart Triage promoted more sustainable staff working patterns by reducing daily patient contacts (from 335 to 330 per day), improving the utilisation of healthcare professionals, lowering same-day appointment demand (the proportion of patients triaged for on-the-day appointments dropped from over 62% to 19%, compared to a 44% national average), and allowing staff to focus more time on in-person and phone requests (with 15-minute appointments maintained), aligning with the British Medical Association’s guidelines on workload control.

Does Rapid Health’s Smart Triage lead to an improved care experience for patients?

Patient care experience encompasses many dimensions, some outside of the remit of Rapid Health’s Smart Triage. This should be acknowledged when assessing whether Rapid Health’s Smart Triage led to an improved care experience. In the Friends and Family survey, most patients reported positive experiences of the service provided by The Groves Medical Centre in the pre-implementation (93%) and post-implementation (89%) periods. This was similar to the proportions identified at an ICS (92%) level and a national (91%) level. The patient survey, with a low response rate of 20 respondents out of 17,500 registered patients, found that:

• 73% disagreed with the statement regarding whether Rapid Health’s Smart Triage was easier to use compared to the previous pathway when submitting medical requests.
• 65% disagreed with the statement regarding whether submitting requests via Rapid Health’s Smart Triage was less stressful compared to the previous pathway.

Overall, 19% of requests via Rapid Health were categorised as ‘red’ and 26% of requests were categorised as ‘amber’. Patients requiring urgent care (triaged as red) received an appointment slot in 54 minutes on average following implementation. Here, 68% of ‘red’ requests were able to be held on the same day as care was requested, increasing to 75% by the next day. All ‘red’ patients seen the next day were processed on the day and would have been contacted by the practice to ensure they were happy to be offered an appointment at a later date.

Does Rapid Health’s Smart Triage lead to an increase in staff satisfaction?

Quantitative and qualitative insights suggested mixed views. Quantitative insights suggested Rapid Health’s Smart Triage released staff time, which could impact staff workload and satisfaction, however qualitative insights presented converse views and were undertaken during a period of staff role and responsibility changes and whilst the practice was not fully staffed:

• 30% of staff were satisfied with the use of Rapid Health’s Smart Triage at The Groves Medical Centre.
• 57% of staff found Rapid Health’s Smart Triage easy to use, compared to 25% who found the previous system easy to use.
• 56% could find the information they needed when using Rapid Health’s Smart Triage.

Despite this, staff satisfaction is multifactorial and depends on parameters outside of Rapid Health’s Smart Triage’s control such as sense of belonging, autonomy, workload, and pay package. It is important to consider wider impacts when reviewing the findings.

Recommendations

Conclusion

Despite the winter pressure and the fact that the evaluation only captured the first four months of implementation, Rapid Health’s Smart Triage demonstrated improved access to care by enabling patients to request and instantly book appointments online and submit admin requests, which contributed to more efficient management of demand and capacity. The autonomous triage allowed for prioritisation of patients requiring urgent care, ensuring that those with the greatest urgency received timely care, while also reducing the average wait time for all non-urgent patients. Although feedback from both staff and patients was mixed, this may be attributed to change impact, the GP practice not being fully staffed, or the possibility of a low response rate leading to an unrepresentative sample. To address this, it is crucial to regularly engage with both groups to ensure that any feedback can be addressed appropriately. Finally, it is encouraging to observe that the results from the July 2024 Friends and Family survey highlight that online access is now the most preferred channel at The Groves Medical Centre.