A training programme did not increase agreement between allied health clinicians prioritizing patients for community rehabilitation

Abstract

Objective: To evaluate the effect of formal training on agreement between clinicians making decisions on client priority.

Setting: A centralized intake service receiving referrals for a community rehabilitation programme.

Design: Agreement was measured between the priority categories allocated to consecutive referrals by one of five clinicians in the referral office compared with a second rating made by an independent occupational therapist, blinded to the initial priority rating. Data collection followed the implementation of four 1-hour workshops involving all raters, designed to increase consistency of triage decisions. Results were compared to a previous study conducted prior to the training.

Participants: Two hundred and one consecutive referrals received for community rehabilitation services, triaged by experienced clinicians with allied health or nursing qualifications.

Outcome measure: Agreement using weighted kappa (κw).

Results: There was no change in agreement between clinicians after training, compared with a previous study in the same setting. Agreement remained moderate (κw = 0.50), with clinicians disagreeing on approximately 30% of referrals.

Conclusions: Three out of 10 clients will receive a different priority rating and waiting time for rehabilitation services depending on which clinician in the referral office made the rating. This result was not improved by conducting a training programme.