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GP receptionists 'could help prevent stroke deaths'

Monday 29 June 2015

"Teaching doctors' receptionists to spot the warning signs of strokes could save thousands of lives a year," the Daily Mail reports.

Educating staff about the warning signs of a stroke, such as a droopy face and speaking difficulties, could lead to improved outcomes, a new pilot study concluded.

The study looked at a large sample of GP practices in one region of the UK. Researchers asked receptionists to take a series of unannounced calls where actors with various stroke symptoms asked for advice.

In about two-thirds of calls the receptionist acted appropriately, either passing them on to a GP or telling them to contact the emergency services.

Generally, the receptionists were more likely to refer on if more common symptoms were described – a drooping face or mouth, a weak arm or slurred speech – and with the greater number of these symptoms given.

These results are likely to give a good indication of how receptionists would respond if a patient called with stroke symptoms and asked for advice. As the researchers suggest, extra receptionist training about stroke, as well as other life-threatening conditions, could help. 

Where did the story come from?

The study was carried out by researchers from the University of Oxford and was supported by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care for Birmingham and the Black Country.

It was published in the peer-reviewed British Journal of General Practice on an open access basis, so it is free to read online or download as a PDF.

The Mail's reporting is generally representative of the research findings, but an alternative focus could be on helping people recognise when they need to call 999 immediately, rather than the receptionist as the possible life-saver.

All of us, whatever our role, could benefit from first aid training, as you never know when it could make the difference between life and death.

Read more about first aid

What kind of research was this?

This was an experimental study involving a cross-section of GP surgeries. The practices took part in simulated phone calls and receptionists completed questionnaires. The aim was to look at the ability of GP receptionists to recognise the symptoms of stroke and direct patients to emergency care where appropriate.

Stroke is one of the leading causes of death and disability, and is estimated to result in 5.7 million deaths worldwide. Timely recognition of symptoms and prompt medical care is essential for the best outcomes.

The GP is said to be the first point of contact for between a quarter and half of people who have had a stroke or mini-stroke (a transient ischaemic attack or TIA), but not all receive the correct emergency referral.  

What did the research involve?

This study called GP receptionists with a series of unannounced simulated patient telephone calls, where the patient was played by an actor role-playing the symptoms of stroke. The study also examined receptionists' knowledge of stroke symptoms using a questionnaire.

The sample included 52 GP surgeries, all from within Birmingham and Solihull NHS primary care providers. Receptionists knew a study was going on, but did not know what it was about, or the nature of the calls or when they would occur.

A total of 520 simulated phone calls were made, with 10 different calls made to each participating practice. There were various acted-out scenarios involving different actors saying different things and presenting with different symptoms.

For example, in one scenario a child could be saying, "I think my Mum's having a stroke. Her mouth is drooping, her speech is slurred, and she can't use her right arm", or a person saying, "I'm not sure what to do. When I look in the mirror my reflection looks funny".

The different scenarios were rated by an expert panel as being easy, moderate or difficult depending on the stroke presentation and the types of symptoms given.

After completion of the call period, all receptionist staff involved were sent questionnaires about their knowledge of stroke. Completed questionnaires were received from 183 receptionists, representative of just over half of those involved.

The researchers analysed the likelihood of immediate care depending on the ease of presentation and the number of common symptoms given.   

What were the basic results?

Overall, the receptionists correctly referred 69% of the calls to immediate care. Such appropriate responses could be either telling the patient to contact emergency services or transferring them through immediately to speak with a GP.

As may be expected, calls recognised as being moderately hard (someone saying their reflection looks funny) or difficult (someone saying they're feverish, throwing up and have double vision) were less likely to be referred than easy, typical presentations.

These easy presentations centred on what are called the three FAST symptoms: facial asymmetry (a drooping mouth), arm weakness and slurred speech, the "T" standing for time to call the ambulance.

The greater the number of these FAST symptoms given, the more likely the person was to be referred for immediate care. Only one or two FAST symptoms were less likely to be referred than when all three were given.

Questionnaire results showed that receptionists' knowledge of stroke symptoms was good, with 96% able to recognise at least one typical FAST symptom, and about three-quarters able to recognise all three.

Less than a third could recognise more unusual presentations such as visual disturbance, dizziness and vomiting, which can occur with rarer strokes involving the base of the brain. 

How did the researchers interpret the results?

The researchers concluded that GP receptionists refer patients with stroke for immediate care when they present with several symptoms, but are less likely to refer them when they present with only one symptom or less common ones.

They said that, "Optimum management of acute stroke in [general practice] requires interventions that improve receptionists' knowledge of lesser-known stroke symptoms." 


This valuable and well-designed study assessed a cross-section of general practices from one UK region, looking at how well receptionists are able to recognise the signs of stroke and give appropriate advice – either immediately passing patients on to the GP or telling them to contact emergency services.

The study has many strengths. These include the large sample of GP surgeries and calls assessed, and that receptionists weren't aware of the nature of the study and the calls were unannounced. At the end of each individual call receptionists were told the call was part of the study and no further action was needed, but they didn't know this when giving advice.

Also, the scenarios acted out were carefully selected to represent the possible symptoms of different types of stroke and were rated for their difficulty by an expert panel.

Though this is only a sample of one region of the UK, the study should give a good representation of receptionist understanding and the types of responses a person may be given if they were to call a GP practice and give such symptoms.

The questionnaire results are possibly less representative – although this demonstrated a good level of understanding about stroke, it was only completed by half of receptionists who took part. The half who completed the questionnaire may have a better understanding than the half who didn't.

Stroke is common, and is associated with high mortality and disability, so this is undoubtedly an important issue. As the researchers suggest, improved receptionist knowledge could have an effect in improving access to immediate care, and training sessions could be helpful. But receptionists are not trained – nor is it their job – to recognise the symptoms of all emergency conditions.

This study focused on stroke, but there are many other acute conditions the study could have looked at alternatively, such as recognising the various symptoms of heart attack.

Many people may think of contacting their GP as the first port of call when they are ill, but it is important for people to know when to call the emergency services or go to an emergency department.

For stroke, this most often includes drooping of the face, slurred speech and weakness on one side of the body, but there can be other symptoms, such as visual disturbance, sickness, severe headache, dizziness, confusion or loss of consciousness.

Time is vital with stroke, so getting to a hospital as soon as possible is most important. There is an old saying that "time is brain" – the quicker a stroke patient can be treated, the less brain damage they will experience.

Analysis by Bazian
Edited by NHS Website