Background Telephone triage plays an important role in managing demand for healthcare. In recent years there has been an increasing use of telephone triage in managing demand for unscheduled health care for general health problems. Policy makers, service providers and service evaluators are interested in the appropriateness of triage decisions in the context of offering an effective and safe service. In 2009 the Department of Health in England announced the establishment of a small number of pilot sites to test a new telephone triage service called ‘NHS 111’. The service offers telephone triage to members of the general population calling about urgent but non-emergency health problems. Calls are triaged by trained non-clinical call advisors and directed to a range of services such as an emergency department, or a general practitioner.
Methods As part of an evaluation of these pilots, in order to provide context for understanding the findings, a rapid evidence assessment was undertaken of the appropriateness of, and compliance with, telephone triage to synthesise the evidence on the percentage of telephone triage decisions assessed as appropriate and the percentage which callers complied with. The aim of this paper is to report on a systematic review of the literature on appropriateness of, and compliance with, telephone triage decisions. The study focused on telephone triage services directing patients to an appropriate health care provider. The principles of rapid evidence assessment were followed.
Results We identified 54 relevant papers; 26 papers reported appropriateness of triage decision, 26 papers reported compliance with triage decision and 2 papers reported both. Nurses triaged calls in most of the studies (n=49). Triage decisions rated as appropriate varied between 44% and 98% (median 75); compliance ranged from 56% to 98% (median 77%). Variation could not be explained by type of service or method of assessing appropriateness. However, inconsistent definitions of appropriateness may explain some variation. Triage decisions to contact primary care (median 66%, range 25%-91%) may have lower compliance than decisions to contact emergency services (median 75%, range 29%-100%) or self care (median 77%, range 26%-100%).
Conclusion Telephone triage services can offer appropriate decisions, and decisions that callers comply with. However the association between the appropriateness of a decision and subsequent compliance requires further investigation and further consideration needs to be given to the minority of calls which are inappropriately managed. We suggest that a definition of appropriateness incorporating both accuracy and adequacy of triage decision should be encouraged.
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