Emergency department staff views of NHS 111 First: qualitative interview study in England
Emergency department staff views of NHS 111 First: qualitative interview study in England
Background: NHS 111 is a phone and online urgent care triage and assessment system that aims to reduce UK ED demand. In 2020, 111 First was introduced to triage patients before entry to the ED and to offer direct booking for patients needing ED or urgent care into same-day arrival time slots. 111 First continues to be used post pandemic, but concerns about patient safety, delays or inequities in accessing care have been voiced. This paper examines ED and urgent care centre (UCC) staff experiences of NHS 111 First.
Method: semistructured telephone interviews were conducted with ED/UCC practitioners across England between October 2020 and July 2021 as part of a larger multimethod study examining the impact of NHS 111 online. We purposively recruited from areas with high need/demand likely to be using NHS 111 services. Interviews were transcribed verbatim and coded inductively by the primary researcher. We coded all items to capture experiences of 111 First within the full project coding tree and from this constructed two explanatory themes which were refined by the wider research team.
Results: we recruited 27 participants (10 nurses, 9 doctors and 8 administrator/managers) working in ED/UCCs serving areas with high deprivation and mixed sociodemographic profiles. Participants reported local triage/streaming systems predating 111 First continued to operate so that, despite prebooked arrival slots at the ED, all attendances were funnelled into a single queue. This was described by participants as a source of frustration for staff and patients. Interviewees perceived remote algorithm-based assessments as less robust than in-person assessments which drew on more nuanced clinical expertise.
Discussion: while remote preassessment of patients before they present at ED is attractive, existing triage and streaming systems based on acuity, and staff views about the superiority of clinical acumen, are likely to remain barriers to the effective use of 111 First as a demand management strategy.
emergency department management, triage
636-640
MacLellan, Jennifer
2035484c-7514-4a4b-9ad4-ef8e3fdc95e9
Turnbull, Joanne
cd1f8462-d698-4a90-af82-46c39536694b
Prichard, Jane
64ba5e39-0b0f-4529-877f-aa6ecc7e7e2e
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
6 July 2023
MacLellan, Jennifer
2035484c-7514-4a4b-9ad4-ef8e3fdc95e9
Turnbull, Joanne
cd1f8462-d698-4a90-af82-46c39536694b
Prichard, Jane
64ba5e39-0b0f-4529-877f-aa6ecc7e7e2e
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
MacLellan, Jennifer, Turnbull, Joanne, Prichard, Jane and Pope, Catherine
(2023)
Emergency department staff views of NHS 111 First: qualitative interview study in England.
Emergency Medicine Journal, 40 (9), .
(doi:10.1136/emermed-2022-212947).
Abstract
Background: NHS 111 is a phone and online urgent care triage and assessment system that aims to reduce UK ED demand. In 2020, 111 First was introduced to triage patients before entry to the ED and to offer direct booking for patients needing ED or urgent care into same-day arrival time slots. 111 First continues to be used post pandemic, but concerns about patient safety, delays or inequities in accessing care have been voiced. This paper examines ED and urgent care centre (UCC) staff experiences of NHS 111 First.
Method: semistructured telephone interviews were conducted with ED/UCC practitioners across England between October 2020 and July 2021 as part of a larger multimethod study examining the impact of NHS 111 online. We purposively recruited from areas with high need/demand likely to be using NHS 111 services. Interviews were transcribed verbatim and coded inductively by the primary researcher. We coded all items to capture experiences of 111 First within the full project coding tree and from this constructed two explanatory themes which were refined by the wider research team.
Results: we recruited 27 participants (10 nurses, 9 doctors and 8 administrator/managers) working in ED/UCCs serving areas with high deprivation and mixed sociodemographic profiles. Participants reported local triage/streaming systems predating 111 First continued to operate so that, despite prebooked arrival slots at the ED, all attendances were funnelled into a single queue. This was described by participants as a source of frustration for staff and patients. Interviewees perceived remote algorithm-based assessments as less robust than in-person assessments which drew on more nuanced clinical expertise.
Discussion: while remote preassessment of patients before they present at ED is attractive, existing triage and streaming systems based on acuity, and staff views about the superiority of clinical acumen, are likely to remain barriers to the effective use of 111 First as a demand management strategy.
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NHS-111-EMJ-Manuscript.R3.MARKED accepted version
- Accepted Manuscript
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636.full
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More information
Accepted/In Press date: 20 June 2023
e-pub ahead of print date: 6 July 2023
Published date: 6 July 2023
Additional Information:
Funding Information:
This study was funded by the NIHR HS&DR Programme (project number 127590) and will be published in full in Health and Social Care Delivery Research. Further information is available at https://fundingawards.nihr.ac.uk/award/NIHR127590 . This paper reports independent research commissioned by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Keywords:
emergency department management, triage
Identifiers
Local EPrints ID: 484931
URI: http://eprints.soton.ac.uk/id/eprint/484931
ISSN: 1472-0205
PURE UUID: 2d40e065-5680-448e-89af-caf478f712fc
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Date deposited: 24 Nov 2023 17:40
Last modified: 18 Mar 2024 02:49
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Author:
Jennifer MacLellan
Author:
Catherine Pope
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