Clinician-led secondary triage in England's urgent care delivery: a cross-sectional study
Clinician-led secondary triage in England's urgent care delivery: a cross-sectional study
BACKGROUND: clinician-led secondary triage, following primary triage by the NHS 111 phone line, is central to England's urgent care system. However, little is known about how secondary triage influences the urgency attributed to patients' needs.
AIM: to describe patterns of secondary triage outcomes and call-related factors (such as call length and time of call) associated with upgrading/downgrading of primary triage outcomes.
DESIGN AND SETTING: cross-sectional analysis of secondary triage call records from four urgent care providers in England using the same digital triage system to support clinicians' decision making.
METHOD: statistical analyses (mixed-effects regression) of approximately 200 000 secondary triage call records were undertaken.
RESULTS: following secondary triage, 12% of calls were upgraded (including 2% becoming classified as emergencies) from the primary triage urgency. The highest odds of upgrade related to chest pain (odds ratio [OR] 2.68, 95% confidence interval [CI] = 2.34 to 3.07) and breathlessness (OR 1.62, 95% CI = 1.42 to 1.85; reference: abdominal pain) presentations. However, 74% of calls were downgraded; notably, 92% (n = 33 394) of calls classified at primary triage as needing clinical attention within 1 h were downgraded. Secondary triage outcomes were associated with operational factors (day/time of call), and most substantially with the clinician conducting triage.
CONCLUSION: non-clinician primary triage has significant limitations, highlighting the importance of secondary triage in the English urgent care system. It may miss key symptoms that are subsequently triaged as requiring immediate care, while also being too risk averse for most calls leading to downgrading of urgency. There is unexplained inconsistency between clinicians, despite all using the same digital triage system. Further research is needed to improve the consistency and safety of urgent care triage.
Humans, Triage, Cross-Sectional Studies, England, Telephone, Time Factors
e427-e434
Sexton, Vanashree
e993bb08-a4a9-48dd-91f4-af033775a555
Atherton, Helen
9bb8932e-7bb7-4781-ab97-114613de99b1
Dale, Jeremy
19fccbd2-1661-4d84-8a94-36bedb12a0e2
Abel, Gary
d14838f4-2a59-4dec-b3ac-527030888e44
1 June 2023
Sexton, Vanashree
e993bb08-a4a9-48dd-91f4-af033775a555
Atherton, Helen
9bb8932e-7bb7-4781-ab97-114613de99b1
Dale, Jeremy
19fccbd2-1661-4d84-8a94-36bedb12a0e2
Abel, Gary
d14838f4-2a59-4dec-b3ac-527030888e44
Sexton, Vanashree, Atherton, Helen, Dale, Jeremy and Abel, Gary
(2023)
Clinician-led secondary triage in England's urgent care delivery: a cross-sectional study.
The British journal of general practice : the journal of the Royal College of General Practitioners, 73 (731), .
(doi:10.3399/BJGP.2022.0374).
Abstract
BACKGROUND: clinician-led secondary triage, following primary triage by the NHS 111 phone line, is central to England's urgent care system. However, little is known about how secondary triage influences the urgency attributed to patients' needs.
AIM: to describe patterns of secondary triage outcomes and call-related factors (such as call length and time of call) associated with upgrading/downgrading of primary triage outcomes.
DESIGN AND SETTING: cross-sectional analysis of secondary triage call records from four urgent care providers in England using the same digital triage system to support clinicians' decision making.
METHOD: statistical analyses (mixed-effects regression) of approximately 200 000 secondary triage call records were undertaken.
RESULTS: following secondary triage, 12% of calls were upgraded (including 2% becoming classified as emergencies) from the primary triage urgency. The highest odds of upgrade related to chest pain (odds ratio [OR] 2.68, 95% confidence interval [CI] = 2.34 to 3.07) and breathlessness (OR 1.62, 95% CI = 1.42 to 1.85; reference: abdominal pain) presentations. However, 74% of calls were downgraded; notably, 92% (n = 33 394) of calls classified at primary triage as needing clinical attention within 1 h were downgraded. Secondary triage outcomes were associated with operational factors (day/time of call), and most substantially with the clinician conducting triage.
CONCLUSION: non-clinician primary triage has significant limitations, highlighting the importance of secondary triage in the English urgent care system. It may miss key symptoms that are subsequently triaged as requiring immediate care, while also being too risk averse for most calls leading to downgrading of urgency. There is unexplained inconsistency between clinicians, despite all using the same digital triage system. Further research is needed to improve the consistency and safety of urgent care triage.
Text
e427.full
- Version of Record
More information
Accepted/In Press date: 9 January 2023
e-pub ahead of print date: 25 May 2023
Published date: 1 June 2023
Additional Information:
© The Authors.
Keywords:
Humans, Triage, Cross-Sectional Studies, England, Telephone, Time Factors
Identifiers
Local EPrints ID: 486843
URI: http://eprints.soton.ac.uk/id/eprint/486843
ISSN: 0960-1643
PURE UUID: 1080545f-38de-4669-bd62-3cd8cafb0541
Catalogue record
Date deposited: 06 Feb 2024 18:32
Last modified: 18 Mar 2024 04:18
Export record
Altmetrics
Contributors
Author:
Vanashree Sexton
Author:
Helen Atherton
Author:
Jeremy Dale
Author:
Gary Abel
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics