Giving callers the option to bypass the telephone waiting line in out-of-hours services: a comparative intervention study

Ebert, J. F.; Huibers, Linda; Christensen, Bo; Lippert, Freddy; Christensen, Morten Bondo

doi:10.1080/02813432.2019.1569427

Cited by 11 publications

(24 citation statements)

References 20 publications

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“…As found in this study, Denmark has a relatively high number of OOH-PC contacts per inhabitants (approximately 500/1000) [11,26] compared with other countries with similar health care organizations (ranging from around 150-410/1000) [27][28][29], whereas the level of EMS contacts (100/1000) is more alike [1,30,31]. In the present study, the number of subsequent hospital contacts depending on type of OOH service differed, which was to be expected when comparing EMS and OOH-PC.…”

Section: Comparison With Literaturesupporting

confidence: 59%

Acute care pathways for patients calling the out-of-hours services

Søvsø

Huibers

Bech

et al. 2020

BMC Health Serv Res

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Background: In Western countries, patients with acute illness or injury out-of-hours (OOH) can call either emergency medical services (EMS) for emergencies or primary care services (OOH-PC) in less urgent situations. Callers initially choose which service to contact; whether this choice reflect the intended differences in urgency and severity is unknown. Hospital diagnoses and admission rates following an OOH service contact could elucidate this. We aimed to investigate and compare the prevalence of patient contacts, subsequent hospital contacts, and the age-related pattern of hospital diagnoses following an out-of-hours contact to EMS or OOH-PC services in Denmark. Methods: Population-based observational cohort study including patients from two Danish regions with contact to EMS or OOH-PC in 2016. Hospital contacts were defined as short (< 24 h) or admissions (≥24 h) on the date of OOH service contact. Both regions have EMS, whereas the North Denmark Region has a general practitioner cooperative (GPC) as OOH-PC service and the Capital Region of Copenhagen the Medical Helpline 1813 (MH-1813), together representing all Danish OOH service types. Calling an OOH service is mandatory prior to a hospital contact outside office hours. Results: OOH-PC handled 91% (1,107,297) of all contacts (1,219,963). Subsequent hospital contacts were most frequent for EMS contacts (46-54%) followed by MH-1813 (41%) and GPC contacts (9%). EMS had more admissions (52-56%) than OOH-PC. For both EMS and OOH-PC, short hospital contacts often concerned injuries (32-63%) and non-specific diagnoses (20-45%). The proportion of circulatory disease was almost twice as large following EMS (13-17%) compared to OOH-PC (7-9%) in admitted patients, whereas respiratory diseases (11-14%), injuries (15-22%) and non-specific symptoms (22-29%) were more equally distributed. Generally, admitted patients were older. Conclusions: EMS contacts were fewer, but with a higher percentage of hospital contacts, admissions and prevalence of circulatory diseases compared to OOH-PC, perhaps indicating that patients more often contact EMS in case of severe disease. However, hospital diagnoses only elucidate severity of diseases to some extent, and other measures of severity could be considered in future studies. Moreover, the socio-demographic pattern of patients calling OOH needs exploration as this may play an important role in choice of entrance.

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Section: Comparison With Literaturesupporting

confidence: 59%

Acute care pathways for patients calling the out-of-hours services

Søvsø

Huibers

Bech

et al. 2020

BMC Health Serv Res

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“…An assessment of nonrespondents showed that non-respondents were similar to participants with regard to age, gender and triage response, but selection bias cannot be ruled out. Yet, very worried callers might not have wished to participate, however this fraction is supposedly limited as only a small low number of callers (< 4%) used an emergency access button to bypass the telephone waiting line in a similar study [33]. Moreover, potential severe illnesses which were treated or refuted in less than 24 h were not included in the endpoint, which might have drawn the results in the direction of an underestimation of the association between DOW and hospital admission.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Self-rated worry is associated with hospital admission in out-of-hours telephone triage – a prospective cohort study

Gamst‐Jensen

Christensen

Lippert

et al. 2020

Scand J Trauma Resusc Emerg Med

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Objective: Telephone triage manages patient flow in acute care, but a lack of visual cues and vague descriptions of symptoms challenges clinical decision making. We aim to investigate the association between the caller's subjective perception of illness severity expressed as "degree-of-worry" (DOW) and hospital admissions within 48 h. Design and setting: A prospective cohort study was performed from January 24th to February 9th, 2017 at the Medical Helpline 1813 (MH1813) in Copenhagen, Denmark. The MH1813 is a primary care out-of-hours service. Participants: Of 38,787 calls received at the MH1813, 11,338 met the inclusion criteria (caller being patient or close friend/relative and agreement to participate). Participants rated their DOW on a 5-point scale (1 = minimum worry, 5 = maximum worry) before talking to a call handler. Main outcome measure: Information on hospitalization within 48 h after the call, was obtained from the Danish National Patient Register. The association was assessed using logistic regression in three models: 1) crude, 2) ageand-gender adjusted and 3) age, gender, co-morbidity, reason for calling and caller status adjusted. Results: A total of 581 participants (5.1%) were admitted to the hospital, of whom 170 (11.3%) presented with a maximum DOW, with a crude odds ratio (OR) for hospitalization of 6.1 (95% confidence interval (CI) 3.9 to 9.6) compared to minimum DOW. Estimates showed dose-response relationship between DOW and hospitalization. In the fully adjusted model, the ORs decreased to 3.1 (95%CI 2.0 to 5.0) for DOW = 5, 3.2 (2.0 to 5.0) for DOW = 4, 1.6 (1.0 to 2.6) for DOW = 3 and 0.8 (0.5 to 1.4) for DOW = 2 compared to minimum DOW. Conclusion: Patients' self-assessment of illness severity as DOW was associated with subsequent hospital admission. Further, it may be beneficial in supporting clinical decision making in telephone triage. Finally, it might be useful as a measure to facilitate patient participation in the triage process.

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“…MH-1813 carry out home visits, whereas the clinic consultations take place in hospital emergency departments. 23 As well as answering direct calls, the physicians also act as consultants for the nurses. Both GPC and MH-1813 were considered OOH-PC services in this study.…”

Section: Settingmentioning

confidence: 99%

<p>Sociodemographic Characteristics Associated with Contacts to Emergency Medical Services and Out-of-Hours Primary Care: An Observational Study of 2.3 Million Citizens</p>

Søvsø¹,

Bech²,

Christensen³

et al. 2020

CLEP

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Background: Out-of-hours (OOH) health care services are often divided into emergency medical services (EMS) and OOH primary care (OOH-PC). EMS and many OOH-PC use telephone triage, yet the patient still makes the initial choice of contacting a service and which service. Sociodemographic characteristics are associated with help-seeking. Yet, differences in characteristics for EMS and OOH-PC patients have not been investigated in any large-scale cohort studies. Such knowledge may contribute to organizing OOH services to match patient needs. Thus, in this study we aimed to explore which sociodemographic patient characteristics were associated with utilizing OOH health care and to explore which sociodemographic characteristics were associated with EMS or OOH-PC contact. Methods: A population-based observational cohort study of inhabitants in two regions (North Denmark Region and Capital Region of Copenhagen) with or without contact to OOH services during 2016 was conducted. Associations between sociodemographic characteristics and OOH contacts (and EMS versus OOH-PC contact) were evaluated by regression analyses. Results: We identified 619,857 patients with OOH contact. Female sex (IRR=1.16 (95% CI: 1.16-1.17)), non-western ethnicity (IRR=1.02 (95% CI: 1.01-1.02)), living alone (IRR=1.08 (95% CI: 1.08-1.09)), age groups ≥81 years (IRR=2.00 (95% CI: 1.98-2.02)) and 0-18 years (IRR=1.66 (95% CI: 1.66-1.67)) and low income (IRR=1.41 (95% CI: 1.40-1.42)) were more likely to contact OOH health care compared to males, Danish ethnicity, citizens cohabitating, age 31-65 years and high income. Disability pensioners more often contacted OOH care (IRR=1.79 (95% CI: 1.77-1.81) compared to employees. Old age (≥81 years) (OR=3.21 (95% CI: 3.13-3.30)), receiving cash benefits (OR=2.45 (95% CI: 2.36-2.54)), low income (OR=1.76 (95% CI: 1.72-1.81)) and living alone (OR=1.40 (95% CI: 1.37-1.42)) were all associated with EMS contacts rather than OOH-PC contacts. Conclusion: Several sociodemographic factors were associated with contacting a health care service outside office hours and with contacting EMS rather than OOH-PC. Old age, low income, low education and low socioeconomic status were of greatest importance.

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Giving callers the option to bypass the telephone waiting line in out-of-hours services: a comparative intervention study

Cited by 11 publications

References 20 publications

Acute care pathways for patients calling the out-of-hours services

Acute care pathways for patients calling the out-of-hours services

Self-rated worry is associated with hospital admission in out-of-hours telephone triage – a prospective cohort study

<p>Sociodemographic Characteristics Associated with Contacts to Emergency Medical Services and Out-of-Hours Primary Care: An Observational Study of 2.3 Million Citizens</p>

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