How Safe Is Triage by an After-Hours Telephone Call Center?

Kempe, Allison; Bunik, Maya; Ellis, Jennifer L.; Magid, David J.; Hegarty, Teresa; Dickinson, L. Miriam; Steiner, John F.

doi:10.1542/peds.2005-3073

Cited by 56 publications

(57 citation statements)

References 27 publications

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“…The related systematic review by Huibers et al 62 included 10 of the papers identified in this review 66,73,74,77,78,82,[89][90][91][92] and reported that a high proportion (97%) of all OOH telephone triage contacts were safe but that the proportion of safe contacts decreased when looking at high-urgency patients. From 10 studies using high-risk simulated patients, the authors found that just 46% were safe, bringing into question whether telephone triage and advice is as safe for higher-urgency patients.…”

Section: Safetymentioning

confidence: 99%

“…72 57 also reported on appropriateness and 11 of the studies identified here were included in the review by Blank et al 73,[75][76][77][80][81][82]84,88,90 This review identified that triage decisions rated as appropriate varied between 44% and 98%. However, many different definitions of appropriateness were used, which leads to difficulty when trying to compare results.…”

Section: Service Impactsmentioning

confidence: 99%

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What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Section: Safetymentioning

confidence: 99%

Section: Service Impactsmentioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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“…Studies suggest that nurse counseling is usually appreciated by parents. Telephone nurse counseling by pediatric call centers have shown good user satisfaction and safety profiles (Kempe et al, 2003(Kempe et al, , 2006. Also, studies report that only about 20% of calls are referred for urgent medical care and the majority of callers comply with nursing recommendations (Belman et al, 2005;Keatinge and Rawlings, 2005;Kempe et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

For children leaving the emergency department before being seen by a physician, counseling from nurses decreases return visits

Gaucher

Bailey

Gravel

2011

International Emergency Nursing

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“…Kaiser Permanente Colorado established an after-hours call line to assist in the triage of pediatric patients and found that 48 percent of those who reached the call center received recommendations for home care, with only 0.2 percent of patients requiring a higher level of care than initially recommended. 23 Further work needs to be done to assess the long-term outcomes and potential cost savings of this model. However, the results support the use of call centers as a safe mechanism for early triage of patients.…”

Section: Of Ed Visitsmentioning

confidence: 99%

The US Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready For Disasters

Lurie¹,

Margolis²,

Rising

2013

Health Affairs

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The emergency care system is an essential part of the US health care system. In addition to providing acute resuscitation and life-and limb-saving care, the emergency care system provides considerable support to physicians outside the emergency department and serves as an important safety-net provider. In times of disaster, the emergency care system must be able to surge rapidly to accommodate a massive influx of patients, sometimes with little or no notice. Extreme daily demands on the system can promote innovations and adaptations that are invaluable in responding to disasters. However, excessive and inappropriate utilization is wasteful and can diminish "surge capacity" when it is most needed. Certain features of the US health care system have imposed strains on the emergency care system. We explore policy issues related to moving toward an emergency care system that can more effectively meet both individuals' needs for acute care and the broader needs of the community in times of disaster. Strategies for the redesign of the emergency care system must include the active engagement of both patients and the community and a close look at how to align incentives to reward quality and efficiency throughout the health care system.

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How Safe Is Triage by an After-Hours Telephone Call Center?

Cited by 56 publications

References 27 publications

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

For children leaving the emergency department before being seen by a physician, counseling from nurses decreases return visits

The US Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready For Disasters

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