Safety of telephone triage in out-of-hours care: A systematic review

Abstract

Objective .Telephone triage in patients requesting help may compromise patient safety, particularly if urgency is underestimated and the patient is not seen by a physician. The aim was to assess the research evidence on safety of telephone triage in out-of-hours primary care. Methods. A systematic review was performed of published research on telephone triage in out-of-hours care, searching in PubMed and EMBASE up to March 2010. Studies were included if they concerned outof-hours medical care and focused on telephone triage in patients with a fi rst request for help. Study inclusion and data extraction were performed by two researchers independently. Post-hoc two types of studies were distinguished: observational studies in contacts with real patients (unselected and highly urgent contacts), and prospective observational studies using high-risk simulated patients (with a highly urgent health problem). Results . Thirteen observational studies showed that on average triage was safe in 97% (95% CI 96.5 -97.4%) of all patients contacting out-of-hours care and in 89% (95% CI 86.7 -90.2%) of patients with high urgency. Ten studies that used high-risk simulated patients showed that on average 46% (95% CI 42.7 -49.8%) were safe. Adverse events described in the studies included mortality (n ϭ 6 studies), hospitalisations (n ϭ 5), attendance at emergency department (n ϭ 1), and medical errors (n ϭ 6). Conclusions . There is room for improvement in safety of telephone triage in patients who present symptoms that are high risk. As these have a low incidence, recognition of these calls poses a challenge to health care providers in daily practice.

The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial)

“…No substantive new research examining the effects of telephone triage for acute care on in-hours primary care workload, resource use, safety or patient experience has been reported during the course of this trial (although new evidence on the safety of telephone triage in out-of-hours care may be pertinent 68 ). Much of this literature is summarised in a systematic review by Bunn et al 27 undertaken in 2005.…”

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

“…The results from the eight reviews (10 papers [57][58][59][60][61][62][63][64][65] ) are shown in Table 4. Many of the references included in the reviews overlapped.…”

“…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.…”

“…Eighty-seven papers representing 83 studies were included in this review and of these eight [57][58][59][60][61][62][63][64][65] were systematic reviews. The results from the eight reviews (10 papers [57][58][59][60][61][62][63][64][65] ) are shown in Table 4.…”

Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study

“…Telephone contact is used variably for assessment and triage of acute problems; [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] general practice consultations; [34][35][36][37][38][39][40] to offer health education; 41,42 and to offer support for those with chronic illness 43,44 or those in need of palliative care. 45 The literature on telephone consultations consists largely of small and heterogeneous primary studies, most of which had practical challenges or methodological flaws.…”