The implementation of the nationwide out-of-hours phone number 1733 in Belgium: analysis of efficiency and safety

Abstract

Background: Belgium has a problem with inappropriate use of emergency services. The government installed the number 1733 for out-of-hours care. Through a dry run test, we learned that 30% of all calls were allocated to the protocol ‘unclear problem’. In only 11.9% of all cases, there was an unclear problem. Methods: The study aimed to determine whether the adjusted protocol ‘unwell for no clear reason’ led to a safer and more efficient referral and to evaluate the efficiency and safety of the primary care protocols (PCPs). The study ran in cross-sectional design involving patients, General Practitioner Cooperatives and telephone operators. A random sample of calls to 1733 and patient referrals were assessed on efficiency and safety. Results: During 6 months in 2018, 11 622 calls to 1733 were registered. Seven hundred fifty-six of them were allocated to ‘unwell for no clear reason’, and a random sample of 180 calls was audited. To evaluate the PCPs, 202 calls were audited. The efficiency and safety of the protocol ‘unwell for no clear reason’ improved, and safety levels for under- and over-triage were not exceeded. The GP’s judged that 9/10 of all patient encounters were correctly referred. Conclusion: This study demonstrated that the 1733-telephone triage system for out-of-hours care is successful if protocols, flow charts and emergency levels are well defined, monitored and operators are trained.

Identifying performance indicators to measure overall performance of telephone triage – a scoping review

“…Inadequate communication and a non-normative symptom description contributed to under-triage [ 71 ]. Triage of patients to an adequate care level is successful if protocols, flow charts, and care levels are well defined and the call handler is well trained [ 29 ].…”

Is tele-diagnosis of dental conditions reliable during COVID-19 pandemic? Agreement between tentative diagnosis via synchronous audioconferencing and definitive clinical diagnosis

“…Such consistently very good reliability of AD diagnosis across dentists' with variable years of experience suggests that employing fresh dental graduates at the first line of AD triage could be safe and also effective in liberating valuable time of highly specialized consultants for other tasks. Such better resource allocation is feasible and probably cost-effective, particularly where safety of decision-making is enhanced by training of dentists and the use of protocols, algorithms and flow charts [42] . These findings might not be entirely surprising; for other medical disciplines, nurses achieved appropriate referral rates and telephone triage when compared with physicians and GPs on many health-related items [ 24 , 43 ], highlighting the potential that well trained and prepared dental assistants or hygienists could safely and reliably attend to the first line of AD triage during an epidemic.…”

The feasibility of teleconsultations in unplanned primary care: a cross section intervention

“…These integrated medical triage protocols 1733-112 are written down in the Belgian Manual for Medical Regulation. (4,5) Each call for a medical care request is classi ed by an operator using the triage protocols, in a certain severity level that corresponds to the appropriate type of regulation. Regulatory resources are resources that can be used to meet patient care needs.…”