Influencing policy and practice in telephone triage service delivery
Our research will help governments decide on the level of expertise required to deliver safe and effective care to patients who require urgent help over the phone.
Telephone triage, the process of assessing the urgency of a patient’s problem over the phone, is increasingly used internationally to manage demand for health care. Pressures to reduce waiting times and keep costs low has meant that those delivering telephone triage are nurses or non-clinical professionals, supported by computer decision support software (CDSS). Our researchers analysed audio recordings of telephone triage calls, along with videos of nurses using CDSS during these calls.
We identified evidence of CDSS adversely affecting nurse communication with patients. For example, patients struggled to communicate their problem in the format required by the software, nurses directed answers from patients that did not fully reflect their symptoms, leading to inaccurate records, and nurses ignored a patient’s suggestion for treatment and diagnosis as they were preoccupied with completing software tasks. These findings raise questions not only about the level of clinical expertise required to deliver triage, but also the role of technology in supporting safe and effective care of patients.
Following this research, Dr Murdoch developed an online module about telephone triage communication. Call handlers, including those working in ambulance services across the UK, undertook the course. Participants reported that the materials enabled them to think differently about telephone triage communication, providing evidence that helped them to determine how they wanted to work as clinicians within ambulance control.
One call handler reported that now:
“we spend more time dealing with less urgent cases as the system and call taker monitor the urgent cases and we have time to spend sorting out what a patient needs. This was feedback from all advisors following the course – that we weren’t given enough time to do what was needed for a patient.”
Dr Murdoch met with government ministers to ensure that our research informs policy on the role of telephone triage in healthcare delivery. Following consultation with Dr Murdoch, Norman Lamb MP wrote to the Chief Executive of NHS England requesting a formal evaluation of the NHS 111 service, which uses non-clinically trained professionals and computer decision support as a frontline service. Dr Murdoch also met with the Belgian Minister for Health because Belgium is considering introducing telephone triage to manage the demand for urgent and emergency care.
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