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Background <p>England’s urgent care telephone triage system comprises non-clinician-led primary triage (NHS111) assessment followed, for approximately 50% patients, by clinician-led secondary triage. Digital decision support is utilised by both. We explore the system’s safety and accuracy relative to patients’ use of emergency departments (EDs) and in-patient care in the subsequent 24&#xa0;h.</p> Methods <p>Descriptive analyses were used to investigate outcomes of 98,946 calls that underwent primary and secondary triage. We investigated sensitivity (safety) and specificity (efficiency/accuracy) in relation to subsequent ED attendance and in-patient hospital admission. Mixed effects regression models were used to explore potential under-estimation of clinical risk (under-triage).</p> Results <p>Sensitivity was greater in primary triage, whilst specificity was greater in secondary triage. The positive predictive value for attending ED after being assigned a triage urgency level of within 2&#xa0;h was 46.0% for secondary triage compared to 20.7% for primary triage; for inpatient admission it was 18.0% and 9.2% respectively. 1.5% (<i>n</i> = 1468) patients triaged to same-day or less urgent care at secondary triage were subsequently admitted for in-patient care. In relation to in-patient admission within 24&#xa0;h, there were greater odds of potential under-triage for calls made between midnight and 6am, and for shorter duration calls, respectively OR = 1.71; CI:1.32–2.21 and OR: 1.66, CI: 1.30–2.11. The service provider (e.g., service provider 2, OR = 5.61; CI:3.36–9.36) and individual clinician (OR covering the 95% midrange = 16.15) conducting triage were the characteristics most greatly associated with this potential under-triage; <i>p</i> &lt; 0.001 for all.</p> Conclusions <p>Clinician-led urgent care triage is more accurate in identifying the likelihood of a need for ED or in-patient care than non-clinician triage. Non-clinician primary triage is risk averse, reflected in its high sensitivity but low specificity. Service and clinician characteristics associated with potential under-triage need further investigation to inform ways of improving the safety and effectiveness of urgent care telephone triage.</p> Clinical trial number <p>Not applicable.</p>

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Safety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine data

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月3日

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  • Vanashree Sexton,
  • Catherine Grimley,
  • Jeremy Dale,
  • Helen Atherton,
  • Gary Abel

摘要

Background

England’s urgent care telephone triage system comprises non-clinician-led primary triage (NHS111) assessment followed, for approximately 50% patients, by clinician-led secondary triage. Digital decision support is utilised by both. We explore the system’s safety and accuracy relative to patients’ use of emergency departments (EDs) and in-patient care in the subsequent 24 h.

Methods

Descriptive analyses were used to investigate outcomes of 98,946 calls that underwent primary and secondary triage. We investigated sensitivity (safety) and specificity (efficiency/accuracy) in relation to subsequent ED attendance and in-patient hospital admission. Mixed effects regression models were used to explore potential under-estimation of clinical risk (under-triage).

Results

Sensitivity was greater in primary triage, whilst specificity was greater in secondary triage. The positive predictive value for attending ED after being assigned a triage urgency level of within 2 h was 46.0% for secondary triage compared to 20.7% for primary triage; for inpatient admission it was 18.0% and 9.2% respectively. 1.5% (n = 1468) patients triaged to same-day or less urgent care at secondary triage were subsequently admitted for in-patient care. In relation to in-patient admission within 24 h, there were greater odds of potential under-triage for calls made between midnight and 6am, and for shorter duration calls, respectively OR = 1.71; CI:1.32–2.21 and OR: 1.66, CI: 1.30–2.11. The service provider (e.g., service provider 2, OR = 5.61; CI:3.36–9.36) and individual clinician (OR covering the 95% midrange = 16.15) conducting triage were the characteristics most greatly associated with this potential under-triage; p < 0.001 for all.

Conclusions

Clinician-led urgent care triage is more accurate in identifying the likelihood of a need for ED or in-patient care than non-clinician triage. Non-clinician primary triage is risk averse, reflected in its high sensitivity but low specificity. Service and clinician characteristics associated with potential under-triage need further investigation to inform ways of improving the safety and effectiveness of urgent care telephone triage.

Clinical trial number

Not applicable.