1. Clinical Telephone Triage in the Prehospital
Setting – Is it Safe and Effective?: A systematic
review
Harry Misselbrook BHSc, BCom, GradCertEM
Introduction
• Emergency ambulances are increasingly sent to low acuity calls not
requiring ambulance transport
• This increases response times and adverse outcomes for patients with
life threating conditions
• Ambulance services are using nurses and paramedics to clinically triage
low acuity callers with the aim of preventing an ambulance response
• Robust safety and efficacy are required for this type of service, and this
research aims to determine the level of both
Methods
• The Electronic databases Cochrane, CINAHL, Scopus and Biomedical
Reference collection (OVID and EBSCO) were searched using the key
terms “Telephone” OR “Secondary” AND “Triage”. Articles describing
prehospital telephone triage were eligible for inclusion.
• Limits included, full text, language (English) and date of publication
(2003 - 2014)
• Reference lists of articles selected for review were examined to identify
potentially relevant articles not identified by the main search strategy.
Conclusions
Clinical safety has been robustly proven and efficacy has been shown
to be high within certain operating environments, but larger and better
designed studies are required to prove this
References
1. Dale, J., Higgins, J., Williams, S., Foster, T., Snooks, H., Crouch, R., Hartley-Sharpe, C., Glucksman E., et al. (2003). Computer assisted assessment and advice for “non-serious” 999 ambulance
service callers: the potential impact on ambulance despatch. Emergency Medicine Journal, 20, 178-183. doi: 10.1136/emj.20.2.178
2. Dale, J., Higgins, J., Williams, S., Foster, T., Snooks, H., Crouch, R., Hartley-Sharpe, C., Glucksman E., et al. (2004). Safety of telephone consultation for “non-serious” emergency ambulance service
patients. BMJ Quality and Safety in Healthcare, 13, 363-373. doi: 10.1136/qshc.2003.008003
3. Eastwood, K., Morgans, A., Smith, K., and Stoelwinder, J. (2014). Secondary triage in prehospital emergency ambulance serives: a systematic review. Emergency Medicine Journal, 0, 1-7. doi:
10.1136/emermed-2013-203120
4. Turner, J., Snooks, H., Youren, A., Dixon, S., Fall, D., Gaze, S., and Davies, J. (2006). The costs and benefits of managing some low-priority 999 ambulance calls by NHS Direct nurse advisers.
Retrieved from University of Sheffield http://www.nets.nihr.ac.uk/__data/assets/pdf_file/0011/64469/FR-08-1304-43.pdf
Take home message:
Clinical Telephone Triage when used with alternative clinical
pathways has high levels of safety and can be effective in
reducing unnecessary ambulance responses. Further research is
needed.
Aim: To determine if clinical telephone triage of low acuity
emergency ambulance calls can be safely and
effectively performed to reduce unnecessary
ambulance attendance.
Findings cont.
• Safety within all studies was extremely high
• There were no serious adverse incidents with rates as low as 0.8%
• Larger studies are required to confidently determine a stable adverse
incident rate
• Efficacy varied wildly from a 52% success rate to <10%
• The most effective studies provided in-house services and allowed
staff to advise private transport appropriate
• The least effective used third party services who could only provide
self-care advice and if any face-to-face assessment was required an
ambulance was sent
• Nurses were 28% more effective than paramedics
• No trials could be easily compared as their methods and
inclusion/exclusion varied wildly
St John New Zealand, Auckland University, Department of Paramedicine
Figure 1. Search results
• 0.8% adverse incident level
• No serious adverse incidents
• Computer decision support system to aid
clinicians increase safety levels
• Up to 52% reduction in ambulance
response
• Varied results due to study difference
• Increased scope = increased efficacy
• Consistent study methods and larger study
sizes required for confidence
• Research what variables make for effective
triage results
Safety
Efficiency
Research
Findings
Eight studies were included in the review (Figure 1). All ambulance-
based studies and majority of primary health telephone triage
showed a very high level of clinical safety. Wide variation in results of
efficacy of triage due to inconsistent methods between different
compared studies
Database search
9480 articles
Telephone triage
in title
293 articles
Relevant to
research
8 articles