Safety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine data
Abstract 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 rela...
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BMC
2025-02-01
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| Series: | BMC Medical Informatics and Decision Making |
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| Online Access: | https://doi.org/10.1186/s12911-025-02888-x |
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| author | Vanashree Sexton Catherine Grimley Jeremy Dale Helen Atherton Gary Abel |
| author_facet | Vanashree Sexton Catherine Grimley Jeremy Dale Helen Atherton Gary Abel |
| author_sort | Vanashree Sexton |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-8c130643cac647a5b7de1d54534534d2 |
| institution | Kabale University |
| issn | 1472-6947 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj-art-8c130643cac647a5b7de1d54534534d22025-02-09T12:40:16ZengBMCBMC Medical Informatics and Decision Making1472-69472025-02-0125111110.1186/s12911-025-02888-xSafety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine dataVanashree Sexton0Catherine Grimley1Jeremy Dale2Helen Atherton3Gary Abel4Warwick Medical School, University of WarwickWarwick Medical School, University of WarwickWarwick Medical School, University of WarwickPrimary Care Research Centre, University of SouthamptonExeter Collaboration for Academic Primary Care, University of ExeterAbstract 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.https://doi.org/10.1186/s12911-025-02888-xDigital triageNHS 111Primary health careUrgent careEmergencies |
| spellingShingle | Vanashree Sexton Catherine Grimley Jeremy Dale Helen Atherton Gary Abel Safety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine data BMC Medical Informatics and Decision Making Digital triage NHS 111 Primary health care Urgent care Emergencies |
| title | Safety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine data |
| title_full | Safety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine data |
| title_fullStr | Safety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine data |
| title_full_unstemmed | Safety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine data |
| title_short | Safety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine data |
| title_sort | safety and accuracy of digitally supported primary and secondary urgent care telephone triage in england an observational study using routine data |
| topic | Digital triage NHS 111 Primary health care Urgent care Emergencies |
| url | https://doi.org/10.1186/s12911-025-02888-x |
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