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Clinician-led secondary triage in England's urgent care delivery : a cross-sectional study
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Sexton, Vanashree, Atherton, Helen, Dale, Jeremy and Abel, Gary (2023) Clinician-led secondary triage in England's urgent care delivery : a cross-sectional study. The British Journal of General Practice, 73 (731). e427-e434. doi:10.3399/BJGP.2022.0374 ISSN 0960-1643.
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Official URL: https://doi.org/10.3399/BJGP.2022.0374
Abstract
Clinician-led secondary triage, following primary triage by the NHS 111 phone line, is central to England's urgent care system. However, little is known about how secondary triage influences the urgency attributed to patients' needs. To describe patterns of secondary triage outcomes and call-related factors (such as call length and time of call) associated with upgrading/downgrading of primary triage outcomes. Cross-sectional analysis of secondary triage call records from four urgent care providers in England using the same digital triage system to support clinicians' decision making. Statistical analyses (mixed-effects regression) of approximately 200 000 secondary triage call records were undertaken. Following secondary triage, 12% of calls were upgraded (including 2% becoming classified as emergencies) from the primary triage urgency. The highest odds of upgrade related to chest pain (odds ratio [OR] 2.68, 95% confidence interval [CI] = 2.34 to 3.07) and breathlessness (OR 1.62, 95% CI = 1.42 to 1.85; reference: abdominal pain) presentations. However, 74% of calls were downgraded; notably, 92% ( = 33 394) of calls classified at primary triage as needing clinical attention within 1 h were downgraded. Secondary triage outcomes were associated with operational factors (day/time of call), and most substantially with the clinician conducting triage. Non-clinician primary triage has significant limitations, highlighting the importance of secondary triage in the English urgent care system. It may miss key symptoms that are subsequently triaged as requiring immediate care, while also being too risk averse for most calls leading to downgrading of urgency. There is unexplained inconsistency between clinicians, despite all using the same digital triage system. Further research is needed to improve the consistency and safety of urgent care triage.
Item Type: | Journal Article | |||||||||
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Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Academic Primary Care Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | |||||||||
Library of Congress Subject Headings (LCSH): | Primary health care -- England, Triage (Medicine) , Triage (Medicine) -- England, Emergency medical services, Emergency medical services -- Communication systems -- England | |||||||||
Journal or Publication Title: | The British Journal of General Practice | |||||||||
Publisher: | Royal College of General Practitioners | |||||||||
ISSN: | 0960-1643 | |||||||||
Official Date: | 2023 | |||||||||
Dates: |
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Volume: | 73 | |||||||||
Number: | 731 | |||||||||
Page Range: | e427-e434 | |||||||||
DOI: | 10.3399/BJGP.2022.0374 | |||||||||
Status: | Peer Reviewed | |||||||||
Publication Status: | Published | |||||||||
Access rights to Published version: | Open Access (Creative Commons) | |||||||||
Date of first compliant deposit: | 8 August 2023 | |||||||||
Date of first compliant Open Access: | 8 August 2023 | |||||||||
RIOXX Funder/Project Grant: |
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