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NHS Direct: consistency of triage outcomes

O'Cathain, A., Webber, E., Nicholl, J., Munro, J.F. and Knowles, E. (2003) NHS Direct: consistency of triage outcomes. Emergency Medicine Journal, 20 (3). pp. 289-292. ISSN 1472-0213

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Abstract

OBJECTIVES: To examine the consistency of triage outcomes by nurses using four types of computerised decision support software in NHS Direct.

METHODS: 119 scenarios were constructed based on calls to ambulance services that had been assigned the lowest priority category by the emergency medical dispatch systems in use. These scenarios were presented to nurses working in four NHS Direct call centres using different computerised decision support software, including the NHS Clinical Assessment System.

RESULTS: The overall level of agreement between the nurses using the four systems was “fair” rather than “moderate” or “good” (k=0.375, 95% CI: 0.34 to 0.41). For example, the proportion of calls triaged to accident and emergency departments varied from 22% (26 of 119) to 44% (53 of 119). Between 21% (25 of 119) and 31% (37 of 119) of these low priority ambulance calls were triaged back to the 999 ambulance service. No system had both high sensitivity and specificity for referral to accident and emergency services.

CONCLUSIONS: There were large differences in outcome between nurses using different software systems to triage the same calls. If the variation is primarily attributable to the software then standardising on a single system will obviously eliminate this. As the calls were originally made to ambulance services and given the lowest priority, this study also suggests that if, in the future, ambulance services pass such calls to NHS Direct then at least a fifth of these may be passed back unless greater sensitivity in the selection of calls can be achieved.

Item Type: Article
Copyright, Publisher and Additional Information: © 2003 BMJ Publishing Group Ltd, and British Association for Accident and Emergency Medicine
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield)
Depositing User: Repository Officer
Date Deposited: 09 Jun 2005
Last Modified: 08 Feb 2013 16:47
Published Version: http://emj.bmjjournals.com/cgi/content/full/20/3/2...
Status: Published
Refereed: Yes
Identification Number: 10.1136/emj.20.3.289
URI: http://eprints.whiterose.ac.uk/id/eprint/315

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