Clinical advisors at NHS 111 improve accuracy for paediatric patients and their advice is more reliably followed: a retrospective observational cohort study

Objective

To determine whether National Health Service (NHS) 111 advice regarding paediatric patients given by clinically trained health advisors (CHAs) is, as previously found for adult patients, less risk-averse, more accurate and complied with more than that given by non-clinically trained health advisors (NHAs)

Design

Retrospective observational study using routinely collected, linked NHS urgent care data.

Setting

NHS 111 triaging services in Yorkshire and the Humber, 2014–2017.

Patients

Children (<16 years) who were the subject of a call to NHS 111.

Main outcome measures

The recommendation given, whether the patient attended the emergency department (ED) within 48 hours and if so whether the patient was admitted to hospital, or considered ‘non-urgent’. Adjusted logistic regressions were used for analysis.

Results

972 221 calls were analysed (26.5% CHA; 73.5% NHA). CHAs were more likely than NHAs to recommend guardian/self-care (OR 45, 95% CI 44 to 46), and less likely to recommend ambulance dispatch (OR 0.5; 95% CI 0.48 to 0.51), ED attendance (OR 0.79; 95% CI 0.77 to 0.8) or primary care (OR 0.163; 95% CI 0.161 to 0.165). Patients were less likely to attend ED following guardian/self-care recommendations from CHAs versus NHAs (OR=0.64; 95% CI 0.56 to 0.74), but no more likely to be admitted if they did attend (OR 1.2; 95% CI 0.8 to 1.8). Callers were more likely to terminate a call before receiving a formal recommendation from a CHA (OR 2.02; 95% CI 2.0 to 2.1). Call-terminators were less likely to attend ED (OR 0.128; 95% CI 0.12 to 0.13) and more likely to be considered non-urgent if attending ED (OR 1.23; 95% CI 1.2 to 1.3) if advised by a CHA.

Conclusions

Paediatric patient journeys suggest triage by CHAs is less risk-averse and more accurate. Patients are more likely to avoid attending ED if advised to by a CHA. Callers who terminate a call early may typically represent the ‘worried well’. CHAs may better identify these patients and discourage them from attending ED in prerecommendation conversation. This has implications for the cost-benefit balance of NHS 111 staffing.