Are telephone-triage services less safe and efficient for managing unplanned care needs of older adults?

Background

As part of the TRANS-SENIOR international training and research network, this study aimed to describe and compare the appropriateness of triage decisions (within the context of safety and efficiency) for real world patient records of younger and older patients dispatched by operators of a national out-of-hours (OOH) telephone triage service to receive further medical care by a general practitioner (GP).

Methods

A descriptive study was conducted using anonymized registry data obtained from the 1733 OOH telephone triage service in the Flemish region of Belgium linked with medical patient records made available via the Mediris platform. All calls received between May 24, 2019 and December 31, 2020 were analyzed. Appropriateness of triage decisions was assessed by comparing the level of urgency estimated by the 1733 telephone triage operator during the call versus the GP during follow-up physical triage of the patient (considered as the gold standard).

Results

N = 8,664 calls were included for analysis. In total, 69.1% of calls involved children or younger adults while 30.9 % involved older adults (65 years and over). The majority of calls (83.5 %) dispatched by operators to receive an OOH GP home visit involved older adults. The total percentage of appropriately triaged calls were distributed as 98.5 % in children and 96.5 % in younger adults versus 72.5 % in older adults. The percentage of under-triage in older adults was distributed as 1.5 % (65 to 74 years), 3.9 % (75 to 84 years) and 3.0 % (≥ 85 years) versus over-triage in older adults distributed as 16.2 % (65 to 74 years), 22.0 % (75 to 84 years) and 29.6 % (≥ 85 years).

Conclusion

Our findings suggest that while the 1733 service may generally be a safe and efficient tool for managing unplanned care needs of the population, there is room for improvement with regards to the efficiency of these services, particularly for older adults. Fruitful research efforts should aim to evaluate and compare findings with calls dispatched to obtain care from emergency medical services using the 1733 service as well as further investigate the nature of over- and under- triaged calls.