Testing the safety of after-hours telephone triage: Patient simulations with validated scenarios

Summary Background The aim of this study is to estimate the appropriateness of recommended dispositions made in response to calls to after hours services offering telephone triage, usually involving nurses. The setting was five local trials sponsored by the Australian government aimed at addressing problems in after hours general practice service provision. All five trials offered telephone triage though the form of this varied considerably. Methods The study was a prospective service audit. Simulated patient calls using validated patient care scenarios with different levels of clinical significance were developed by a consensus panel of experts. Sixty telephone calls were monitored by a member of the research team to assess whether provider responses were in conformity with recommended dispositions. Results Services fell well short of a 100% appropriate response rate across all five trials. Services generally performed poorly for cases with high clinical implications such as presumed meningococcal meningitis and gastroenteritis with dehydration in a child. In general, problems of undertriage were more common than overtriage. Conclusions The safety of dispositions of telephone triage services requires further study. Simulated patient calls may be more useful for quality improvement purposes than the usual method of random audit of audiotaped calls of real patients using service records.