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Management of non-serious 999 calls by nurse-led telephone triage and advice or referral: building on initial research
The Editors’ response to Dale et al.’s paper  rightly highlights the need for further research to
evaluate the safety, appropriateness and effectiveness of the management
of some non-serious 999 calls with telephone advice only.
At the time of the ‘Telephone Ad...
At the time of the ‘Telephone Advice study’ that was undertaken in
London and the West Midlands Ambulance Services, NHS Direct did not exist
and the Reforming Emergency Care agenda was in its infancy. Developments
since then have only served to reinforce the importance and relevance of
this initial work, as well as providing a further context and opportunity
to take this research forward. Most recently, the Department of Health has
in “Developing NHS Direct”  clearly set out a target for the management of
some low priority 999 calls by NHS Direct.
We have now secured funding to carry out a collaborative project
between the Universities of Sheffield and Swansea and in three ambulance
and corresponding NHS Direct Sites (Wales, Manchester and Thames Valley)
to evaluate the management of non-serious 999 calls with either self care
or referral to alternative healthcare following nurse-led telephone
triage. This two-year study is being funded by the Department of Health
Service Delivery and Organisation (SDO) Research Programme starting in
The study is being undertaken in three phases:
1. Identification of appropriate ambulance service dispatch codes for
transfer to NHS Direct for further triage2. A randomised controlled trial of passing calls within the designated
codes to NHS Direct nurses for further triage and subsequent self-care
advice or referral to alternative care agencies3. Full testing of capacity, resource and operational consequences for the
ambulance service and NHS Direct of implementing the new service
Outcomes to be measured include:
Providing appropriate care for 999 callers is a key aspect of the
Reforming Emergency Care programme. Telephone triage, advice or referral
provided by NHS Direct seems to offer a sensible and efficient
alternative, but will depend on the triage systems being compatible and
capacity being available. As the EMJ Editors point out, identifying non-
serious 999 calls at the point of the call being made is not simple, and
not all non-serious calls are suitable for telephone advice. Older people
who fall, for instance, may not need an immediate, ‘lights and sirens’
response – but telephone advice will not help them off the floor either.
Only robust, well-designed research can answer the questions that surround
the tempting alternative of NHS Direct management of some 999 calls. We
hope that this study will provide these answers and look forward to
sharing our results at the end of the research.
Helen SnooksJanette TurnerMalcolm Woollard
on behalf of the project team.
(1) J Dale, J Higgins, S Williams, T Foster, H Snooks, R Crouch, C Hartley-Sharpe, E Glucksman, R Hooper, S George. Computer assisted
assessment and advice for “non-serious” 999 ambulance service callers: the
potential impact on ambulance despatch. Emerg Med J 2003; 20:178-183.
(2) Department of Health. Developing NHS Direct: A strategy document for
the next three years. London: Department of Health, April 2003.