Aims and Objectives The NHS111 telephone triage service aims to direct patients to the correct level of care and reduce pressure on urgent and emergency care (UEC) services. However, some studies show NHS111 is associated with increased UEC use. Previous research in adults identified low patient compliance with NHS111 advice and risk-averse over-triaging by ‘Non-Clinically Trained Call-handlers’ (NCTCs) as contributing to UEC demand. Patient compliance and triaging accuracy were also positively associated with the call-handler’s clinical skill. Here, we examined whether this relationship existed for calls regarding paediatric patients aged under 16.

Method and Design We performed a retrospective observational analysis using a large, linked routine UEC dataset. All NHS111 calls made in the entire Yorkshire region between 1/4/2013-31/3/2017 concerning paediatric patients (1,155,310 calls) were linked with subsequent visits to emergency departments (EDs) within 48 hours. Logistic regressions were performed to investigate whether, after controlling for complaint type, the call-handler’s clinical skill level predicted the advice given, its accuracy, and patient compliance.

Results and Conclusion Clinically Trained Call-handlers (CTCs) were much more likely than NCTCs to recommend self-care (OR=10.75*) and less likely to recommend ambulance conveyance (OR=0.43*), ED attendance (OR=0.76*) or primary care (OR=0.18*). Patients were less likely to attend ED following self-care advice from a CTC vs NCTC (OR=0.06*).

Patients attending ED following consultation with a CTC vs NCTC were more likely to receive a low-urgency ED classification if they received NHS111 advice to self-care (OR=1.25*) or seek primary care (OR=1.09*), but less likely to receive a low-urgency classification if advised to attend ED (OR=0.947*)

CTCs typically recommend lower-acuity dispositions for paediatric patients. ED attendance patterns suggest that patients have more trust in CTCs, and ED urgency classifications indicate that CTCs triage more accurately. This has implications for managing the trade-off between employing highly-skilled call-handlers vs accurate triaging and reducing unnecessary UEC use.