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Telephone triage of young adults with chest pain: population analysis of NHS24 calls in Scottish unscheduled care
  1. Peter Hodgins1,
  2. Megan McMinn1,
  3. Matthew James Reed1,2,
  4. Stewart William Mercer1,
  5. Bruce Guthrie1
  1. 1Centre for Population Health Sciences, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
  2. 2Emergency Medicine Research Group Edinburgh (EMERGE), Edinburgh Royal Infirmary, Edinburgh, UK
  1. Correspondence to Professor Bruce Guthrie, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh EH8 9AG, UK; Bruce.Guthrie{at}ed.ac.uk

Abstract

Background Telephone triage is increasingly used to manage unscheduled care demand. Younger adults are frequent users, and commonly call with chest pain. We compared pathways of care in younger adults calling with chest pain, and associations of patient characteristics and telephone triage recommendation with hospital admission.

Methods A retrospective study of all triage calls with chest pain to NHS24 advice line by people aged 15–34 years between 1 January 2015 and 31 December 2017 where chest pain was recorded as the call reason. Recommended outcome and subsequent use of services were determined using the continuous urgent care pathways (CUPs) database which records single episodes of care spanning multiple services. We determined the number of services involved, the proportion of patients with inpatient admission, those with an admission for an ‘acute-and-serious’ diagnosis, and the association between the triage call recommendation and these outcomes.

Results There were 102 822 CUPs identified, with 1251 different combinations of services. The most common pathway was an NHS24 call then attendance at a primary care out-of-hours (PCOOH) centre, accounting for 38 643 (37.6%) CUPs. 9060 (8.8%) CUPs ended with hospital admission, 3030 (3.0%) the result of an ‘acute-and-serious’ diagnosis. 8453 (8.2%) were given ‘self-care’ advice and not referred further, while 46.9% ended at PCOOH and 15.2% at ED. ‘Asthma, unspecified’ was the most frequent ‘acute-and-serious’ diagnosis. Compared with people given self-care advice, referral to other services had increased odds of inpatient admission (adjusted OR (aOR) for ambulance called 28.7, 95% CI 22.6 to 36.3; for 1-hour in-home general practitioner (GP) visit arranged aOR 36.8, 95% CI 23.2 to 58.5) and for admission with an ‘acute-and-serious’ diagnosis (aOR ambulance called 23.9, 95% CI 16.2 to 35.4; aOR 1-hour GP visit 48.3, 95% CI 25.5 to 91.6).

Conclusion Chest pain triage by NHS24 appears safe, but care pathways can involve multiple service contacts. While acuity assigned to the call is strongly related to the odds of hospital admission and odds of an ‘acute-and-serious’ diagnosis, ‘overtriage’ means few patients are directed to self-care advice.

  • chest - non trauma
  • emergency care systems
  • primary care
  • triage
  • urgent care
  • access to care

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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Footnotes

  • Handling editor Edward Carlton

  • Twitter @PeteHodgins, @mattreed73

  • Contributors All authors contributed to the writing of this paper. BG is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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