Table 1

Secondary telephone triage of low-priority ambulance patients

First Author (Year)Study DesignStudy Quality LevelBias ReportedCountryTriagistPeak Times IndicatedReported Financial BenefitAlternate Service ProvidersFinal Patient Recommendation /disposition
Study
Crowther (2009)N/AN/ANot ReportedWalesNurseNoNot ReportedUnknown

  • ambulance dispatch

  • referred to ED

  • routine primary care service required

  • urgent primary care service required

  • self-care

  • other healthcare professional ie. midwife, dentist

  • other services required (no figures given)

Smith (2001)Two-phase prospective study2Yes. Selection BiasUSANurse43% 1500–2300 hrs;
69% 1500–0700 hrs		Unspecified
saving reported		None

  • referred to 911 (17%)

  • referred to ED (11%)

  • referred to urgent care clinic (5%)

  • referred to patients primary care provider (24%)

  • referred to community resource (11%)

  • home self care (31%)

Fox (1981)Prospective5Not ReportedUSAEMT-I (intermediate)NoUnspecified saving reportedPrivate conveyance serviceNone
Dale (2003)Pragmatic controlled trial2Not ReportedUKNurse/ ParamedicNoNot ReportedNone

  • immediate care (25%)

  • urgent care (23%)

  • moderately urgent (24%)

  • routine care (14%)

  • home care (14%)

Dale (2004)Case Series3Yes
Professional bias of data reviewers		UKNurse/ ParamedicNoNot ReportedN/ANone
Studnek (2012)Two-phase retrospective study4Not ReportedUSANurseNoNot ReportedNone

  • immediate care (71%)

  • delayed care (29%)

Turner (2006)RCT & Observational study2Not ReportedUKNurseNo£8-102 saving per patientNone

  • 999 ambulance (27%)

  • ED immediately (11%)

  • ED within 4hrs (6%)

  • GP immediately (16%)

  • GP other (6%)

  • Pharmacist (0.2%)

  • other professional care (1%)

  • self care (2%)

  • missing (31%)

GenderPatient AgeFollow up SurveyUnderwent Secondary TriageDecision-making Support ToolsHours of OperationDeemed Safe?
NoneNoneNoneUnknown
3041 calls handled post pilot		Computer-base algorithm0800–2000Yes
Male 46%
Female 54%		Range
0–10 29.3%
11–20 12%
21–30 17.3%
31–40 14.3%
41–50 9.8%
51–60 4.5%
61–70 0.8%
 > 70 12%

  • 85 (64%) participated in follow-up

  • Condition better than at the time of 911 call 88%

  • Condition the same as at the time of 911 call 6%

  • missing 6%

  • 81 (96%) satisfied with the outcome

133Triage algorithm (unknown if computer-based)24/7Yes
NoneNoneNoneUnknownList of questions. (unknown if computer-based)1300–2100Not Stated
Male 40%
Female 60%		Mean age
44.5 years

  • 15.4% of those triaged as requiring an ambulance were admitted to hospital

  • 9.1% of those triaged as not requiring an ambulance were admitted to hospital

635Computer-based algorithm0700–1100 hrs or 1100–1500 hrs or
1500–1900 hrs or
1900–2300 hrs		Uncertain
NoneNoneNone635NoneN/AYes
NoneMean age
49.9 years		None530Not SpecifiedNot SpecifiedYes
Male (43%)
Female (57%)
Missing (0.6%)		Range
0–15 7.7%
16–45 26.7%
46–75 28.7%
 > 75 35.6%
Missing 1.3%

  • 601 (34%) participated to varying degrees in follow-up

  • Problem completely better (15%)

  • Improved (48.7%)

  • The same (25.6%)

  • Worse (10.7%)

  • 241 (of 284; 85%) were satisfied with the service

1766Computer-based algorithmRegion 1: 0800–1800 hrs 7 days
Region 2: 1100–2300 hrs, then 24/7
Region 3: 0900–1900 hrs Mon-Fri; then 0700 hrs –2345 hrs 7 days		Yes

  • ED, emergency department; EMT-I, emergency medical technician–intermediate; GP, general practitioner.