Table IV.
Overview of adverse events in telephone triage (n=13).
| Adverse events | |||||||
| First author | Year | Setting | Design | Mortality (after call) | Hospitalisations (after non-urgent disposition) | ED attendance (after non-urgent disposition) | Errors |
| Sher | 1994 | Telephone helpline | Follow-up study (n=317) | - | - | - | Patient status at follow-up: 3.8% worse, but no medical emergencies |
| Lattimer | 1998 | Primary care physician cooperatives | Randomised controlled trial (nurse telephone consultation vs. normal primary care physician cooperative practice) (n=7308 vs. 7184) | Within 7 days: 0.9% in control and 0.8% in nurse triage | - | - | - |
| Thompson | 1999 | Primary care physician cooperatives | Randomised controlled trial (n=100 vs. 123) | Within 7 days: no significant differences found (control vs. nurse triage) | - | - | - |
| Kempe (outcomes) | 2003 | After-hours call centre of children's hospital | Retrospective study (n=1561) | No reported deaths | 4.6% urgently referred children vs. 0.45% non-urgent referred children; Weighted rate of under-referral with hospitalisation was 0.3% | - | - |
| Labarere | 2003 | After-hours primary care call centre | Follow-up study (n=409) | Death after call with non-urgent disposition: (0.2%) | - | Of patients advised to visit primary care physician during office hours, 9.6% were referred to ED subsequently | - |
| Of patients with self-care advice, 32.8% went to primary care physician and 10.1% were subsequently referred to ED | |||||||
| St George | 2005 | Healthline | Retrospective observational cohort study (n=90) | In only 1.1% did the three reviewers consider that the lower endpoint posed some risk to the patient | |||
| Hildebrandt1 | 2006 | Private family medicine call handling | Retrospective observational study (N=119) | - | Within 2 weeks: 2% related to call | - | 2% suffered clinical harm; 1% were at risk of future harm; 26% experienced discomfort |
| Kempe (safe) | 2006 | Pediatric after-hours call centre | Retrospective follow-up study (n=32,968) | No deaths within 1 week; | Potential under-referral with subsequent hospitalisation: 0.2% (calls with a non-urgent disposition) | - | - |
| Stewart | 2006 | NHS Direct and ED | Follow-up study (n=3,312) | - | 21% of non-referred patients vs. 12% of NHS referred patients | - | - |
| Hirsh | 2007 | Tertiary care paediatric hospital with call centre for paediatricians | Retrospective follow-up study (n=83) | - | 24-hour under-referral rate: 5.2% (hospital admission after non-urgent disposition of CC) | - | - |
| Killip | 2007 | After-hours telephone service for family medicine clinic | Retrospective observational study (n=63) | - | - | - | In total 22% of calls involved any errors that could have threatened patient safety: 14% of calls had medical errors, 11% had patient errors; 3% of calls involved errors with potentially serious consequences for the patient |
| Fourny | 2009 | University hospital-affiliated Emergency Medical Service call centre | Prospective observational cohort study (n=245) | In-hospital mortality did not differ according to the appropriateness of the initial dispatcher's decision | - | - | Inappropriate initial decision resulted in median times to reperfusion increasing by 42 minutes (patients receiving fibrinolysis) and 63 minutes (patients undergoing primary PC) |
| St George | 2009 | Nurse-on-call: telephone triage line | Retrospective observational study (N=173 189) | - | - | - | 0.023% risk incidents, but no critical outcomes |
Note: 1Hildebrandt: self-triage of patients who have to decide whether or not their problem is an emergency (calls not forwarded).