Do callers to out-of-hours care misuse an option to jump the phone queue?

Abstract

Objectives: Out-of-hours (OOH) services provide access to healthcare outside normal office hours, but the waiting time can sometimes be long. All callers must wait in the telephone queue, even if the health problem is urgent or life-threatening. We tested an emergency access button (EAB), which allowed callers with perceived severe health problems to bypass the queue. We aimed to investigate the severity of the health problems and the relevance of EAB use (assessed by triage professionals). Additionally, we aimed to calculate the number of suspected acute myocardial infarctions (AMI) and ambulance dispatches.

Design: Descriptive study of a randomized intervention.

Setting: OOH services in two major Danish healthcare regions.

Subjects: 217,510 callers participated; 146,355 were randomized to intervention, and 6554 of 6631 (98.8%) questionnaires were completed by OOH triage professionals.

Intervention: An EAB allowing randomly selected callers to bypass the telephone queue.

Main outcome measures: Severity of contact and relevance of EAB use. Number of suspected AMIs and ambulance dispatches.

Results: In both settings, contacts with EAB use concerned significantly more severe health problems than contacts without EAB use (p < 0.001). Triage professionals rated EAB use as “not relevant” in 23% of cases. Significantly more EAB users (10.4%) than EAB non-users (3.3% with EAB option and 1.7% without EAB option, p < 0.001) had a suspected AMI.

Conclusions: We found higher proportions of severe health problems, suspected AMIs, and ambulance dispatches among EAB users. Only 23% of EAB use was rated “not relevant”. This suggests that the EAB is used as intended.

Key points

• Out-of-hours healthcare is challenged by increasing demand and long triage waiting times.

• An emergency access button may allow severely ill callers to jump the queue.

• Callers who bypassed the queue were more severely ill than callers who did not bypass the queue.

• Only 23% of bypassers presented “not relevant” health problems according to the triage staff.Trial registration: Identifier NCT02572115 registered at Clinicaltrials.gov on 5 October 2015.

Keywords:

• After-Hours Care
• Delivery of Health Care
• Health Services Accessibility
• Triage
• Risk Assessment
• General Practice

Acknowledgements

The author group would like to thank the triage professionals at the GPC in the Central Denmark Region and the Emergency Medical Services, Copenhagen, in the Capital Region of Denmark for participating in the study.

Ethical considerations

The study was conducted in accordance with the CONSORT guidelines and complies with the ethical standards of the Helsinki Declaration and national regulations on research. The Committee on Health Research Ethics of the Central Denmark Region found that no approval was required for this type of trial. All callers were informed of the project and given the opportunity to decline participation after hearing the welcome message when entering the telephone queue.

Disclosure statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare that no support from any organisation has been granted for the submitted work except for the above. JFE has received research grants and honorariums from the foundations listed above. MBC and LH have been funded by TrygFonden, and FL is the CEO of Emergency Medical Services Copenhagen, which includes MH-1813. No other relationships or activities exist that may have influenced the submitted work.

Transparency statement

The lead author confirms that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the study as originally planned have been explained.

Data sharing

The EU regulations on the protection of personal data implies that the authors are not authorised to share non-aggregated data with a third party. However, data are available from Jonas F Ebert on reasonable request.

Additional information

Funding

We thankfully acknowledge the funding provided for this study by the Danish foundation TrygFonden, the Foundation for Primary Healthcare Research of the Central Denmark Region (Praksisforskningsfonden), the Multipractice Foundation (MPU-fonden), and the Committee for Quality Improvement and Continuing Medical Education (Kvalitets- og Efteruddannelsesudvalget) of the Central Denmark Region. The Emergency Medical Services Copenhagen in the Capital Region of Denmark have received unrestricted research grants from the Laerdal Foundation. The funding bodies had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript, nor in the decision to submit the manuscript for publication.