Telephone triage of young adults with chest pain: population analysis of NHS24 calls in Scottish unscheduled care

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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 between 1/1/15 and 31/12/17 where chest pain was recorded as the call reason. Recommended outcome and subsequent use of services was 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 centre, accounting for 38,643 (37.6%) CUPs. 9060 (8.8%) CUPs ended with hospital admission, 2975 (2.9%) 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 to people given self-care advice, referral to other services had increased odds of inpatient admission (adjusted odds ratio for ambulance called 28.7, 95%CI 22.6-36.3; for 1-hour in-home GP visit arranged aOR 36.8, 95%CI 23.2-58.5) and for admission with an ‘acute-and-serious’ diagnosis (aOR ambulance called 23.9, 95%CI 16.2-35.4; aOR 1-hour GP visit 48.3, 95%CI 25.5-91.6).

Conclusion: Chest pain triage by NHS24 appears safe, but care pathways can involve multiple service contacts. Whilst acuity assigned to the call is strongly related to the odds of hospital admission and odds of an ‘acute-and-serious’ diagnosis, ‘over-triage’ means few patients are directed to self-care advice.
Original languageEnglish
JournalEmergency Medicine Journal
Issue number210594
DOIs
Publication statusPublished - 21 Oct 2021

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