Potential for advice from doctors to reduce the number of patients referred to emergency departments by NHS 111 call handlers: observational study

Objective: To determine the effect of using experienced general practitioners (GPs) to review the advice given by call handlers in NHS 111, a national service giving telephone advice to people seeking medical care. Design: Observational study following the introduction of GPs to review call handlers' decisions which had been made using decision support software. Setting: NHS 111 call centre covering Cambridgeshire and Peterborough. Intervention: When a call handler using standard NHS 111 decision support software would have advised the caller to attend the hospital accident and emergency (A&E) department, the decision was reviewed by an experienced GP. Main outcome measures: Percentage of calls where an outcome other than A&E attendance was recommended by the GP. Results: Of 1474 cases reviewed, the GP recommended A&E attendance in 400 cases (27.1%). In the remainder of cases, the GP recommended attendance at a primary care out-of-hours centre or minor injury unit in 665 cases (45.2%) and self-management or some alternative strategy in 409 (27.8%). Conclusions: Fewer callers to NHS 111 would be sent to emergency departments if the decision was reviewed by an experienced GP. Telephone triage services need to consider whether using relatively unskilled call handlers supported by computer software is the most cost-effective way to handle requests for medical care.