A UK-based semi-structured interview study exploring two-step and one-step urgent care telephone triage

Background There are two models of urgent care telephone triage in the UK: one-step triage that is conducted by a clinician, and two-step triage involving an initial triage by a non-clinical call advisor followed by a secondary clinician triage. Both models may involve digital triage (computerised decision support). Little is known about patient experiences of receiving two-step triage.

Aim We aimed to explore patients’ and carers’ experiences of two-step triage in relation to experiences of one-step triage.

Design & setting Semi-structured interviews were conducted with patients and carers that had undergone one-step or two-step urgent care triage in England or Northern Ireland.

Method Data were thematically analysed; Oben’s conceptual framework of patient experience was used to interpret findings. Findings were reported in line with Standards for Reporting Qualitative Research (SPQR) framework.

Results 25 patients/carers were interviewed. Complexity, delays and frustration were described in relation to two-step triage. Communication with non-clinicians was often experienced as scripted and inflexible, whilst communication with clinicians was described as more natural and empathetic. Reassurance experienced during triage enabled some patients to stay home without seeking further care.

Conclusions Minimising the complexity experienced by patients should be factored into planning two-step triage services. Further research should explore how digital triage can be adapted to promote more natural flow of communication and how empathetic communication during triage may enable self-care. Training for clinicians should emphasise such communication and the importance of giving sufficient time to patients during triage.