The appropriateness of, and compliance with, telephone triage decisions: a systematic review and narrative synthesis

Aim. This paper is a report of the synthesis of evidence on the appropriateness of, and compliance with, telephone triage decisions. Background. Telephone triage plays an important role in managing demand for health care. Important questions are whether triage decisions are appropriate and patients comply with them. Data sources. CINAHL, Cochrane Clinical Trials Database, Medline, Embase, Web of Science, and Psyc Info were searched between 1980–June 2010. Design. Literature review: Rapid Evidence Synthesis. Review methods. The principles of rapid evidence assessment were followed. Results. We identified 54 relevant papers: 26 papers reported appropriateness of triage decision, 26 papers reported compliance with triage decision, and 2 papers reported both. Nurses triaged calls in most of the studies (n = 49). Triage decisions rated as appropriate varied between 44–98% and compliance ranged from 56–98%. Variation could not be explained by type of service or method of assessing appropriateness. However, inconsistent definitions of appropriateness may explain some variation. Triage decisions to contact primary care may have lower compliance than decisions to contact emergency services or self care. Conclusion. Telephone triage services can offer appropriate decisions and decisions that callers comply with. However, the association between the appropriateness of a decision and subsequent compliance requires further investigation and further consideration needs to be given to the minority of calls which are inappropriately managed. We suggest that a definition of appropriateness incorporating both accuracy and adequacy of triage decision should be encouraged.