ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2023
Clinician-led secondary triage in England's urgent care delivery: a cross-sectional study.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 6 citations in OpenAlex.
- Clinical advisors at NHS 111 improve accuracy for paediatric patients and their advice is more reliably followed: a retrospective observational cohort study.Archives of disease in childhood · 2026Observational
- Exploring two-step and one-step urgent care telephone triage: a UK-based semi-structured interview study.BJGP open · 2025Article
- Variation in the use of primary care-led investigations prior to a cancer diagnosis: analysis of the National Cancer Diagnosis Audit.BMJ quality & safety · 2025Article
- Safety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine data.BMC medical informatics and decision making · 2025Observational
- General Practice Community Pharmacist Consultation Service: an exploratory patient survey.BJGP open · 2025Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundClinician-led secondary triage, following primary triage by the NHS 111 phone line, is central to England's urgent care system. However, little is known about how secondary triage influences the urgency attributed to patients' needs.
aimTo describe patterns of secondary triage outcomes and call-related factors (such as call length and time of call) associated with upgrading/downgrading of primary triage outcomes. DESIGN AND
settingCross-sectional analysis of secondary triage call records from four urgent care providers in England using the same digital triage system to support clinicians' decision making.
methodStatistical analyses (mixed-effects regression) of approximately 200 000 secondary triage call records were undertaken.
resultsFollowing secondary triage, 12% of calls were upgraded (including 2% becoming classified as emergencies) from the primary triage urgency. The highest odds of upgrade related to chest pain (odds ratio [OR] 2.68, 95% confidence interval [CI] = 2.34 to 3.07) and breathlessness (OR 1.62, 95% CI = 1.42 to 1.85; reference: abdominal pain) presentations. However, 74% of calls were downgraded; notably, 92% (
conclusionNon-clinician primary triage has significant limitations, highlighting the importance of secondary triage in the English urgent care system. It may miss key symptoms that are subsequently triaged as requiring immediate care, while also being too risk averse for most calls leading to downgrading of urgency. There is unexplained inconsistency between clinicians, despite all using the same digital triage system. Further research is needed to improve the consistency and safety of urgent care triage.
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