Multi-method approach to the development of contextual telephone triage systems.

Background: Emergency medical services (EMS) resources are limited on the African continent and in other low- to middle-income countries. An inappropriate emergency response may increase EMS operational costs, response time intervals for subsequent emergencies, and influence patient outcome negatively. Established telephone triage systems are cost-prohibitive; are not validated to the heterogenous cultures, countries and systems across Africa; and have only moderate diagnostic accuracy performance. The aim of this paper is to describe a multi-method approach to developing contextual telephone triage systems that can be replicated or adapted to other contexts. Methods: Seven distinct but integrated steps are proposed to develop contextual telephone triage systems iteratively. The seven steps are: 1) understanding context and purpose, 2) review qualitative descriptions, 3) review quantitative clinical variables, 4) build an algorithm and script, 5) test the algorithm for accuracy, 6) refine the algorithm, 7) implement with training, coaching and quality assurance. This approach combines multiple methods including qualitative content analysis, classification and regression models, and diagnostic accuracy studies. Conclusion: By developing and implementing accurate and contextual telephone triage systems, dispatch decision-making can be guided which may result in improved EMS efficiency, decreased cost, and improved patient outcomes.