A study of out of hours services in the Netherlands has revealed shortcomings in the way patients are triaged.

The study of 17 out of hours services, reported in the British Medical Journal, found that triagists tended to ask a limited number of questions and often failed to achieve the right clinical outcome. General practitioners did no better than other types of triagist.

The study led by Hay Derkz used “standardised” patients to make calls to out of hours services. Each “patient” presented seven clinical case three times each over a period of 12 months, making a total of 357 calls.

The study looked at the way that calls were handled and found that the “mean percentage of obligatory questions asked compared with the standard was 21%” It also found that responses to questions about clinical condition were not always correctly evaluated.

The quality of information given to patients on how to manage their condition and what to do if it worsened was also “consistently poor for all cases and for all out of hours services.”

Overall, the study concluded that triagists achieved the appropriate triage outcome in just 58% of cases and that they underestimated the urgency of the condition they were dealing with in 41% of cases.

A commentary in the BMJ notes that the findings are not entirely unexpected, given concerns about telephone consultation services in the UK and the mixed picture presented by previous studies.

It argues that while earlier studies have generally found telephone consultation services to be safe, this may just be because they were not robust enough to pick up the relatively infrequent cases of harm to patients.

It says the protocols to which different triage services work should be published and made available to patients online so they can follow them if they wish. It also argues that new models of care should be treated as interventions in their own right and rigorously evaluated before and after their introduction.


Quality of clinical aspects of call handling at Dutch out of hours centres: cross-sectional national study. BMJ2008;337:a1264.