The Impact on Health Service Delivery of Providing an Alternative Telephone Pathway for Acute But Non-Urgent Healthcare Needs: A Scoping Review of International Practice

OBJECTIVES: The aim of alternative telephone pathways, distinct from 112/999 emergency numbers, is to triage people with acute but non-urgent healthcare needs in the pre-hospital setting in order to reduce emergency department (ED) attendance and provide timely assistance and appropriate care. As part of an ongoing health technology assessment in Ireland, a scoping review was undertaken to assess the impact of introducing such a pathway on health service providers.

METHODS: Empirical evidence from OECD countries was sought from Medline and Embase and supplemented with grey literature sources published since 2004. Data were extracted independently by two reviewers using a standardised, pre-piloted electronic data extraction form.

RESULTS: A total of 71 studies were identified. Across studies, a wide range of health system stakeholders were considered when assessing the impact of introducing an alternative telephone pathway, such as primary care and out-of-hours (OOH) services, EDs, ambulance services, and patients. Due to differences in models of service delivery and the metrics reported, results across service areas were not comparable. Reported service impacts include reduced home visits OOH in Denmark and Scotland, reduced ED presentations and ambulance call outs in Sweden, Australia and Japan, and increased in-hours primary care contacts in Sweden and Scotland. There is conflicting evidence from England regarding the impact on ambulance activity, while no effect on ED and ambulance activity was demonstrated in Denmark and Scotland. Furthermore, impacts may occur across multiple services concurrently.

CONCLUSIONS: Alternative telephone pathways can positively assist callers to access timely and appropriate care. A call may not resolve care needs but instead impact upon stakeholders by shifting resource use between different healthcare settings. The evidence suggests that there are many interacting factors, unique to each country, which can influence the impact of alternative telephone pathways on health service delivery.