Successful pilot test of new triage process for 8-1-1

A proposal submitted to the Specialist Services Committee’s (SSC) Quality and Innovation (Q&I) Initiative by Dr Eric Grafstein led to a pilot project to make physician telephone consultations available for more urgent 8-1-1 calls. Dr Grafstein wanted to determine if adding a physician to the call process would reduce the number of urgent calls (considered red calls by the HealthLink BC 8-1-1 line) that ended up in the emergency department. 

The HLBC Physician Triage pilot project was tested in the Vancouver Coastal Health (VCH) region. About 35 physicians were involved from both VCH and Fraser Health, and all received training from the HLBC 8-1-1 team. VCH handled an average of 29 red calls every day during the pilot project.

Some of the project metrics included client satisfaction, cost avoidance, operational experience, safety, and effectiveness. The overall results showed a 14.4% reduction in visits to the emergency department compared to a similar period in 2015. For children age 17 or younger, there was a 20.3% reduction. Cost avoidance ranged from $55 to $119 per consultation, depending on whether a specialist was involved. This does not include costs to the patient such as loss of work time. Caller satisfaction was extremely high (4.7 on a 5-point scale), and nurses’ satisfaction was 8.6 on a 10-point scale.

Part of the evaluation included comparing 30-day mortality outcomes from 2015 to outcomes during the same period in 2016 while the pilot project was in effect. Within 30 days of an 8-1-1 call, there were 12 adult deaths in 2015 compared to five adult deaths in 2016.

SSC funded the 5-month pilot through the Q&I Initiative. The service is no longer operating because funding is complete, but the project results are being sent to the Ministry of Health senior executive and the Pan-Canadian Teletriage Working Group. Different sustainable service models and the strategic direction for HealthLink BC will be considered. There is also interest by BC Emergency Health Services in understanding if a physician triage model at 8-1-1 has any value in helping 9-1-1 triage calls.