Patient compliance with NHS 111 advice: Analysis of adult call and ED attendance data 2013-2017.

Jen Lewis,Susan Croft,Tony Stone,Colin O’Keeffe,Richard Jacques,Suzanne Mason,Rebecca Simpson,Itamar Ashkenazi

doi:10.1371/journal.pone.0251362

Jen Lewis, Susan Croft + Show 6 more

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https://doi.org/10.1371/journal.pone.0251362

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Abstract

The NHS 111 telephone advice and triage service is a vital part of the management of urgent and emergency care (UEC) services in England. Demand for NHS 111 advice has increased since its introduction in 2013, and the service is of particular importance in light of the current pandemic and resulting increased demand for emergency care. Currently, little is known about the effectiveness of NHS 111 in terms of the appropriateness of the advice given, or about the compliance of patients with that advice. We aimed to address this issue by analysing a large linked routine dataset of all NHS 111 calls (n = 3,631,069) and subsequent emergency department (ED) attendances made in the Yorkshire & Humber region from March 2013-March 2017. We found that many patients do not comply with advice, with 11% (n = 289,748) of patients attending ED when they are advised to self-care or seek primary care. We also found that a considerable number of these patients are further classed as urgent (88%, n = 255,931) and a substantial minority (37%, 106,207) are subsequently admitted to hospital. Further, many patients who are sent an ambulance or told to attend ED are classed as non-urgent upon attending ED (9%, n = 42,372). This research suggests that the level at which NHS 111 is currently triaging results in many hundreds of thousands of mis-triaged cases annually. Additionally, patients frequently do not comply with the advice they receive. This has implications for understanding the accuracy and efficiency of triaging systems.

Highlights

The National Health Service (NHS) 111 telephone advice and triage service was set up in 2013 to improve access to urgent and emergency care (UEC) for patients in England and direct them to the most appropriate level of care for their health needs
We found that those given a primary care disposition recommended within 1–2 hours had a higher likelihood of resorting to an emergency department (ED) attendance than those requiring primary care over a longer time period (Table 2)
We found that around 10% of low acuity NHS 111 recommendations are not complied with

Summary

Introduction

The NHS 111 telephone advice and triage service was set up in 2013 to improve access to urgent and emergency care (UEC) for patients in England and direct them to the most appropriate level of care for their health needs. The NHS Long Term Plan is committed to NHS 111 as part of an integrated urgent care approach to reduce pressure on hospital services [1]. A number of studies have been conducted examining the impact of NHS 111 in reducing demand on urgent care systems. Patient satisfaction with the service was high and patients tended to comply with the advice given [2], it is unclear whether this has changed.

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