Exploring two-step and one-step urgent care telephone triage: a UK-based semi-structured interview study

There are two models of urgent care telephone triage in the UK: one-step triage that is conducted by a clinician, and two-step triage involving an initial triage by a non-clinical call adviser followed by a secondary clinician triage. Both models may involve digital triage (computerised decision support). Little is known about patient experiences of receiving two-step triage.

To explore patients' and carers' experiences of two-step triage in relation to experiences of one-step triage.

Semi-structured interviews were conducted between July 2021 and February 2022 with patients and carers who had undergone one-step or two-step urgent care triage in England or Northern Ireland.

Data were thematically analysed; Oben's conceptual framework of patient experience was used to interpret findings. Findings were reported in line with the Standards for Reporting Qualitative Research framework.

In total, 25 patients or carers were interviewed. Complexity, delays, and frustration were described in relation to two-step triage. Communication with non-clinicians was often experienced as scripted and inflexible, while communication with clinicians was described as more natural and empathetic. Reassurance experienced during triage enabled some patients to stay home without seeking further care.

Minimising the complexity experienced by patients should be factored into planning two-step triage services. Further research should explore how digital triage can be adapted to promote more natural flow of communication and how empathetic communication during triage may enable self-care. Training for clinicians should emphasise such communication and the importance of giving sufficient time to patients during triage.