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Appropriateness of NHS 111 Wales outcomes-using the Call Prioritisation Streaming System: a RAND/UCLA modified Delphi

Rhiannon Elizabeth Roynon1, Mike Brady2, Peter Noblett3

  • 1Welsh Ambulance Services University NHS Trust, Cwmbran, UK rhiannon.roynon@wales.nhs.uk.

BMJ Open
|July 11, 2025
PubMed
Summary

The Call Prioritisation Streaming System (CPSS) in NHS 111 Wales effectively assesses urgent healthcare needs, demonstrating high appropriateness in patient outcomes. This clinical decision support software ensures safe and efficient patient care pathways.

Keywords:
Clinical Decision-MakingClinical ProtocolsDelphi TechniqueDigital TechnologyInformation technologyTelemedicine

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Area of Science:

  • Health Informatics
  • Clinical Decision Support Systems
  • Healthcare Management

Background:

  • NHS 111 Wales utilizes the Call Prioritisation Streaming System (CPSS), a Computer Decision Support Software, for urgent healthcare assessments.
  • CPSS integrates patient data with a knowledge base using algorithms to guide recommendations and patient dispositions.
  • The implementation of CPSS represented a significant change in clinical digital processes, necessitating post-implementation clinical assurance.

Purpose of the Study:

  • To verify and validate the safety and correct functioning of the CPSS after its implementation.
  • To assess the appropriateness of patient outcomes determined by the CPSS through expert clinical review.

Main Methods:

  • An adapted Delphi-Rand/UCLA appropriateness method was employed to evaluate patient outcomes.
  • Round 1 involved 189 anonymized cases reviewed by 49 international expert clinicians, with consensus defined as >75% agreement.
  • Round 2 focused on non-consensus cases, with expert clinicians providing contextual information for content analysis.

Main Results:

  • Consensus on outcome appropriateness was achieved in 83% of reviewed cases (144 out of 189).
  • For cases with consensus, expert clinicians agreed with the CPSS-determined outcome 90.5% of the time.
  • Even in non-consensus cases, outcome agreement remained high at 60.9%, indicating general acceptance of the system's recommendations.

Conclusions:

  • The post-implementation clinical assurance of CPSS in NHS 111 Wales demonstrated high levels of outcome appropriateness.
  • Content analysis revealed key themes for enhancement: clinical considerations, referral pathways, and system-driven safeguarding.
  • No significant clinical safety concerns were identified, assuring patients, service providers, and stakeholders of the system's reliability.