Addressing key items for the triage of older adults in a non-clinical operator-led out-of-hours telephone triage service in Belgium: preliminary results of an e-Delphi study

Background: This study aimed to achieve expert consensus regarding key items to be addressed by non-clinical operators using computer-software integrated medical dispatch protocols to manage out-of-hours telephone triage (OOH-TT) services for calls involving older adults seeking non -urgent unplanned care across Belgium. 

Methods:  A three-part classic e-Delphi study was conducted. A purposive sample of n=17 experts specialized in unplanned care for older persons across Belgium were recruited for participation as panelists in our study. Eligibility criteria included experts with at least two years of experience relevant to unplanned care for older adults and/or telephone triage. Level of consensus was defined a priori to be reached when at least 70% of the panelists agreed or disagreed regarding the value of each item proposed within a survey. Responses were quantitatively and qualitatively analyzed over several rounds until expert consensus was found. Descriptive and thematic analyzes were used to aggregate responses.

Results:  A total of 12 responses were obtained for the first part of the study followed by 10 responses for part two and eight responses for the third and final part of the study. Overall, the majority of panelists responded that they believe there to be missing protocol topics which are not currently covered by the existing OOH-TT service protocols but that should be added to improve the quality of triage for calls involving older adults ≥ 65 years of age seeking unplanned care. The majority of panelists also reported that all of the top 10 most frequently used protocols for triaging older adults via the OOH-TT service were used as frequently as they would expect but that they believed some modifications should be made to the content. Full consensus between panelists was found for all items on nine of the 11 included topics and protocols discussed. Further details can be found in Supplementary Files 4.5 (survey two results) and 4.6 (consensus meeting results)

Conclusion:  This research presents a useful step towards addressing current gaps in the existing protocols used by the OOH-TT service and for identifying important content related benchmarks which must be targeted within the larger scope of providing non-urgent OOH-TT services for older adults seeking non-urgent unplanned care.