The implementation of the nationwide out of hours phone number 1733. Analysis of efficiency and safety.

Abstract Background In Belgium there is a problem with improper use of emergency services. The government installed an emergency number 1733 for out of hours care. Through a dry run test we learned that 10% of all calls were allocated to the protocol ‘unclear problem’. In only 10% of all cases, there was indeed an unclear problem.Methods This study aimed to determine whether the adjusted protocol ‘unwell for no clear reason’ led to a safer and more efficient referral and to evaluate the efficiency and safety of the specific primary care protocols. The study was performed in a retrospective and prospective design and involved the community, patients, General Practitioner Cooperatives, emergency departments and telephone operators.Results During 6 months in 2018, 11622 calls to 1733 were registered. 756 of these calls were allocated to ‘unwell for no clear reason’. A random sample of 180 calls was re-listened. The efficiency and safety of the protocol ‘unwell for no clear reason’ improved. The safety levels for under- and over-triage were not exceeded. The GP’s on duty judged that 9/10 of all patient encounters were correctly allocated. In less than 1% of all referrals, there was an under-triage.Conclusion This study demonstrated that the implementation of a 1733-operating system to triage patients to an adequate care level is successful if protocols, flow charts and care levels are well defined and operators well trained.