Most Danes call the out-of-hours services or the 1-1-2 emergency number if they need medical treatment when their own GP is closed. But the fact is that we know very little about the best way of organising the emergency telephone service in Denmark to ensure the greatest possible degree of safety and efficiency in the treatment of patients.

Professor Flemming Bro and senior researcher Morten Bondo Christensen from the Research Unit for General Practice at Aarhus University are heading a new research project which will chart the referrals. Morten Bondo Christensen, who is himself a general practitioner (GP), is pleased with the grant from the TrygFonden, which will allow them to initiate a study that can have significance for the future organisation of the entire emergency telephone service in Denmark.

"One of the things we will examine is whether doctors can handle more contacts and complete treatment of more patients over the phone than they do today. We will also take a closer look at whether nurses send more patients further in the system than doctors in the same situation - either for consultation, home visits or to the emergency rooms. Because in reality we really do not know what is safest and most cost-effective in either situation," says Morten Bondo Christensen. 

Doctor or nurse on the line?

One focal point is examining the advantages and disadvantages of having a doctor or nurse on the other end of the phone line.

The study will also take a closer look at how patients progress in the system. Do they call again? Is an ambulance dispatched? Do they subsequently visit their own GP more often? The survey can thus provide a well-documented picture of the consequences of one or the other type of telephone service. 

"It is also possible to imagine that having a nurse doing the triage will mean that more people will wait until their own GP is available again. But again, we do not know the consequences of this," explains Morten Bondo Christensen.

"Jump button" could transfer 1-1-2 calls

The research group will also study the effect of a number of new initiatives in the emergency telephone service. They will e.g. take a closer look at a so-called "jump button" which gives people the opportunity to jump the queue if they themselves assess the situation to be particularly critical. People know that they will be placed on hold in a queue if they call the out-of-hours medical services or 1813, which can mean that more people will call 1-1-2, even if this is not necessary.

"If it turns out that we can use a simple function to reduce the number of phone calls to the costly 1-1-2 number, with fewer unnecessary ambulance callouts as a result, then we will already have come a long way. Both patients and society in general are interested in avoiding a troublesome diagnostic process at the hospital involving anaesthesiologists and consultants if the patient can receive direct and faster help with the diagnosis and treatment already upon contact to the out-of-hours medical services," says Morten Bondo Christensen. He also points to the fact that the button has worked well in the Netherlands.

A better basis for decision-making

The project is funded by the TrygFonden, which has supported development of the entire area of emergency research for a number of years.

"The emergency area is characterised by strong emotions and strong interests. We hope that this project will provide more reliable knowledge and a better basis for decision-making. In Denmark we have unique opportunities to shed light on these questions because we can use the national registers to follow the progress of patients. Do we overlook seriously ill patients, or do we send too many of them to the hospital when they could just as easily have gone to their own GP? One particularly strong point of the project is the participation of both the Capital Region of Denmark and the Central Denmark Region. The two regions have chosen different models for how people should take emergency contact to the healthcare system," says Director of Research at the TrygFonden, Anders Hede.

The TrygFonden has granted DKK 8.2 million to six different projects focusing on out-of-hours care and telephone triage. The research group will implement the projects over the next six years. In addition to Morten Bondo, the group comprises postdoc Linda Huibers and senior researcher Grete Moth. Both are employed at the Research Unit for General Practice.

Further information: 

Senior Researcher, General Practitioner, PhD Morten Bondo Christensen
Aarhus University, Research Unit for General Practice
Tel.: +45 2332 1624
mbc@alm.au.dk

Postdoc, PhD Grete Moth
Aarhus University, Research Unit for General Practice
Tel.: +45 2537 4567
grete.moth@alm.au.dk

Postdoc, PhD Linda Huibers
Aarhus University, Research Unit for General Practice
Tel.: +45 8716 7959
huibers@alm.au.dk

Director of Research, Anders Hede
TrygFonden
Tel.: +45 4110 6136
ah@trygfonden.dk