A Delphi study to develop an evidence-based Non-Emergency Telephone Triage Safety Performance Framework (NETTSPF)

Telephone triage has received relatively little attention in the patient safety research space, especially in non-emergency settings. Existing healthcare contributory factors frameworks for investigating safety are often designed with face-to-face and secondary care settings in mind. As a result, the unique safety challenges associated with telephone triage (e.g., lack of visibility of the caller, onus on caller to perform clinical tests) may not be identified when these frameworks are applied to incident investigation. Previously, a systematic review and best-fit framework synthesis using SEIPS 2.0 (Holden et al., 2013) identified existing evidence of factors contributing to patient safety outcomes in non-emergency telephone triage (Poots et al., 2025). There was limited research in the UK setting, NHS111, and Integrated Urgent Care. Therefore, a modified Delphi panel of 23 telephone triage and safety experts from England and Wales was assembled, to ascertain the appropriateness of the synthesised factors, and the utility of a preliminary framework for understanding safety in the NHS111 (which triages upwards of one million calls per month in the UK) and similar systems. There was high agreement with synthesised and suggested factors which resulted in 186 items for inclusion in the NETTSPF, suggesting there are common contributory factors across non-emergency telephone triage systems. To increase framework usability, individual items were grouped into 18 themes using thematic analysis. The items presented can be adopted to support safety training and incident investigation in telephone triage and other call-centre based healthcare settings. Future research and evaluation should focus on NETTSPF’s efficacy for improving elements of incident investigation (e.g., identifying contributory factors, writing recommendations). A structural framework was also developed and requires additional refinement.