Health system use and outcomes of urgently triaged callers to a nurse-managed telephone service for provincial health information after initiation of supplemental virtual physician assessment: a descriptive study

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Figure 1:
Overview of the flow of callers through 8-1-1 and the HealthLink BC Emergency iDoctors in Assistance (HEiDi) service during the study period (Nov. 16, 2020, through Apr. 30, 2021, inclusive). Thicker-weighted box outlines and arrows indicate the flow of callers specific to this study. Note: ED = emergency department, HCP = health care provider, HLBC = HealthLink BC, MD = medical doctor, RN = registered nurse, VP = virtual physician. *Number of nursing service calls are only for the HEiDi hours of 0900–2300 (previously 1000–2200 until Jan. 4, 2021). 8-1-1 nursing services also take calls outside of HEiDi’s hours. †Not included in study. ‡A consultation could be cancelled by the patient or HEiDi service for several reasons (e.g., caller or HEiDi disconnected, caller does not require service, incorrect record, no associated record). §This number indicates the number of caller encounters provided by HEiDi VPs and included in the study, excluding any referred callers who abandoned or cancelled their call before seeing the VP.

Table 1:

Participant characteristics

Characteristic	No. (%) of callers^* n = 5886
Sex, female	3668 (62.3)
Age, yr, mean ± SD	39.3 ± 24.7
Age group, yr
0–1	400 (6.8)
1–4	409 (6.9)
5–19	490 (8.3)
20–39	1882 (32.0)
40–64	1642 (27.9)
≥ 65	1063 (18.1)
Health authority
Fraser	2271 (38.6)
Interior	994 (16.9)
Northern	270 (4.6)
Vancouver Coastal	1281 (21.8)
Vancouver Island	1065 (18.1)
Missing	5
Attached to FP or practice	4786 (85.0)
Missing or unknown	257
Rural location	895 (15.2)
Missing	15
HLBC health concern
Musculoskeletal	1023 (17.4)
Gastroenterology	965 (16.4)
Neurology	715 (12.1)
Cardiovascular	444 (7.5)
Respiratory	435 (7.4)
Other^†	2304 (39.1)
Economic dependency quintile
1 (least deprived)	1598 (27.2)
2	1227 (20.9)
3	1046 (17.8)
4	1010 (17.2)
5 (most deprived)	986 (16.8)
Missing	19

Note: FP = family physician, HLBC = HealthLink BC, SD = standard deviation.
↵* Unless indicated otherwise. Percentages were calculated after removing missing or unknown values from the denominator.
↵† “Other” collapses the remaining health concern options in HLBC’s list. See Appendix 3, Supplemental Table S1, available at www.cmajopen.ca/content/11/3/E459/suppl/DC1, for a full list of health concerns.

Table 2:

Callers’ health service use categorized by virtual physician disposition^*

Variable	No. (%) of calls by disposition					No. (%) of all calls n = 5937
Variable	Go to ED now n = 1546	See primary care MD now n = 556	Schedule an MD or HCP appointment n = 1773	Try home treatment n = 1834	Other n = 228	No. (%) of all calls n = 5937
Calls followed by at least 1 ED visit within 24 h	971 (62.8)	140 (25.2)	160 (9.0)	112 (6.1)	40 (17.5)	1423 (24.0)
Calls followed by at least 1 hospital admission within 7 d	141 (9.1)	17 (3.1)	37 (2.1)	54 (2.9)	9 (3.9)	258 (4.3)
Hospital admissions directly from ED	124 (87.9)	12 (70.6)	30 (81.1)	44 (81.5)	6 (66.7)	216 (83.7)
Calls followed by at least 1 FP visit within 1 1d	162 (10.5)	132 (23.7)	388 (21.9)	176 (9.6)	31 (13.6)	889 (15.0)
Calls followed by at least 1 FP visit within 7 d^*	517 (33.4)	236 (42.4)	812 (45.8)	536 (29.2)	82 (36.0)	2183 (36.8)
Calls followed by no health service use within 7 d^†	141 (9.2)	115 (20.7)	507 (28.6)	892 (48.6)	70 (30.7)	1725 (29.1)

Note: ED = emergency department, FP = family physician, HCP = health care provider, MD = medical doctor.
↵* Visits within 7 days includes all visits within 1 day.
↵† Defined as no recorded death, ED visit, hospital admission or medical claim of any type. Additional 8-1-1 calls were not counted as additional health service use.