# Evaluation of the performance of telephone triage service

## TL;DR

This study evaluates how a medical helpline affects emergency care use and patient pathways using a performance measurement framework.

## Contribution

The study tests a validated performance measurement framework in a real-world setting for a medical helpline service.

## Key findings

- The framework shows the helpline effectively handles high call volumes and provides timely support outside office hours.
- Data availability and indicator complexity pose challenges for performance measurement implementation.
- Improving data collection and incorporating patient perspectives are crucial for enhancing service outcomes.

## Abstract

There is a growing need to assess the impact of the Medical Helpline (MH) 116117 on emergency care services and patient pathways. This study aims to test a validated performance measurement (PM) framework in a real-life setting and evaluate how MH influences ED service utilization and patient pathways in acute care settings.

We tested the PM framework to evaluate the Finnish MH service. A quantitative before-and-after analysis was conducted using data from Vantaa for two periods: January 1 to December 31, 2016 ("Before Period") and January 1 to December 31, 2021 ("After Period"). Patient pathways were mapped by linking MH call logs and electronic health records (EHR). Data analysis included compliance and non-compliance rates for triage instructions, accessibility metrics, ED referral patterns, and cost-per-call calculations. Costs were categorized into fixed and variable components, and triage levels, diagnoses, and follow-up care outcomes were evaluated within the PM framework. The dataset included information from 146,858 patients who sought ED services during the study periods.

The framework provides a valuable tool for continuously measuring and improving MH performance. However, its usability highlights typical PM challenges, including data availability issues and indicator complexity. Broader validation and further development are necessary for systematic implementation. Future efforts should improve data collection processes to support more comprehensive evaluations and address identified gaps. Nevertheless, successful PM requires more than just a feasible measurement tool —it demands developing expertise in PM, refining processes, and understanding how these changes impact patient outcomes. Using a framework, PM demonstrates that the MH effectively manages high call volumes and provides timely support, particularly outside regular office hours. While patient satisfaction is generally high, advancing expertise in PM and refining processes are crucial to better understanding and enhancing patient outcomes. These efforts will further improve the quality and efficiency of MH services.

This study addresses a critical gap in evidence-based support for assessing MH performance—an essential foundation for defining current and future care standards. The proposed framework offers actionable insights to support cost control and improve the quality of care delivery. Findings underscore the value of comprehensive monitoring across performance domains to enhance service effectiveness. Nonetheless, further refinement of the framework is necessary to more accurately capture patient outcomes and assess the real-world impact of these services. Going forward, incorporating patients’ perspectives and focusing on outcomes that are meaningful to them will be equally important. Establishing standardised performance metrics is crucial for enabling valid comparisons across different service providers.

Not applicable.

The online version contains supplementary material available at 10.1186/s13049-025-01462-8.