PhD Travel Grant building global connections


Ash was encouraged to apply for the travel grant by her Warwick Supervisor, Dr Helen Atherton, Associate Professor of Primary Care Research and Digital Health lead at the Unit of Academic Primary Care, Warwick Medical School.

Ash started her PhD at WMS in October 2019 and is looking to complete her research in March 2023. Her research is focussed on telephone based digital triage in UK based urgent care delivery. She is interested in patient outcomes relating to digital triage, including experience, safety, and patients’ subsequent use of healthcare. She is using large routine datasets and data linkage as part of this mixed methods project, in order to identify patterns in the use of these systems.

Her PhD ultimately aims to investigate how telephone-based digital triage in the use of urgent, out of hours care can be improved.

Digital triage involves the use of a ‘digital triage’ software by a call handler or clinician who is assessing the patient’s symptoms to identify the urgency of the problem and subsequent advice given to them, which may include referral or signposting to other services. These telephone-based helplines are intended to help manage patient demand within the healthcare system through referring patients to appropriate care, in an equitable and safe way. Ash notes that within England, patients calling the national NHS 111 service will initially speak with a non-clinician with no medical training and approx. 24% of these callers are referred to emergency services, 15% are referred to self-care, 8% are referred to another service and approx. 50% of callers will undergo a secondary triage which is completed by a nurse; this 50% is the population being evaluated in the PhD.

Of particular interest to Ash’s research is identifying areas of clinical risk. For example, in the 50% of calls referred to a nurse for secondary triage, approx. 2% of these patients are referred to emergency care following the nurse’s assessment. There is speculation about whether this group should have been referred directly to emergency rather than the initial non-clinician transferring them to the Nurse triage.

Ash comments "understanding what happens in these calls is complex, for example my qualitative study has suggested callers may be down-playing their symptoms and therefore don’t perceive there is an emergency initially” 

She has used regression modelling which factors in the top 20 symptoms callers present with, as well as other patient, and service level factors. One of her key findings is looking at high risk health concerns i.e., in which patients the nurse will upgrade the advice given by the non-clinician in the initial level of triage. She has identified that this occurs more in calls about chest pain & breathlessness therefore these calls may be considered high risk.

Ash conducted a systematic review initially and one of the findings was in relation to patients with language barriers often given priority, partly due to the communication challenges, so nurses tend to be more risk averse.  Ash hopes to look at a follow-on study which looks at focussing on the clinician / nurse experience and identifying the high- risk areas to ensure patients receive the best care.

Moving forward Ash is hoping to work at Warwick as a research fellow where she will be looking at follow up studies regarding how patients go on to use emergency departments after they have undergone secondary nurse triage.

She is interested in continuing her research, and she would ideally like to focus on particularly high-risk patient groups. She also sees herself supervising other PhD students in the future. Ash notes how valuable the PhD travel grant has been, particularly the opportunities to present her research to many different groups including Ambulance Victoria, the department of General practice and department of Paramedicine at Monash University, and to gain an understanding of differences and similarities between models of care between the UK and Australia.