“Call First, Save Lives”: Implementation of Telephone Pre-Triage at the Local Health Unit of Braga and Future Perspectives for Access to the Emergency Department in Portugal
DOI:
https://doi.org/10.24950/rspmi.2835Keywords:
Crowding, Emergency Medicine/methods, Emergency Service, Hospital, Hotlines, Patient Satisfaction, Primary Health Care, Telephone, TriageAbstract
Introduction: Emergency Department (ED) overcrowding and inadequate use are widespread challenges. Telephone triages (TTs) are among the most studied solutions. The Portuguese "Call First, Save Lives" (CFSL) innovative project implemented a pre-hospital telephone triage (SNS24) to optimize patient referral pathways (RPs). This study provides the first patient-centered integrated evaluation of its implementation at the Local Health Unit of Braga (LHUB).
Methods: A questionnaire was applied to a convenience sample of 128 adult patients attending the LHUB Emergency Department (July-September 2025), assessing sociodemographic characteristics, referral pathways and patient satisfaction. Clinical data and ED-episode outcomes were extracted from health records.
Results: A clear gap between the project's awareness (93.8%) and actual SNS24-referrals (24.2%) was found. Self-referral predominated (56.3%). Most patients (58.6%) did not contact the line, mentioning perceived urgency, undesirable operational barriers (such as excessive waits and unanswered calls) or simply not considering it. Understanding of the "Call First, Save Lives" benefits was limited, and satisfaction was low (2.98/5) and significantly associated with the RP (p=0.004).
Primary care services (PCS) were largely bypassed, despite high Family Physician coverage (89.8%) and satisfaction (80.9%).
Referral pathways did not influence waiting time or triage category. Older age was a significant predictor of not contacting (p=0.016) nor being referred by SNS24 (p=0.043).
Conclusion: The "Call First, Save Lives" project at the Local Health Unit of Braga still faces significant implementation challenges. Self-referral persists within a saturated system, where “calling first” has yet to demonstrate measurable impacts. Misconceptions about telephone triages and primary care service, along with limited health literacy, sustain direct ED access. These findings underscore the need to optimize SNS24 performance, triage algorithms and patient engagement.
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