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Video-supported telephone triage in emergency primary healthcare: an observational study from Norway.

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Title: Video-supported telephone triage in emergency primary healthcare: an observational study from Norway.
Authors: Sandal N; National Centre for Emergency Primary Healthcare, NORCE Norwegian Research Centre AS, Bergen, Norway nsan@norceresearch.no.; Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway.; Department of Global Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway., Johansen IH; National Centre for Emergency Primary Healthcare, NORCE Norwegian Research Centre AS, Bergen, Norway., Hjortdahl M; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.; UiT The Arctic University of Norway Norwegian Centre for Rural Medicine, Tromsø, Troms, Norway., Baste V; National Centre for Emergency Primary Healthcare, NORCE Norwegian Research Centre AS, Bergen, Norway., Ness S; Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway., Zakariassen E; National Centre for Emergency Primary Healthcare, NORCE Norwegian Research Centre AS, Bergen, Norway.; Department of Global Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway.
Source: BMJ open [BMJ Open] 2026 May 15; Vol. 16 (5), pp. e115378. Date of Electronic Publication: 2026 May 15.
Publication Type: Journal Article; Observational Study
Language: English
Journal Info: Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
Imprint Name(s): Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
MeSH Terms: Triage*/methods , Primary Health Care* , Telephone* , Emergency Medical Service Communication Systems*, Humans ; Norway ; Female ; Male ; Adult ; Infant ; Child, Preschool ; Child ; Adolescent
Abstract: Objectives: To describe how video support is used in telephone triage at Norwegian Local Emergency Medical Communication Centres (LEMCs), including frequency, call duration, patterns of video use and associations with urgency and response assessments.
Design: An observational study using national-level operational data and prospectively collected triage data from the Watchtower Project.
Setting: Norwegian LEMCs, which provide 24/7 nurse-managed telephone triage within the municipal emergency primary healthcare system, handling a broad range of medical inquiries.
Participants: 79 LEMCs using the Norwegian Air Ambulance video solution in 2024 and six LEMCs participating in the Watchtower Project in 2022-2023.
Main Outcome Measures: Frequency of video use and call duration with and without video support. Video use across caller and patient characteristics and reasons for contact. Changes in urgency level and intended response following video use.
Results: The national-level dataset included 2 242 522 calls and the Watchtower dataset included 109 281 calls. Nationally, video was used in 4.9% of answered calls. Median call duration was 7:13 min (IQR: 5:09-10:02) with video and 3:58 min (IQR: 2:18-6:16) without video (p<0.001). Video was most frequently used in the evening, for children (47% aged 0-15 years), and in calls initiated by next of kin (58%). Skin-related issues accounted for 65% of all video-supported calls. Following video use, urgency changed in 36% of contacts (22% downgraded, 14% upgraded), and the intended response changed in 31%. Changes occurred in both directions, including shifts between nurse-managed and physician-managed responses.
Conclusion: Video-supported calls were longer than non-video calls. Video is used selectively and is associated with bidirectional adjustments in urgency and response assessments in a substantial share of calls.
(© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)
Competing Interests: Competing interests: NS holds a PhD fellowship funded as a part of a collaboration with the Norwegian Air Ambulance Foundation (NAAF), a non-profit charity organisation that developed and owns the video solution used in the LEMCs observed in this study. SN is employed by NAAF. EZ holds a professorship at the University of Bergen funded by NAAF. Beyond this funding, EZ has no obligations to the foundation and serves in an independent role at the University of Bergen. IHJ, MH and VB declare no competing interests.
References: Br J Gen Pract. 2019 Aug 29;69(686):e586-e594. (PMID: 31160368)
JMIR Hum Factors. 2024 Nov 15;11:e52301. (PMID: 39622708)
Patient Educ Couns. 2024 Nov;128:108376. (PMID: 39079431)
BMJ Open. 2013 Nov 14;3(11):e003451. (PMID: 24231457)
PLoS One. 2023 Apr 19;18(4):e0284557. (PMID: 37075056)
Br Paramed J. 2021 Sep 01;6(2):49-58. (PMID: 34539255)
Scand J Caring Sci. 2002 Jun;16(2):142-8. (PMID: 12000667)
PLoS One. 2022 Apr 14;17(4):e0266007. (PMID: 35421109)
BMC Health Serv Res. 2009 Jun 23;9:105. (PMID: 19549325)
BMJ Open. 2025 Nov 4;15(11):e097622. (PMID: 41193219)
Acad Emerg Med. 2017 Sep;24(9):1137-1149. (PMID: 28493626)
Syst Rev. 2024 Jun 22;13(1):162. (PMID: 38909273)
BMJ Open Qual. 2024 May 21;13(2):. (PMID: 38772882)
JAMA Netw Open. 2025 Jul 1;8(7):e2519020. (PMID: 40591356)
BMC Fam Pract. 2011 May 13;12:30. (PMID: 21569483)
BMC Emerg Med. 2024 May 28;24(1):89. (PMID: 38807042)
Scand J Prim Health Care. 2021 Jun;39(2):139-147. (PMID: 33792485)
JMIR Med Inform. 2024 Apr 4;12:e47039. (PMID: 38596835)
BMC Fam Pract. 2017 Sep 6;18(1):84. (PMID: 28874124)
Scand J Trauma Resusc Emerg Med. 2025 Jun 19;33(1):108. (PMID: 40537850)
Scand J Trauma Resusc Emerg Med. 2025 Jan 8;33(1):5. (PMID: 39780267)
BMC Nurs. 2023 Sep 28;22(1):345. (PMID: 37770869)
PLoS One. 2018 Aug 30;13(8):e0203316. (PMID: 30161242)
BMC Fam Pract. 2015 Apr 10;16:47. (PMID: 25887747)
BMJ Open. 2024 Oct 8;14(10):e086716. (PMID: 39384244)
BMJ Open. 2020 Jan 19;10(1):e033481. (PMID: 31959608)
Fam Pract. 2020 Nov 28;37(6):744-750. (PMID: 32597962)
BMC Health Serv Res. 2008 Mar 26;8:62. (PMID: 18366754)
BMC Emerg Med. 2024 Jun 11;24(1):99. (PMID: 38862922)
Br J Gen Pract. 2005 Dec;55(521):956-61. (PMID: 16378566)
BMJ Open. 2022 Dec 16;12(12):e063395. (PMID: 36526307)
Scand J Prim Health Care. 2011 Dec;29(4):198-209. (PMID: 22126218)
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BMJ. 2020 Mar 12;368:m998. (PMID: 32165352)
J Adv Nurs. 2009 Dec;65(12):2621-9. (PMID: 19941546)
Contributed Indexing: Keywords: ACCIDENT & EMERGENCY MEDICINE; Nursing research; Primary Health Care; Telemedicine; Triage
Entry Date(s): Date Created: 20260519 Date Completed: 20260716 Latest Revision: 20260819
Update Code: 20260819
PubMed Central ID: PMC13182412
DOI: 10.1136/bmjopen-2025-115378
PMID: 42152444
Database: MEDLINE
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  Data: Video-supported telephone triage in emergency primary healthcare: an observational study from Norway.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Sandal+N%22&quot;&gt;Sandal N&lt;/searchLink&gt;; National Centre for Emergency Primary Healthcare, NORCE Norwegian Research Centre AS, Bergen, Norway nsan@norceresearch.no.; Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway.; Department of Global Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Johansen+IH%22&quot;&gt;Johansen IH&lt;/searchLink&gt;; National Centre for Emergency Primary Healthcare, NORCE Norwegian Research Centre AS, Bergen, Norway.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Hjortdahl+M%22&quot;&gt;Hjortdahl M&lt;/searchLink&gt;; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.; UiT The Arctic University of Norway Norwegian Centre for Rural Medicine, Troms&#248;, Troms, Norway.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Baste+V%22&quot;&gt;Baste V&lt;/searchLink&gt;; National Centre for Emergency Primary Healthcare, NORCE Norwegian Research Centre AS, Bergen, Norway.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Ness+S%22&quot;&gt;Ness S&lt;/searchLink&gt;; Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Zakariassen+E%22&quot;&gt;Zakariassen E&lt;/searchLink&gt;; National Centre for Emergency Primary Healthcare, NORCE Norwegian Research Centre AS, Bergen, Norway.; Department of Global Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway.
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  Data: &lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Triage%22&quot;&gt;Triage*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Triage+methods%22&quot;&gt;methods&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Primary+Health+Care%22&quot;&gt;Primary Health Care*&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Telephone%22&quot;&gt;Telephone*&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Emergency+Medical+Service+Communication+Systems%22&quot;&gt;Emergency Medical Service Communication Systems*&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Humans%22&quot;&gt;Humans&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Norway%22&quot;&gt;Norway&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Female%22&quot;&gt;Female&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Male%22&quot;&gt;Male&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Adult%22&quot;&gt;Adult&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Infant%22&quot;&gt;Infant&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Child%2C+Preschool%22&quot;&gt;Child, Preschool&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Child%22&quot;&gt;Child&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Adolescent%22&quot;&gt;Adolescent&lt;/searchLink&gt;
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  Data: Objectives: To describe how video support is used in telephone triage at Norwegian Local Emergency Medical Communication Centres (LEMCs), including frequency, call duration, patterns of video use and associations with urgency and response assessments.&lt;br /&gt;Design: An observational study using national-level operational data and prospectively collected triage data from the Watchtower Project.&lt;br /&gt;Setting: Norwegian LEMCs, which provide 24/7 nurse-managed telephone triage within the municipal emergency primary healthcare system, handling a broad range of medical inquiries.&lt;br /&gt;Participants: 79 LEMCs using the Norwegian Air Ambulance video solution in 2024 and six LEMCs participating in the Watchtower Project in 2022-2023.&lt;br /&gt;Main Outcome Measures: Frequency of video use and call duration with and without video support. Video use across caller and patient characteristics and reasons for contact. Changes in urgency level and intended response following video use.&lt;br /&gt;Results: The national-level dataset included 2 242 522 calls and the Watchtower dataset included 109 281 calls. Nationally, video was used in 4.9% of answered calls. Median call duration was 7:13 min (IQR: 5:09-10:02) with video and 3:58 min (IQR: 2:18-6:16) without video (p&amp;lt;0.001). Video was most frequently used in the evening, for children (47% aged 0-15 years), and in calls initiated by next of kin (58%). Skin-related issues accounted for 65% of all video-supported calls. Following video use, urgency changed in 36% of contacts (22% downgraded, 14% upgraded), and the intended response changed in 31%. Changes occurred in both directions, including shifts between nurse-managed and physician-managed responses.&lt;br /&gt;Conclusion: Video-supported calls were longer than non-video calls. Video is used selectively and is associated with bidirectional adjustments in urgency and response assessments in a substantial share of calls.&lt;br /&gt; (&#169; Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)
– Name: Abstract
  Label: Competing Interests
  Group: Ab
  Data: Competing interests: NS holds a PhD fellowship funded as a part of a collaboration with the Norwegian Air Ambulance Foundation (NAAF), a non-profit charity organisation that developed and owns the video solution used in the LEMCs observed in this study. SN is employed by NAAF. EZ holds a professorship at the University of Bergen funded by NAAF. Beyond this funding, EZ has no obligations to the foundation and serves in an independent role at the University of Bergen. IHJ, MH and VB declare no competing interests.
– Name: Ref
  Label: References
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(PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2216378566%22&quot;&gt;16378566)&lt;/searchLink&gt;&lt;br /&gt;BMJ Open. 2022 Dec 16;12(12):e063395. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2236526307%22&quot;&gt;36526307)&lt;/searchLink&gt;&lt;br /&gt;Scand J Prim Health Care. 2011 Dec;29(4):198-209. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2222126218%22&quot;&gt;22126218)&lt;/searchLink&gt;&lt;br /&gt;Nurs Open. 2019 Apr 02;6(3):842-848. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2231367407%22&quot;&gt;31367407)&lt;/searchLink&gt;&lt;br /&gt;BMJ. 2020 Mar 12;368:m998. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2232165352%22&quot;&gt;32165352)&lt;/searchLink&gt;&lt;br /&gt;J Adv Nurs. 2009 Dec;65(12):2621-9. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2219941546%22&quot;&gt;19941546)&lt;/searchLink&gt;
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        Value: 10.1136/bmjopen-2025-115378
    Languages:
      – Code: eng
        Text: English
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        StartPage: e115378
    Subjects:
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Norway
        Type: general
      – SubjectFull: Female
        Type: general
      – SubjectFull: Male
        Type: general
      – SubjectFull: Adult
        Type: general
      – SubjectFull: Infant
        Type: general
      – SubjectFull: Child, Preschool
        Type: general
      – SubjectFull: Child
        Type: general
      – SubjectFull: Adolescent
        Type: general
      – SubjectFull: Triage methods
        Type: general
      – SubjectFull: Primary Health Care
        Type: general
      – SubjectFull: Telephone
        Type: general
      – SubjectFull: Emergency Medical Service Communication Systems
        Type: general
    Titles:
      – TitleFull: Video-supported telephone triage in emergency primary healthcare: an observational study from Norway.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Sandal N
      – PersonEntity:
          Name:
            NameFull: Johansen IH
      – PersonEntity:
          Name:
            NameFull: Hjortdahl M
      – PersonEntity:
          Name:
            NameFull: Baste V
      – PersonEntity:
          Name:
            NameFull: Ness S
      – PersonEntity:
          Name:
            NameFull: Zakariassen E
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 15
              M: 05
              Text: 2026 May 15
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 2044-6055
          Numbering:
            – Type: volume
              Value: 16
            – Type: issue
              Value: 5
          Titles:
            – TitleFull: BMJ open
              Type: main
ResultId 1