Telephone triage, both for in hours and out of hours consultations, has increased dramatically in recent years, and in many respects this is welcome. Telephone consulting can improve access to care for many patients,1 and out of hours care provided by call centres in particular can improve the efficiency of healthcare provision.2 Several unanswered questions remain, however, with respect to the quality and safety of such clinical encounters because of the relative paucity of evidence on this mode of consulting.3

The linked study by Derkx and colleagues (doi: 10.1136/bmj.a1264) highlights the potential shortcomings of telephone based consultations in the context of out of hours triage of patients in the Netherlands.4 Strengths of the study include a carefully considered sampling strategy of call centres and the use of standardised clinical encounters using simulated patients.

Out of hours consultations are …