Pia Stark, Unit Manager 1177 Västmanland, on how digital triage is used to create better prioritization, better patient experience, and greater accessibility

In Region Västmanland, 1177 is used directly as a tool to prioritize and direct patients appropriately, while increasing accessibility in healthcare. Through digital triage, healthcare staff gain an early picture of the patient’s needs, making it possible to act faster, work more systematically, and use resources more effectively.

The service has evolved from an initial initiative during the pandemic into a central digital gateway to healthcare. Today, the chat is an established part of operations, where residents can receive support, guidance, and assessment, as well as help navigating further into the healthcare system.

For Pia Stark, Unit Manager for 1177 phone and chat services, this development is not just about a new channel, but about a new way of working.

“I am responsible for our chat service, 1177 Direct, and for the phone operations. I work extensively with operational development, future-oriented issues, and IT-related matters,” says Pia Stark.

Today, the way of working is clearly structured: the majority of cases are forwarded to the resident’s healthcare center, while those assessed as more urgent in triage are directed to 1177’s own operations for an initial rapid assessment.

“If you receive a higher priority in triage, you come to us. There we do an initial prioritization and ensure the case is handled in a timely manner.”

Triage provides an initial medical compass

For Pia, one of the biggest differences between phone and digital entry is precisely the ability to get an initial picture of the case before contact begins.

“In the phone service, we have no triage. You might have five calls in the queue and you don’t know which one is actually the most urgent. Perhaps it’s call number three involving serious chest pain that really should be handled immediately. You don’t know that. That person just has to wait until they get through.”

In chat, triage functions as an initial support for prioritization.

“Triage gives us an indication of what the patient is seeking care for and how urgent it is. If you receive three or four chats simultaneously, you can quickly see which one needs to be handled first. You never have that option on the phone. There, everything goes in the order patients called in.”

This doesn’t mean triage replaces the nurse’s assessment. On the contrary, Pia is careful to describe it as a support tool, not a definitive answer.

“It’s not the truth. It’s a rough picture of how the patient answered the questions. That’s why we always ask a first question: ‘Can you describe in your own words the symptoms you are experiencing right now?’ That gives us additional information about how urgent the case actually is.”

This is where triage’s value becomes clear: it helps healthcare staff sort, prioritize, and work more accurately, while the professional assessment always remains decisive.

A value for the patient: not having to start over

Another important dimension is the patient experience. When triage works well, patients don’t need to repeat the same information over and over again.

In Västmanland, 1177 actively works with consent, so that healthcare centers can access the previous chat, including summaries and any images.

“If the patient gives consent, the healthcare center can read our previous chat. Then the patient doesn’t need to repeat themselves. That’s extremely important for the patient experience, because it’s a comment you often hear: that you have to say the same thing over and over again.”

For Pia, this is not just about convenience, but also about using information that already exists to create a better care pathway.

“Our goal is to move away from patients needing to repeat themselves. If the healthcare center has access to the chat, the images, and our summary, there is already a foundation to build from.”

This is also where triage takes on a systemic function. It becomes not just a support in the individual case, but part of building a more coherent flow of information between different parts of the healthcare system.

A more mature tool — and more mature users

Pia also describes how both the tool and the residents have developed over time. In the beginning, responses in triage could be contradictory or difficult to interpret. Today she sees a clear difference.

“Patients have gotten better at understanding the triage flow, and I also feel that the triage itself has become clearer. In the beginning there could sometimes be loops and similar questions appearing multiple times. I don’t experience that in the same way anymore.”

She particularly highlights that it has become easier to trust the auto-anamnesis generated by triage.

“Previously I was more skeptical of the auto-anamnesis. Now it’s more the case that you can trust it. Not blindly, but it provides much better support than before.”

She also highlights the value of free text, where residents can add information not fully captured in the question flow.

“The free text is valuable. Something can come through there that the patient didn’t quite understand how to enter into the triage, but which still provides important information for us.”

At the same time, she emphasizes that staff must be alert to the risks of forming preconceived notions.

“It’s important not to get stuck in the power of words over thought. Just because it says ‘tonsillitis’ or ‘urinary tract symptoms’ I must not lock myself into that. I still need to ask my questions and rule out other causes.”

For operations: better management and greater capacity

For the organization as a whole, the digital entry point has also created new opportunities. When Region Västmanland moved from national collaboration to more regional management, the effects became clearer.

“What we see today is that when there is a long queue on the phone, more people choose chat. We have a button option for chat in the phone system, and we see that more people use it when wait times get longer.”

According to Pia, the service today handles roughly the same number of residents by phone as before, but also around 18,000 residents per year through chat.

“The difference is that we answer more calls and have greater accessibility. We’re almost at 90 percent of calls answered. Chat has meant that we have moved residents from phone to a digital entry point.”

It is therefore not just a new channel, but also a way to relieve pressure on the phone service and increase overall accessibility.

And in the chat work itself, there is also a clear efficiency gain.

“Normally a nurse has between five and seven chats going simultaneously. It depends on how quickly the resident responds and how complex the case is. But it means you can help several people at the same time in a way that’s simply not possible on the phone.”

Triage becomes an important enabler here: without the initial structure and prioritization, it would be considerably more difficult to work safely with multiple parallel cases.

Healthcare that meets residents where they are

Pia returns several times to the point that digital entry points are not just an internal efficiency question, but a matter of meeting residents’ expectations.

“Many younger people are used to communicating in writing. They write to each other all the time. We in healthcare need to meet that, because it is in some ways the future.”

When the region rolled out the chat service broadly, volumes increased rapidly, from around 1,500–1,800 chats per month to around 7,500–8,000.

“There is a need, otherwise it wouldn’t look like this. Different groups of residents choose different channels. Some want to call and talk to someone. Others want to write. So we need to be able to offer different ways in.”

That reasoning also applies to the new initiative on video assessment calls, recently introduced on weekday evenings. Pia sees particularly great value here when it comes to children.

“It’s difficult to describe symptoms on behalf of another person. If I as a nurse can see the child at the same time, I get a completely different opportunity to assess general condition, breathing, skin color, and muscle tone. Having that channel has been incredibly valuable.”

She also sees video as a way to create reassurance, particularly in situations where the patient or guardian is worried but may not need physical care.

A tool that must be understood to be used correctly

An important point in the interview is that digital triage is not just about introducing a tool. It’s about building knowledge within the organization.

Pia has herself become deeply engaged in understanding how triage works, what flows direct patients to different priority levels, and how results should be interpreted.

“You have to understand how the system works in order to work with it. If you don’t understand how the triage engine functions and thinks, it becomes difficult to analyze the results and know how to handle them.”

This applies to staff as well, even if they don’t need the same depth of system knowledge.

“Staff need to understand enough to be able to evaluate what they receive and signal when something seems unusual. If someone wonders why a chat ended up with us as priority 1, we need to be able to go back and understand why.”

This is also where the traceability of digital tools becomes a strength. When something feels wrong, it can be followed up, analyzed, and improved.

Advice for others who want to succeed with digital triage

In closing, Pia points to a few key factors for other organizations looking to get more value from digital entry points and triage:

“Talk a lot about the digital channels and who they are for. It’s the residents who are asking for these services, and we in healthcare need to adapt.”

“Don’t be afraid of the digital tools. They don’t give you the truth, but they give you a map. You still have to apply your patient safety thinking.”

“And learn how the system works. You can’t work against the system. You have to understand it in order to use it correctly.”

For Pia, it is precisely in that combination that the real value emerges: a digital tool that provides structure and support, a profession that makes the medical assessment, and an organization willing to develop its ways of working based on how residents actually want to seek care.