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Rashidi F, Simbar M, Safari S, Kiani Z. The design of an Obstetric Telephone Triage Guideline (OTTG): a mixed method study. BMC Womens Health 2024; 24:246. [PMID: 38637803 PMCID: PMC11025151 DOI: 10.1186/s12905-024-03076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/04/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Clarifying the dimensions and characteristics of obstetric telephone triage is important in improving the quality of services in the health system because researchers can evaluate the effectiveness of treatment, care and diagnostic measures in the form of obstetric telephone triage by developing a guideline. Therefore, this study aimed to design an Obstetric Telephone Triage Guideline (OTTG) using a mixed-method study. METHODS The present study was carried out using an exploratory sequential mixed method study in two qualitative and quantitative phases. An inductive-deductive approach was also used to determine the concept of obstetric telephone triage. In this respect, a qualitative study and a literature review were used in the inductive and deductive stages, respectively. Moreover, the validity of the developed guideline was confirmed based on experts' opinions and results of the AGREE II tool. RESULTS The guideline included the items for evaluating the severity of obstetric symptoms at five levels including "critical", "urgent", "less urgent", "no urgent", and "recommendations". The validity of the guideline was approved at 96%, 95%, 97%, 95%, 93%, and 100% for six dimensions of AGREE II including scope and purpose, stakeholder involvement, the rigor of development, clarity of presentation, applicability, and editorial independence, respectively. CONCLUSION The OTTG is a clinically comprehensive, easy-to-use, practical, and valid tool. This guideline is a standardized tool for evaluating the severity of symptoms and determining the urgency for obstetrics triage services. By using this integrated and uniform guideline, personal biases can be avoided, leading to improved performance and ensuring that patients are not overlooked. Additionally, the use of OTTG promotes independent decision-making and reduces errors in triage decision-making.
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Affiliation(s)
- Farzaneh Rashidi
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Saeed Safari
- Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Kiani
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Haimi M, Wheeler SQ. Safety in Teletriage by Nurses and Physicians in the United States and Israel: Narrative Review and Qualitative Study. JMIR Hum Factors 2024; 11:e50676. [PMID: 38526526 PMCID: PMC11002740 DOI: 10.2196/50676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/25/2023] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The safety of telemedicine in general and telephone triage (teletriage) safety in particular have been a focus of concern since the 1970s. Today, telehealth, now subsuming teletriage, has a basic structure and process intended to promote safety. However, inadequate telehealth systems may also compromise patient safety. The COVID-19 pandemic accelerated rapid but uneven telehealth growth, both technologically and professionally. Within 5-10 years, the field will likely be more technologically advanced; however, these advances may still outpace professional standards. The need for an evidence-based system is crucial and urgent. OBJECTIVE Our aim was to explore ways that developed teletriage systems produce safe outcomes by examining key system components and questioning long-held assumptions. METHODS We examined safety by performing a narrative review of the literature using key terms concerning patient safety in teletriage. In addition, we conducted system analysis of 2 typical formal systems, physician led and nurse led, in Israel and the United States, respectively, and evaluated those systems' respective approaches to safety. Additionally, we conducted in-depth interviews with representative physicians and 1 nurse using a qualitative approach. RESULTS The review of literature indicated that research on various aspects of telehealth and teletriage safety is still sparse and of variable quality, producing conflicting and inconsistent results. Researchers, possibly unfamiliar with this complicated field, use an array of poorly defined terms and appear to design studies based on unfounded assumptions. The interviews with health care professionals demonstrated several challenges encountered during teletriage, mainly making diagnosis from a distance, treating unfamiliar patients, a stressful atmosphere, working alone, and technological difficulties. However, they reported using several measures that help them make accurate diagnoses and reasonable decisions, thus keeping patient safety, such as using their expertise and intuition, using structured protocols, and considering nonmedical factors and patient preferences (shared decision-making). CONCLUSIONS Remote encounters about acute, worrisome symptoms are time sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important in the field of teletriage, which has a high potential for error. This underregulated subspecialty lacks adequate development and substantive research on system safety. Research may commingle terminology and widely different, ill-defined groups of decision makers with wide variation in decision-making skills, clinical training, experience, and job qualifications, thereby confounding results. The rapid pace of telehealth's technological growth creates urgency in identifying safe systems to guide developers and clinicians about needed improvements.
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Affiliation(s)
- Motti Haimi
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Health Systems Management Department, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
- Meuhedet Healthcare Services - North District, Tel Aviv, Israel
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Rose DE, Leung LB, McClean M, Nelson KM, Curtis I, Yano EM, Rubenstein LV, Stockdale SE. Associations Between Primary Care Providers and Staff-Reported Access Management Challenges and Patient Perceptions of Access. J Gen Intern Med 2023; 38:2870-2878. [PMID: 37532877 PMCID: PMC10593665 DOI: 10.1007/s11606-023-08172-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/13/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND/OBJECTIVE Optimizing patients' access to primary care is critically important but challenging. In a national survey, we asked primary care providers and staff to rate specific care processes as access management challenges and assessed whether clinics with more of these challenges had worse access outcomes. METHODS Study design: Cross sectional. National Primary Care Personnel Survey (NPCPS) (2018) participants included 6210 primary care providers (PCPs) and staff in 813 clinics (19% response rate) and 158,645 of their patients. We linked PCP and staff ratings of access management challenges to veterans' perceived access from 2018-2019 Survey of Healthcare Experiences of Patients-Patient Centered Medical Home (SHEP-PCMH) surveys (35.6% response rate). MAIN MEASURES The NPCPS queried PCPs and staff about access management challenges. The mean overall access challenge score was 28.6, SD 6.0. The SHEP-PCMH access composite asked how often veterans reported always obtaining urgent appointments same/next day; routine appointments when desired and having medical questions answered during office hours. ANALYTIC APPROACH We aggregated PCP and staff responses to clinic level, and use multi-level, multivariate logistic regressions to assess associations between clinic-level access management challenges and patient perceptions of access. We controlled for veteran-, facility-, and area-level characteristics. KEY RESULTS Veterans at clinics with more access management challenges (> 75th percentile) had a lower likelihood of reporting always receiving timely urgent care appointments (AOR: .86, 95% CI: .78-.95); always receiving routine appointments (AOR: .74, 95% CI: .67-.82); and always reporting same- or next-day answers to telephone questions (AOR: .79, 95% CI: .70-.90) compared to veterans receiving care at clinics with fewer (< 25th percentile) challenges. DISCUSSION/CONCLUSION Findings show a strong relationship between higher levels of access management challenges and worse patient perceptions of access. Addressing access management challenges, particularly those associated with call center communication, may be an actionable path for improved patient experience.
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Affiliation(s)
- Danielle E Rose
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Lucinda B Leung
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael McClean
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Karin M Nelson
- VA Puget Sound Healthcare System, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Elizabeth M Yano
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Lisa V Rubenstein
- Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Fielding School of Public Health, UCLA, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Susan E Stockdale
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
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Engeltjes B, van Herk N, Visser M, van Wijk A, Cronie D, Rosman A, Scheele F, Wouters E. Patients' experiences with an obstetric telephone triage system: A qualitative study. PATIENT EDUCATION AND COUNSELING 2023; 108:107610. [PMID: 36584556 DOI: 10.1016/j.pec.2022.107610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Telephone Triage Systems aim to provide a uniform and practical system for healthcare professionals in order to prioritize urgency of care. A disadvantage of telephone triage system could be that the conversations are experienced as less personal, as it uses a uniform procedure for every patient. Therefore, aside from the clinical relevance, patient expectations, experiences and satisfaction were studied. OBJECTIVE The purpose of this study is to explore patients' experiences with obstetric telephone triage. METHODS A descriptive, qualitative design to explore experiences after triage with Dutch Obstetric Telephone Triage System. Participants, recruited from two Dutch hospitals, were pregnant women who received triage by telephone. Semi-structured interviews were held. The following topics were discussed: expectations before triage, experiences with triage, waiting time, information and communication, approach of healthcare professional, and quality of treatment. Data were analyzed using open, axial and selective coding. RESULTS Overall, the participants experienced the telephone conversation as satisfactory. This was due to the perceived professionalism with high accessibility and perceived reassurance. The approach of the professional was experienced as friendly and empathetic. Participants suggested that triage services could be improved by looking specifically at information provision. Explaining in advance how the service works can be helpful to create more awareness and to align better with expectations. CONCLUSION Participants reported that they could tell their own story and most participants realized that the professional asked extra questions in order to quantify the seriousness of the complaints. The level of involvement in the next steps of their care episode experienced by respondents lead us to conclude that the professional intended patient-centered care. PRACTICE IMPLICATIONS Improving the provision of information during waiting times and about the accessibility of the service can increase the quality of obstetric triage care. Patient involvement is necessary to increase trust and to meet the needs of the patient.
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Affiliation(s)
- Bernice Engeltjes
- Athena institute for transdisciplinary research, Faculty of science, VU University, Amsterdam, the Netherlands; Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands.
| | - Nikki van Herk
- Department of Obstetrics and Gynecology, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Maud Visser
- Department of Obstetrics and Gynecology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Astrid van Wijk
- Department of Healthcare Education, OLVG Teaching Hospital, Amsterdam, the Netherlands
| | - Doug Cronie
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Ageeth Rosman
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Fedde Scheele
- Athena institute for transdisciplinary research, Faculty of science, VU University, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Eveline Wouters
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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Lindberg BH, Rebnord IK, Høye S. Effect of an educational intervention for telephone triage nurses on out-of-hours attendance: a pragmatic randomized controlled study. BMC Health Serv Res 2023; 23:4. [PMID: 36597106 PMCID: PMC9807970 DOI: 10.1186/s12913-022-08994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Telephone triage has been established in many countries as a response to the challenge of non-urgent use of out-of-hours primary care services. However, limited evidence is available regarding the effect of training interventions on clinicians' telephone consultation skills and patient outcomes. METHODS This was a pragmatic randomized controlled educational intervention for telephone triage nurses in 59 Norwegian out-of-hours general practitioners' (GPs) cooperatives, serving 59% of the Norwegian population. Computer-generated randomization was performed at the level of out-of-hours GP cooperatives, stratified by the population size. Thirty-two out-of-hours GP cooperatives were randomized to intervention. One cooperative did not accept the invitation to participate in the educational programme, leaving 31 cooperatives in the intervention group. The intervention comprised a 90-minute e-learning course and 90-minute group discussion about respiratory tract infections (RTIs), telephone communication skills and local practices. We aimed to assess the effect of the intervention on out-of-hours attendance and describe the distribution of RTIs between out-of-hours GP cooperatives and list-holding GPs. The outcome was the difference in the number of doctor's consultations per 1000 inhabitants between the intervention and control groups during the winter months before and after the intervention. A negative binomial regression model was used for the statistical analyses. The model was adjusted for the number of nurses who had participated in the e-learning course, the population size and patients' age groups, with the out-of-hours GP cooperatives defined as clusters. RESULTS The regression showed that the intervention did not change the number of consultations for RTIs between the two groups of out-of-hours GP cooperatives (incidence rate ratio 0.99, 95% confidence interval 0.91-1.07). The winter season's out-of-hours patient population was younger and had a higher proportion of RTIs than the patient population in the list-holding GP offices. Laryngitis, sore throat, and pneumonia were the most common diagnoses during the out-of-hours primary care service. CONCLUSIONS The intervention did not influence the out-of-hours attendance. This finding may be due to the intervention's limited scope and the intention-to-treat design. Changing a population's out-of-hours attendance is complicated and needs to be targeted at several organizational levels.
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Affiliation(s)
- Bent Håkan Lindberg
- grid.5510.10000 0004 1936 8921Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, 0315 Oslo, Norway
| | - Ingrid Keilegavlen Rebnord
- grid.509009.5National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sigurd Høye
- grid.5510.10000 0004 1936 8921Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, 0315 Oslo, Norway
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Brasseur E, Gilbert A, Donneau AF, Monseur J, Ghuysen A, D’Orio V. Reliability and validity of an original nurse telephone triage tool for out-of-hours primary care calls: the SALOMON algorithm. Acta Clin Belg 2022; 77:640-646. [PMID: 34081571 DOI: 10.1080/17843286.2021.1936353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Due to the persistent primary care physicians shortage and the substantial increase in their workload, the organization of primary care calls during out-of-hours periods has become an everyday challenge. The SALOMON algorithm is an original nurse telephone triage tool allowing to dispatch patients to the best level of care according to their conditions. This study evaluated its reliability and criterion validity in rea-life settings. METHODS In this 5-year study, out-of-hours primary care calls were dispatched into four categories: Emergency Medical Services Intervention (EMSI), Emergency Department referred Consultation (EDRC), Primary Care Physician Home visit (PCPH), and Primary Care Physician Delayed visit (PCPD). We included data of patients' triage category, resources, and destination. Patients included into the primary care cohort were classified undertriaged if they had to be redirected to an emergency department (ED). Patients from the ED cohort were considered overtriaged if they did not require at least three diagnostic resources, one emergency-specific treatment or any hospitalization. In the ED cohort, only patients from the University Hospitals were considered. RESULTS 10,207 calls were triaged using the SALOMON tool: 19.2% were classified as EMSI, 15.8% as EDRC, 62.8% as PCPH, and 2.2% as PCPD. The triage was appropriate for 85.5% of the calls with a 14.5% overtriage rate. In the PCPD/PCPH cohort, 96.9% of the calls were accurately triaged and 3.1% were undertriaged. SALOMON sensitivity and specificity reached 76.6% and 98.3%, respectively. CONCLUSION SALOMON algorithm is a valid triage tool that has the potential to improve the organization of out-of-hours primary care work.
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Affiliation(s)
- Edmond Brasseur
- Emergency Department, University Hospital Center of Liège, Liège, Belgium
| | - Allison Gilbert
- Emergency Department, University Hospital Center of Liège, Liège, Belgium
| | - Anne-Françoise Donneau
- Biostatistics Unit, University of Liège, Liège, Belgium
- Public Health Department, University of Liège, Liège, Belgium
| | - Justine Monseur
- Biostatistics Unit, University of Liège, Liège, Belgium
- Public Health Department, University of Liège, Liège, Belgium
| | - Alexandre Ghuysen
- Emergency Department, University Hospital Center of Liège, Liège, Belgium
- Public Health Department, University of Liège, Liège, Belgium
| | - Vincent D’Orio
- Emergency Department, University Hospital Center of Liège, Liège, Belgium
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Engeltjes B, Rosman A, Bertens LCM, Wouters E, Cronie D, Scheele F. Reliability of Dutch Obstetric Telephone Triage. Risk Manag Healthc Policy 2021; 14:3247-3254. [PMID: 34393531 PMCID: PMC8357617 DOI: 10.2147/rmhp.s319564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Safety and efficiency of emergency care can be optimized with a triage system which uses urgency to prioritize care. The Dutch Obstetric Telephone Triage System (DOTTS) was developed to provide a basis for assessing urgency of unplanned obstetric care requests by telephone. Reliability and validity are important components in evaluating such (obstetric) triage systems. Objective To determine the reliability of Dutch Obstetric Telephone Triage, by calculating the inter-rater and intra-rater reliability. Methods To evaluate the urgency levels of DOTTS by testing inter-rater and intra-rater reliability, 90 vignettes of possible requests were developed. Nineteen participants, from hospitals where DOTTS had been implemented, rated in two rounds a set of ten vignettes. The five urgency levels and five presenting symptoms had an equal spread and had to be entered in accordance with DOTTS per vignette. Urgency levels were dichotomized into high urgency and intermediate urgency. Inter-rater reliability was rated as degree of agreement between two different participants with the same vignette. Intra-rater reliability was rated as agreement by the same participants at different moments in time. The degree of inter-rater and intra-rater reliability was tested using weighted Cohen’s Kappa and ICC. Results The agreement of urgency level between participants in accordance with predefined urgency level per vignette was 90.5% (95% CI 87.5–93.6) [335 of 370]. Agreement of urgency level between participants was 88.5% (95% CI 84.9–93.0) [177 of 200] and 84.9% (95% CI 78.3–91.4) after re-rating [101 of 119]. Inter-rater reliability of DOTTS expressed as Cohen’s Kappa was 0.77 and as ICC 0.87; intra-rater reliability of DOTTS expressed as Cohen’s Kappa was 0.70 and as ICC 0.82. Conclusion Inter-rater and intra-rater reliability of DOTTS showed substantial correlation, and is comparable to other studies. Therefore, DOTTS is considered reliable.
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Affiliation(s)
- Bernice Engeltjes
- Athena Institute for Transdisciplinary Research, Faculty of Science, VU University, Amsterdam, the Netherlands.,Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Ageeth Rosman
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Eveline Wouters
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Doug Cronie
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Fedde Scheele
- Athena Institute for Transdisciplinary Research, Faculty of Science, VU University, Amsterdam, the Netherlands.,Department of Healthcare Education, OLVG Teaching Hospital, Amsterdam, the Netherlands
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Het gebruik van videobeelden bij triage op de huisartsenpost. ACTA ACUST UNITED AC 2021; 64:42-44. [PMID: 34376860 PMCID: PMC8336669 DOI: 10.1007/s12445-021-1240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Bij een deel van de patiënten die de huisartsenpost bellen, kunnen triagisten de klacht niet goed beoordelen omdat ze de patiënt niet kunnen zien. Dan wordt er een consult afgesproken, terwijl dat achteraf niet altijd nodig bleek te zijn. Het gebruik van videobeelden kan dit probleem mogelijk oplossen, maar er zijn vragen over de toegevoegde waarde van deze methode. In dit artikel geven we antwoord op vragen als: hoe vaak worden videobeelden ingezet bij triage, wat is daarvoor de indicatie en is het gebruik doelmatig, effectief en veilig?
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Engeltjes B, Van Dijk C, Rosman A, Rijke R, Scheele F, Wouters E. Validation of Dutch Obstetric Telephone Triage System: A Prospective Validation Study. Risk Manag Healthc Policy 2021; 14:1907-1915. [PMID: 34007228 PMCID: PMC8121677 DOI: 10.2147/rmhp.s306390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Objective and Purpose A triage system that prioritizes care according to medical urgency has a favorable effect on safety and efficiency of emergency care. The Dutch obstetric telephone triage system is comparable to physical triage systems. It consists of five urgency levels: resuscitation and life threatening (U1), emergency (U2), urgent (U3), non-urgent (U4) and self-care advice (U5). The purpose of this study was to determine the diagnostic and external validity of the Dutch obstetric telephone triage system in obstetric emergency care. Patients and Methods The validity of the Dutch obstetric telephone triage system was studied in a prospective observational study in four hospitals. Diagnostic validity of usual care was determined by comparing the assigned urgency level of the Dutch obstetric telephone triage system with a reference standard. This reference standard was obtained by face-to-face clinical assessment in hospital following telephone triage. Clinical follow-up after assessment was also recorded. For statistical analyses, urgency levels were dichotomized into high urgency (U1, U2) and intermediate urgency (U3, U4). Self-care advice (U5) could not be studied because these patients were not referred to hospital. Results In total, 983 cases (U1-U4) across the four hospitals were included, 625 (64%) cases were categorized as high urgency and 358 (36%) as intermediate urgency. The Dutch obstetric telephone triage system’s urgency level agreed with the reference standard in 53% (n=525; 95% CI 50–57%). According to the reference standard the Dutch obstetric telephone triage system had undertriage in 16% (n=160) and overtriage in 30% (n=298) of the cases. Sensitivity for high urgency was 76% (95% CI 72–80), specificity 49% (95% CI 44–53). Positive predictive value and negative predictive value were 60% (95% CI 56–63) and 67% (95% CI 62–72), respectively. After clinical assessment, urgent care was needed in 8.7% (n=31) of the intermediate-urgency cases, none of these cases were life threatening situations. Conclusion DOTTS shows an acceptable diagnostic validity with room for improvement.
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Affiliation(s)
- Bernice Engeltjes
- Athena Institute for Transdisciplinary Research, Faculty of Science, VU University, Amsterdam, the Netherlands.,Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Corlijn Van Dijk
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ageeth Rosman
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Rudy Rijke
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Fedde Scheele
- Athena Institute for Transdisciplinary Research, Faculty of Science, VU University, Amsterdam, the Netherlands.,Department of Healthcare Education, OLVG Teaching Hospital, Amsterdam, the Netherlands
| | - Eveline Wouters
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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10
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Jansen T, Hek K, Schellevis FG, Kunst AE, Verheij RA. Income-related differences in out-of-hours primary care telephone triage using national registration data. Emerg Med J 2021; 38:460-466. [PMID: 33853937 DOI: 10.1136/emermed-2020-209649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Telephone triage is used to facilitate efficient and adequate acute care allocation, for instance in out-of-hours primary care services (OPCSs). Remote assessment of health problems is challenging and could be impeded by a patient's ambiguous formulation of his or her healthcare need. Socioeconomically vulnerable patients may experience more difficulty in expressing their healthcare need. We aimed to assess whether income differences exist in the patient's presented symptoms, assessed urgency and allocation of follow-up care in OPCS. METHOD Data were derived from Nivel Primary Care Database encompassing electronic health record data of 1.3 million patients from 28 OPCSs in 2017 in the Netherlands. These were linked to sociodemographic population registry data. Multilevel logistic regression analyses (contacts clustered in patients), adjusted for patient characteristics (eg, age, sex), were conducted to study associations of symptoms, urgency assessment and follow-up care with patients' income (standardised for household size as socioeconomic status (SES) indicator). RESULTS The most frequently presented symptoms deduced during triage slightly differed across SES groups, with a larger relative share of trauma in the high-income groups. No SES differences were observed in urgency assessment. After triage, low income was associated with a higher probability of receiving telephone advice and home visits, and fewer consultations at the OPCS. CONCLUSIONS SES differences in the patient's presented symptom and in follow-up in OPCS suggest that the underlying health status and the ability to express care needs affect the telephone triage process . Further research should focus on opportunities to better tailor the telephone triage process to socioeconomically vulnerable patients.
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Affiliation(s)
- Tessa Jansen
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Karin Hek
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - François G Schellevis
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, locatie VUMC, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, locatie AMC, Amsterdam, The Netherlands
| | - Robert A Verheij
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Tranzo, Tilburg University, School of Social and Behavioral Sciences, Tilburg, The Netherlands
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Rysst Gustafsson S, Eriksson I. Quality indicators in telephone nursing - An integrative review. Nurs Open 2020; 8:1301-1313. [PMID: 33369230 PMCID: PMC8046143 DOI: 10.1002/nop2.747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/30/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022] Open
Abstract
Aim The aim of this study was to identify factors that indicate quality in telephone nursing. Design An integrative literature review. Method A literature search was performed in October 2018, in the PubMed, CINAHL, Cochrane Library, Academic Search, PsycINFO, Scopus and Web of Science databases. A total of 30 included were included and data that corresponded to the study's aim were extracted and categorized along the three areas of quality as described by Donabedian (Milbank Quarterly, 83, 691), namely structure, process and outcome. Results The analysis revealed ten factors indicating quality in telephone nursing (TN): availability and simplicity of the service, sustainable working conditions, specialist education and TN experience, healthcare resources and organization, good communication, person‐centredness, competence, correct and safe care, efficiency and satisfaction. TN services need to target all ten factors to ensure that the care given is of high quality and able to meet today's requirements for the service.
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Affiliation(s)
- Silje Rysst Gustafsson
- Division of nursing and medical technology, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Irene Eriksson
- School of Health Sciences, University of Skövde, Skövde, Sweden
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12
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Peršolja M. The quality of nursing care as perceived by nursing personnel: Critical incident technique. J Nurs Manag 2020; 29:432-441. [PMID: 33051916 DOI: 10.1111/jonm.13180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/26/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
AIMS To identify the determinants of the quality of nursing care from the perceptions of nursing personnel. BACKGROUND The quality of nursing care is often measured with standards, expectations, satisfaction and outcomes, but in developing countries, it relies mostly on negative indicators. METHODS A descriptive qualitative study was used. Semi-structured interviews based on the critical incident technique were conducted with a convenience sample of 136 nursing personnel who told 225 stories. RESULTS Seven quality determinants of nursing care were identified as follows: standard of care, triage and assessment, emergency care, communication with the patient or family, communication with colleagues, multidisciplinary teamwork and helping colleagues. The most important one was the standard of care. CONCLUSION Quality nursing care is based on the degree of excellence nursing personnel show with regard to their competences in technical care, communication and teamwork. A key attribute of quality nursing care is defined by the related standards, and the focus is mostly on the nursing care process. IMPLICATIONS FOR NURSING MANAGEMENT These findings can increase awareness of the determinants of nursing quality and the qualities of the nursing personnel involved and can help managers to evaluate nursing practice, select new employees and organise teams.
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Affiliation(s)
- Melita Peršolja
- Faculty of Health Sciences, University of Primorska, Nova Gorica, Slovenia
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13
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Graversen DS, Christensen MB, Pedersen AF, Carlsen AH, Bro F, Christensen HC, Vestergaard CH, Huibers L. Safety, efficiency and health-related quality of telephone triage conducted by general practitioners, nurses, or physicians in out-of-hours primary care: a quasi-experimental study using the Assessment of Quality in Telephone Triage (AQTT) to assess audio-recorded telephone calls. BMC FAMILY PRACTICE 2020; 21:84. [PMID: 32386511 PMCID: PMC7211335 DOI: 10.1186/s12875-020-01122-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 03/04/2020] [Indexed: 11/10/2022]
Abstract
Background To explore and compare safety, efficiency, and health-related quality of telephone triage in out-of-hours primary care (OOH-PC) services performed by general practitioners (GPs), nurses using a computerised decision support system (CDSS), or physicians with different medical specialities. Methods Natural quasi-experimental cross-sectional study conducted in November and December 2016. We randomly selected 1294 audio-recorded telephone triage calls from two Danish OOH-PC services triaged by GPs (n = 423), nurses using CDSS (n = 430), or physicians with different medical specialities (n = 441). An assessment panel of 24 physicians used a validated assessment tool (Assessment of Quality in Telephone Triage - AQTT) to assess all telephone triage calls and measured health-related quality, safety, and efficiency of triage. Results The relative risk (RR) of poor quality was significantly lower for nurses compared to GPs in four out of ten items regarding identifying and uncovering of problems. For most items, the quality tended to be lowest for physicians with different medical specialities. Compared to calls triaged by GPs (reference), the risk of clinically relevant undertriage was significantly lower for nurses, while physicians with different medical specialties had a similar risk (GP: 7.3%, nurse: 3.7%, physician: 6.1%). The risk of clinically relevant overtriage was significantly higher for nurses (9.1%) and physicians with different medical specialities (8.2%) compared to GPs (4.3%). GPs had significantly shorter calls (mean: 2 min 57 s, SD: 105 s) than nurses (mean: 4 min 44 s, SD: 168 s). Conclusions Our explorative study indicated that nurses using CDSS performed better than GPs in telephone triage on a large number of health-related items, had a lower level of clinically relevant undertriage, but were perceived less efficient. Calls triaged by physicians with different medical specialities were perceived less safe and less efficient compared to GPs. Differences in the organisation of telephone triage may influence the distribution of workload in primary and secondary OOH services. Future research could compare the long-term outcomes following a telephone call to OOH-PC related to safety and efficiency.
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Affiliation(s)
- D S Graversen
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark. .,Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - M B Christensen
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - A F Pedersen
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A H Carlsen
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - F Bro
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - H C Christensen
- Emergency Medical Services, Copenhagen, Denmark.,The National Clinical Databases (RKKP), Copenhagen, Denmark
| | - C H Vestergaard
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - L Huibers
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark
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14
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Haimi M, Brammli-Greenberg S, Baron-Epel O, Waisman Y. Assessing patient safety in a pediatric telemedicine setting: a multi-methods study. BMC Med Inform Decis Mak 2020; 20:63. [PMID: 32245469 PMCID: PMC7126468 DOI: 10.1186/s12911-020-1074-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/17/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Telemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. We aimed to explore the level of safety of a pediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians and the reasonableness of their decisions. METHODS This retrospective multi-method study investigated the decision-making process of physicians in a pediatric tele-triage service provided in Israel. The first section of the study investigates several measures relating to patient safety in the telemedicine setting. Two physicians reviewed a random sample of 339 parent-physician consultations conducted via a pediatric telemedicine service provided by a healthcare organization during 2014-2017. The consultations were analyzed for factors that may have affected the online physicians' decisions, with an emphasis on the appropriateness of the diagnoses and the reasonableness of the decisions. The online physicians' decisions were also compared to the subsequent outcomes (i.e., parental compliance with the recommendations and medical follow-ups within the healthcare system) after each consultation. The second section of the study (using a qualitative approach) consisted of interviews with 15 physicians who work in the pediatric telemedicine service, in order to explore their subjective experiences and efforts for assuring patient safety. The physicians were asked about factors that may have affected their reaching an appropriate diagnosis and a reasonable decision while maintaining patient safety. RESULTS The first section of the study demonstrates high levels of diagnosis appropriateness (98.5%) and decision reasonableness (92%), as well as low levels of false-positive (2.65%) and false-negative (5.3%), good sensitivity (82.85%), and high specificity (96.15%). A high association between the online decisions and the subsequent outcomes was also observed. The second section of the study presents physicians' means for ensuring high patient safety - by implementing a range of factors that helped them reach appropriate diagnoses and reasonable decisions. CONCLUSIONS The results show overall high patient safety in the pediatric tele-triage service that was examined. However, decision makers must strive to implement additional means for further enhancing the clinicians' ability to reach accurate diagnoses and provide optimal treatments within the tele-triage settings - with the aim of ensuring patient safety.
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Affiliation(s)
- Motti Haimi
- Clalit Health Services, Digital Health Wing, Central Division, Tel Aviv, Israel. .,Rappaport Faculty of Medicine, Technion, Haifa, Israel. .,School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel. .,Clalit Health Services , Sharon- Shomron District, Hadera, Israel.
| | - Shuli Brammli-Greenberg
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Orna Baron-Epel
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Yehezkel Waisman
- The Emergency Department, Schneider Children's Medical Center, Petach-Tikvah, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Siddiqui N, Greenfield D, Lawler A. Calling for confirmation, reassurance, and direction: Investigating patient compliance after accessing a telephone triage advice service. Int J Health Plann Manage 2019; 35:735-745. [PMID: 31803956 DOI: 10.1002/hpm.2934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/24/2019] [Accepted: 10/10/2019] [Indexed: 11/06/2022] Open
Abstract
Understanding the influence of a telephone triage advice service (TTAS) on patients seeking care is critical to realize enhancements in patient care, functioning of emergency departments (EDs), and effectiveness of the health system. This study addresses the question: what influence does a TTAS have on a patient's attendance at an ED and the wider health system? Records from 2016 to 2017 of 12,741 calls from a national TTAS were linked to 72,577 ED presentations to a hospital in regional Australia, retrospectively. Matching criteria included patient within the hospital's statistical local area code, age, gender, and ED attendance within 8 hours of TTAS call. Five statistical analyses of the data were conducted. There were 2857 matches. TTAS patients accessing the ED had a slightly higher proportion of women and a greater proportion of children under 4 years than usual. When TTAS confirmed callers' inclination for ED care, however only up to 69% subsequently attended the ED. When TTAS redirected others initially less inclined to more urgent care, up to 62% attended the ED. TTAS empowers vulnerable patients to access appropriate and timely services and promotes clinical and functional integration of care. Improvements of TTAS can come through investigation of callers' compliance factors.
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Affiliation(s)
- Nazlee Siddiqui
- Australian Institute of Health Service Management, Tasmanian School of Business and Economics, University of Tasmania, Hobart, Australia
| | - David Greenfield
- Australian Institute of Health Service Management, Tasmanian School of Business and Economics, University of Tasmania, Hobart, Australia
| | - Anthony Lawler
- Department of Health Tasmania, University of Tasmania, Hobart, Australia
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16
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Sandelius S, Wahlberg AC. Telenurses' experiences of monitoring calls to parents of children with gastroenteritis. Scand J Caring Sci 2019; 34:658-665. [PMID: 31614015 DOI: 10.1111/scs.12768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/01/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVE To describe telenurses' experiences of monitoring calls in telephone advice nursing to parents of children with gastroenteritis. BACKGROUND In previous studies, making monitoring calls is mentioned as a method used by telenurses to assess the need for care. MonitoringTHE terms 'care-seekers', 'care-seeker' and 'careseekers' are used inconsistently in the article. Please suggest which one to follow. We suggest Care-seeker calls in telephone advice nursing have been described as when telenurses call care-seekers back once or twice after an initial call. Calls from parents of children with gastroenteritis are common, and many of these calls result in telenurses providing self-care advice. METHODS Nineteen telenurses from two healthcare call centres in Sweden were interviewed. Data were analysed using inductive qualitative content analysis. RESULTS One main category, four generic categories and eleven sub-categories emerged. The telenurses described how working with monitoring calls aimed to provide self-care at home in a patient-safe way. Their focus on the parents aimed at increasing their feeling of security and focus on the child aimed at ensuring patient safety. Monitoring calls also provided a learning opportunity for parents and telenurses, and the possibility of relieving pressure on healthcare services. The findings indicate that the use of monitoring calls aims to provide a patient-safe form of telephone advice nursing. CONCLUSION This study shows that many parents feel insecure when their child has gastroenteritis, and the use of monitoring calls may be an effective approach to help them feel more secure at home with their sick child.
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Affiliation(s)
- Susanna Sandelius
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anna Carin Wahlberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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17
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Heidet M, Canoui-Poitrine F, Revaux F, Perennou T, Bertin M, Binetruy C, Palazzi J, Tapiero E, Nguyen M, Reuter PG, Lecarpentier E, Vaux J, Marty J. Factors affecting medical file documentation during telephone triage at an emergency call centre: a cross-sectional study of out-of-hours home visits by general practitioners in France. BMC Health Serv Res 2019; 19:531. [PMID: 31362748 PMCID: PMC6668156 DOI: 10.1186/s12913-019-4350-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background In France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre. The quality of a systematic physician-led triage has not been determined in France and may affect the efficiency of the OOH-HV process. The objectives of this study were first, to evaluate the quality of reporting in the electronic patient’s file after such triage and second, to analyse the factors associated with altered reporting. Methods Cross-sectional study in a French urban emergency call centre (district of Paris area) from January to December 2015. For a random selection of 30 days, data were collected from electronic medical files that ended with an OOH-HV decision. Missing key quality criteria (medical interrogation, diagnostic hypothesis or ruled-out severity criteria) were analysed by univariate then multivariate logistic regression, adjusted on patient, temporal and organizational data. Results Among 10,284 OOH-HVs performed in 2015, 748 medical files were selected. Reasons for the encounter were digestive tract symptoms (22%), fever (19%), ear nose and throat symptoms, and cardiovascular and respiratory problems (6% each). Medical interrogation was not reported in 2% of files (n = 16/748) and a diagnostic hypothesis in 58% (n = 432/748); ruled-out severity criteria were not reported in 60% (n = 449/748). On multivariate analysis, altered reporting was related to the work overload of triage assistants (number of incoming calls, call duration, telephone occupation rate; p < 0.03). Conclusion In the electronic files of patients requiring an OOH-HV by a GP in a French urban area, quality in medical reporting appeared to depend on organizational factors only, especially the triage assistants-related work factors. Corrective measures are needed to ensure good quality of triage and care. Electronic supplementary material The online version of this article (10.1186/s12913-019-4350-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthieu Heidet
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France. .,Université Paris-Est Créteil (UPEC), EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), Créteil, France.
| | - Florence Canoui-Poitrine
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, Département de Santé Publique, Créteil, France.,Université Paris-Est Créteil (UPEC), EA-7376 (Clinical Epidemiology and Ageing, CEpiA), Créteil, France
| | - François Revaux
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Thomas Perennou
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Maeva Bertin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Charles Binetruy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Julien Palazzi
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Eric Tapiero
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Michel Nguyen
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Paul-Georges Reuter
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Raymond Poincaré, SAMU 92, Garches, France
| | - Eric Lecarpentier
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Julien Vaux
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France.,Université Paris-Est Créteil (UPEC), EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), Créteil, France
| | - Jean Marty
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France.,Université Paris-Est Créteil (UPEC), EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), Créteil, France
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18
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Brasseur E, Servotte JC, Donneau AF, Stipulante S, d'Orio V, Ghuysen A. Triage for out-of-hours primary care calls: a reliability study of a new French-language algorithm, the SALOMON rule. Scand J Prim Health Care 2019; 37:227-232. [PMID: 31033368 PMCID: PMC6567030 DOI: 10.1080/02813432.2019.1608057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Triage systems for out-of-hours primary care physician (PCP) calls have been implemented empirically but no triage algorithm has been validated to date. A triage algorithm named SALOMON (Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne) was developed to guide triage nurses. This study assessed the performance of the algorithm using simulated PCP calls. Methods: Ten nurses were involved in 130 simulated PCP call scenarios, allowing the determination of SALOMON's inter-rater agreement by comparing the actual choices of a specific triage flowchart and the level of care selected as compared with reference assignments. Intra-rater agreement was estimated by comparing triage after training (T1) and 3 to 6 months after SALOMON use in clinical practice (T2). Results: Overall selection of flowcharts was accurate for 94 .1% of scenarios at T1 and 98.7% at T2. Level of triage was adequate for 93.4% of scenarios at T1 and 98.5% at T2. Both flowchart and triage level accuracy improved significantly from T1 to T2 (p < 0.0001). SALOMON algorithm use is associated with a 0.97/0.99 sensitivity and 0.97/0.99 specificity, at T1/T2 respectively. Conclusions: Results revealed that using the SALOMON algorithm is valid for out-of-hours PCP calls triage by nurses. The criterion validity of this algorithm should be further evaluated through its implementation in a real life setting.
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Affiliation(s)
- Edmond Brasseur
- Emergency Department, University Hospital Center of Liege, Liege, Belgium;
| | - Jean-Christophe Servotte
- Medical Simulation Center of Liege, University of Liege, Liege, Belgium;
- Public Health Sciences Department, University of Liege, Liege, Belgium;
| | | | | | - Vincent d'Orio
- Emergency Department, University Hospital Center of Liege, Liege, Belgium;
| | - Alexandre Ghuysen
- Emergency Department, University Hospital Center of Liege, Liege, Belgium;
- Medical Simulation Center of Liege, University of Liege, Liege, Belgium;
- Public Health Sciences Department, University of Liege, Liege, Belgium;
- CONTACT Alexandre Ghuysen Emergency Department, University Hospital Center of Liege, CHU de Liège, Service des urgences, Avenue Hippocrate, 13, B-4000 Liège, Belgium; Medical Simulation Center of Liege, University of Liege, Liege, Belgium; Public Health Sciences Department, University of Liege, Liege, Belgium
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19
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Physicians' experiences, attitudes and challenges in a Pediatric Telemedicine Service. Pediatr Res 2018; 84:650-656. [PMID: 30120402 DOI: 10.1038/s41390-018-0117-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Telemedicine in general, and telephone triage, in particular, is considered a high-stress clinical activity and involves decision making under conditions of uncertainty and urgency. AIM We wanted to explore the experiences, attitudes, and challenges of the physicians in a Pediatric Telemedicine Service operated in Israel, and to explore whether the doctors are using non-medical factors (not related to the medical problem), when making the clinical decisions in this setting. METHODS We used a qualitative methodology in order to obtain rich data that would reflect the participants' subjective experiences. Fifteen physicians who worked during the last 5 years in the "Pediatrician Online of Clalit" service were interviewed. Data were analyzed thematically. FINDINGS Seven main themes concerning the physicians' challenges during their work at this service were revealed, including difficulties diagnosing from a distance, treating unfamiliar patients, working alone, urgency and load of calls, technological obstacles, and a "moral conflict" between the desire to meet parents' expectations and maintain standards of care. The physicians stated that non-medical factors also affect their decisions. CONCLUSIONS In telemedicine setting, physicians face various difficulties and challenges, requiring special expertise, qualities and skills. Special measures are needed to obtain proper diagnosis and decisions.
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20
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Bailey CM, Newton JM, Hall HG. Telephone triage and midwifery: A scoping review. Women Birth 2018; 31:414-421. [DOI: 10.1016/j.wombi.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/23/2017] [Accepted: 12/01/2017] [Indexed: 11/30/2022]
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21
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Plat FM, Peters YAS, Loots FJ, de Groot CJA, Eckhardt T, Keizer E, Giesen P. Ambulance dispatch versus general practitioner home visit for highly urgent out-of-hours primary care. Fam Pract 2018; 35:440-445. [PMID: 29272417 DOI: 10.1093/fampra/cmx121] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patients with life-threatening conditions who contact out-of-hours primary care either receive a home visit from a GP of a GP cooperative (GPC) or are handed over to the ambulance service. OBJECTIVE The objective of this study was to determine whether highly urgent visits, after a call to the GPC, are delivered by the most appropriate healthcare provider: GPC or ambulance service. METHODS We performed a cross-sectional study using patient record data from a GPC and ambulance service in an urban district in The Netherlands. During a 21-month period, all calls triaged as life-threatening (U1) to the GPCs were included. The decision to send an ambulance or not was made by the triage nurse following a protocolized triage process. Retrospectively, the most appropriate care was judged by the patient's own GP, using a questionnaire. RESULTS Patient and care characteristics from 1081 patients were gathered: 401 GPC visits, 570 ambulance responses and 110 with both ambulance and GPC deployment. In 598 of 1081 (55.3%) cases, questionnaires were returned by the patients' own GP. About 40% of all visits could have been carried out with a lower urgency in retrospect, and almost half of all visits should have received a different type of care or different provider. In case of ambulance response, 60.7% concerned chest pain. CONCLUSION Research should be done on the process of triage and allocation of care to optimize labelling complaints with the appropriate urgency and to deploy the appropriate healthcare provider, especially for patients with chest pain.
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Affiliation(s)
- Fredrik M Plat
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Yvonne A S Peters
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Feike J Loots
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Corline J A de Groot
- Mobile Doctors Service Foundation Haaglanden [Stichting Mobiele Artsen Service Haaglanden (SMASH)], The Hague, The Netherlands
| | - Thomas Eckhardt
- Municipal Health Service Haaglanden [Gemeentelijke Gezondheidsdienst (GGD) Haaglanden], The Hague, The Netherlands
| | - Ellen Keizer
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Paul Giesen
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
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22
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Smits M, Keizer E, Ram P, Giesen P. Development and testing of the KERNset: an instrument to assess the quality of telephone triage in out-of-hours primary care services. BMC Health Serv Res 2017; 17:798. [PMID: 29197376 PMCID: PMC5712191 DOI: 10.1186/s12913-017-2686-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Telephone triage is a core but vulnerable part of the care process at out-of-hours general practitioner (GP) cooperatives. In the Netherlands, different instruments have been used for assessing the quality of telephone triage. These instruments focussed mainly on communicational aspects, and less on the medical quality of triage decisions. Our aim was to develop and test a minimum set of items to assess the quality of telephone triage. METHODS A national survey among all GP cooperatives in the Netherlands was performed to examine the most important aspects of telephone triage. Next, corresponding items from existing instruments were searched on these topics. Subsequently, an expert panel judged these items on importance, completeness and formulation. The concept KERNset consisted of 24 items about the telephone conversation: 13 medical, ten communicational and one regarding both types. It was pilot tested on measurement characteristics, reliability, validity and variation between triagists. In this pilot study, 114 anonymous calls from four GP cooperatives spread across the Netherlands were judged by three out of eight raters, both internal and external raters. RESULTS Cronbach's alpha was .94 for the medical items and .75 for the communicational items. Inter-rater reliability: complete agreement between the external raters was 45% and reasonable agreement 73% (difference of maximally one point on the five-point scale). Intra-rater reliability: complete agreement within raters was 55% and reasonable agreement 84%. There were hardly any differences between internal and external raters, but there were differences in strictness between individual raters. The construct validity was confirmed by the high correlation between the general impression of the call and the items of the KERNset. Of the differences within items 19% could be explained by differences between triage nurses, which means the KERNset is able to demonstrate differences between triage nurses. CONCLUSIONS The KERNset can be used to assess the quality of telephone triage. The validity is good and differences between calls and between triage nurses can be measured. A more intensive training for raters could improve the reliability.
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Affiliation(s)
- Marleen Smits
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), P.O Box 9101, 114 IQ healthcare, 6500, HB, Nijmegen, The Netherlands.
| | - Ellen Keizer
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), P.O Box 9101, 114 IQ healthcare, 6500, HB, Nijmegen, The Netherlands
| | - Paul Ram
- Maastricht University, Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Paul Giesen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), P.O Box 9101, 114 IQ healthcare, 6500, HB, Nijmegen, The Netherlands
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O'Brien LK, Drobnick P, Gehman M, Hollenbeak C, Iantosca MR, Luchs S, Manning M, Palm SK, Potochny J, Ritzman A, Tetro-Viozzi J, Trauger M, Armstrong AD. Improving Responsiveness to Patient Phone Calls: A Pilot Study. J Patient Exp 2017; 4:101-107. [PMID: 28959714 PMCID: PMC5593260 DOI: 10.1177/2374373517706611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Optimal patient-physician communication in the outpatient clinical setting is critical for safe and effective patient care. Keeping track of multiple patient telephone messages can be difficult and hazardous if a structured system is not in place. A multidisciplinary group at Hershey Medical Center developed a standardized approach for addressing patient telephone calls at their outpatient surgical clinics. This program was designed to improve the patient experience by providing a realistic time frame for phone calls to be returned and requests fulfilled. Additionally, this system permitted phone calls to be tracked and documented appropriately and allowed for prioritization of urgent and emergent messages. Our intent for this program was to close potential gaps within the communication chain at our outpatient surgical clinics, improve overall communication between clinicians and their patients, and improve both patient and employee satisfaction.
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Affiliation(s)
| | - Patricia Drobnick
- Penn State Milton S. Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | - Mary Gehman
- Penn State Milton S. Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | | | - Mark R Iantosca
- Penn State Milton S. Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | - Sherri Luchs
- Penn State Milton S. Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | - Maureen Manning
- Penn State Milton S. Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | - Susan K Palm
- Penn State Milton S. Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | - John Potochny
- Penn State Milton S. Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | - Angela Ritzman
- Penn State Milton S. Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | - Jennie Tetro-Viozzi
- Penn State Milton S. Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | - Mary Trauger
- Penn State Milton S. Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | - April D Armstrong
- Penn State Milton S. Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
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Raphael D, Waterworth S, Gott M. Telephone communication between practice nurses and older patients with long term conditions - a systematic review. J Telemed Telecare 2016; 23:142-148. [PMID: 26787642 DOI: 10.1177/1357633x15625398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and aims Long term conditions are a significant health problem faced by older people worldwide. Telephone communication is often used to deliver health care to patients and is an important tool in improving access to care. Previous research has shown that primary health care nurses communicate with patients by telephone, but little is known about the way in which telephone communication can be used to benefit older patients with long term conditions. The aims of this review were to identify the range and scope of telephone use between practice nurses working in primary health care and older people with long term conditions, explore which elements of this communication has been successful, and determine whether older people see telephone communication as useful for their needs. Methods A systematic search of the literature was conducted through CINAHL, Medline, Web of Science and EMBASE between July and August 2015. Included were English language articles containing older adults, primary care nurses and both qualitative and quantitative designs. Results Five studies met the inclusion criteria. All were intervention studies, and none looked at routine telephone communication between nurse and patient. Most studies showed that telephone based interventions were successful in improving pre-determined disease-specific health indicators. Conclusions All telephone communication interventions in this review focused on a specific long term condition, which they aimed to help patients self-manage. While all studies' samples included older patients, they did not consider them separately in relation to the effectiveness of the intervention. What was also lacking was the patient perspective regarding effectiveness in all but one study.
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Affiliation(s)
- Deborah Raphael
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Susan Waterworth
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
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Keizer E, Maassen I, Smits M, Wensing M, Giesen P. Reducing the use of out-of-hours primary care services: A survey among Dutch general practitioners. Eur J Gen Pract 2016; 22:189-95. [PMID: 27248713 DOI: 10.1080/13814788.2016.1178718] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Out-of-hours primary care services have a high general practitioner (GP) workload with increasing costs, while half of all contacts are non-urgent. OBJECTIVES To identify views of GPs to influence the use of the out-of-hours GP cooperatives. METHODS Cross-sectional survey study among a random sample of 800 GPs in the Netherlands. RESULTS Of the 428 respondents (53.5% response rate), 86.5% confirmed an increase in their workload and 91.8% felt that the number of patient contacts could be reduced. A total of 75.4% GP respondents reported that the 24-h service society was a 'very important' reason why patients with non-urgent problems attended the GP cooperative; the equivalent for worry or anxiety was 65.8%, and for easy accessibility, 60.1%. Many GPs (83.9%) believed that the way telephone triage is currently performed contributes to the high use of GP cooperatives. Measures that GPs believed were both desirable and effective in reducing the use of GP cooperatives included co-payment for patients, stricter triage, and a larger role for the telephone consultation doctor. GPs considered patient education, improved telephone accessibility of daytime general practices, more possibilities for same-day appointments, as well as feedback concerning the use of GP cooperatives to practices and triage nurses also desirable, but less effective. CONCLUSION This study provides several clues for influencing the use of GP cooperatives. Further research is needed to examine the impact and safety of these strategies. [Box: see text].
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Affiliation(s)
- Ellen Keizer
- a Radboud University Medical Center, Radboud Institute for Health Sciences , IQ Healthcare , Nijmegen , The Netherlands
| | - Irene Maassen
- a Radboud University Medical Center, Radboud Institute for Health Sciences , IQ Healthcare , Nijmegen , The Netherlands
| | - Marleen Smits
- a Radboud University Medical Center, Radboud Institute for Health Sciences , IQ Healthcare , Nijmegen , The Netherlands
| | - Michel Wensing
- a Radboud University Medical Center, Radboud Institute for Health Sciences , IQ Healthcare , Nijmegen , The Netherlands
| | - Paul Giesen
- a Radboud University Medical Center, Radboud Institute for Health Sciences , IQ Healthcare , Nijmegen , The Netherlands
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van der Biezen M, Schoonhoven L, Wijers N, van der Burgt R, Wensing M, Laurant M. Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi-experimental study. J Adv Nurs 2016; 72:1813-24. [PMID: 26969826 DOI: 10.1111/jan.12954] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/30/2022]
Abstract
AIM To provide insight into the impact of substituting general practitioners with nurse practitioners in out-of-hours services on: (1) the number of patients; and (2) general practitioners' caseload (patient characteristics, urgency levels, types of complaints). BACKGROUND General practitioners' workload during out-of-hours care is high, and the number of hours they work out-of-hours has increased, which raises concerns about maintaining quality of care. One response to these challenges is shifting care to nurse practitioners. DESIGN Quasi-experimental study comparing differences between and within out-of-hours teams: experimental, one nurse practitioner and four general practitioners; control, five general practitioners. METHODS Data of 12,092 patients from one general practitioners cooperative were extracted from medical records between April 2011 and July 2012. RESULTS The number of patients was similar in the two study arms. In the experimental arm, the nurse practitioner saw on average 16·3% of the patients and each general practitioner on average 20·9% of the patients. General practitioners treated more older patients; higher urgency levels; and digestive, cardiovascular and neurological complaints. Nurse practitioners treated more patients with skin and respiratory complaints. Substitution did not lead to a meaningful increase of general practitioners' caseload. CONCLUSION The results show that nurse practitioners can make a valuable contribution to patient care during out-of-hours. The patients managed and care provided by them is roughly the same as general practitioners. In areas with a shortage of general practitioners, administrators could consider employing nurses who are competent to independently treat patients with a broad range of complaints to offer timely care to patients with acute problems.
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Affiliation(s)
- Mieke van der Biezen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | | | | | - Regi van der Burgt
- Foundation for Development of Quality Care in General Practice, Eindhoven, The Netherlands
| | - Michel Wensing
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Miranda Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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The effect of nurses' preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial. Int J Nurs Stud 2016; 58:12-20. [PMID: 27087294 PMCID: PMC4845697 DOI: 10.1016/j.ijnurstu.2016.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 11/30/2022]
Abstract
Background Nurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. Design Questionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage. Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse. Settings 15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK. Participants 45 nurse practitioners and practice nurse trained in the use of clinical decision support software. Methods We investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. Results Valid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more likely to recommend patients for follow-up (OR 3.17, 95% CI 1.18–5.55). Conclusion Nurse characteristics were associated with disposition of triage calls to within practice follow-up. Nurse practitioners or those who reported feeling ‘more prepared’ for the role were more likely to manage the call definitively. Practices considering nurse triage should ensure that nurses transitioning into new roles feel adequately prepared. While standardised training is necessary, it may not be sufficient to ensure successful implementation.
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Smits M, Hanssen S, Huibers L, Giesen P. Telephone triage in general practices: A written case scenario study in the Netherlands. Scand J Prim Health Care 2016; 34:28-36. [PMID: 26893132 PMCID: PMC4911030 DOI: 10.3109/02813432.2016.1144431] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE General practices increasingly use telephone triage to manage patient flows. During triage, the urgency of the call and required type of care are determined. This study examined the organization and adequacy of telephone triage in general practices in the Netherlands. DESIGN Cross-sectional observational study using a web-based survey among practice assistants including questions on background characteristics and triage organization. Furthermore, practice assistants were asked to assess the required type of care of written case scenarios with varying health problems and levels of urgency. To determine the adequacy of the assessments, a comparison with a reference standard was made. In addition, the association between background characteristics and triage organization and the adequacy of triage was examined. SETTING Daytime general practices. SUBJECTS Practice assistants. MAIN OUTCOME MEASURES Over- and under-estimation, sensitivity, specificity. RESULTS The response rate was 41.1% (n = 973). The required care was assessed adequately in 63.6% of cases, was over-estimated in 19.3%, and under-estimated in 17.1%. The sensitivity of identifying patients with a highly urgent problem was 76.7% and the specificity was 94.0%. The adequacy of the assessments of the required care was higher for more experienced assistants and assistants with fixed daily work meetings with the GP. Triage training, use of a triage tool, and authorization of advice were not associated with adequacy of triage. CONCLUSION Triage by practice assistants in general practices is efficient (high specificity), but potentially unsafe in highly urgent cases (suboptimal sensitivity). It is important to train practice assistants in identifying highly urgent cases. KEY POINTS General practices increasingly use telephone triage to manage patient flows, but little is known about the organization and adequacy of triage in daytime practices. Telephone triage by general practice assistants is efficient, but potentially unsafe in highly urgent cases. The adequacy of triage is higher for more experienced assistants and assistants with fixed daily work meetings with the general practitioner.
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Affiliation(s)
- Marleen Smits
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Health Care (IQ healthcare), Nijmegen, The Netherlands
- CONTACT Marleen Smits Radboud University Medical Center, PO Box 9101, 114 IQ Healthcare, 6500 HB Nijmegen, The Netherlands
| | - Suzan Hanssen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Health Care (IQ healthcare), Nijmegen, The Netherlands
| | | | - Paul Giesen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Health Care (IQ healthcare), Nijmegen, The Netherlands
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Turner J, Coster J, Chambers D, Cantrell A, Phung VH, Knowles E, Bradbury D, Goyder E. What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03430] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
- Janette Turner
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Viet-Hai Phung
- College of Social Science, University of Lincoln, Lincoln, UK
| | - Emma Knowles
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Philips H, Van Bergen J, Huibers L, Colliers A, Bartholomeeusen S, Coenen S, Remmen R. Agreement on urgency assessment between secretaries and general practitioners: an observational study in out-of-hours general practice service in Belgium. Acta Clin Belg 2015; 70:309-14. [PMID: 25819448 DOI: 10.1179/2295333715y.0000000017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND In some European countries telephone triage (TT) during out-of-hours primary care showed to be safe and effective. Other countries, such as Belgium, may not have trained auxiliary personnel while their national health services want to establish TT. OBJECTIVES To compare urgency levels assessed by secretaries and general practitioners in one general practice cooperative in Belgium. METHODS Percentage of correct-, under-, and over-triage were calculated in total and per reason for encounter. Inter-rater agreement was investigated. RESULTS The secretaries correctly triaged (same urgency level) 77% of the telephone calls, under-triaged 10% and over-triaged 13%.'Shortness of breath', 'skin cuts', 'chest pain', 'feeling unwell' and 'syncope' were often under-triaged. CONCLUSION Before introducing TT, auxiliary staff should be trained and protocols should be used.
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Affiliation(s)
- H Philips
- Department of Primary and Interdisciplinary Care, University of Antwerp , Antwerp, Wilrijk, Belgium
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31
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Guimarães DS, Soares EJO, Júnior GF, Medeiros DD. Attributes and circumstances that induce inappropriate health services demand: a study of the health sector in Brazil. BMC Health Serv Res 2015; 15:65. [PMID: 25885287 PMCID: PMC4339295 DOI: 10.1186/s12913-015-0728-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 02/05/2015] [Indexed: 11/20/2022] Open
Abstract
Background The current economic and social context has required health systems to provide top quality services and to be efficient in controlling costs. An obstacle to achieve these goals is the inappropriate health services demand. This study aims to present these inappropriate health service demand determinants from data on telephone calls made to a medical advice call centre. Methods This study used a Brazilian medical advice call centre data sample in the period of November and December 2012 (n = 19690), which supplied data on the user’s initial request, the physician’s recommendation, information on the patient and circumstances (the day and time of the day of the telephone call). The convergence between user intent and medical recommendation consists in adequate demand; otherwise the divergence consists in an inadequate one. In this way, using a logistic regression model, the critical factors that determine inappropriate health services request could be estimated. Results In general, the user’s initial intent is the most critical for the inappropriate health system demand occurrence: the greater the complexity of the patient’s initial intent, the greater the chance the intent is wrong: (OR: 1.160; 95% CI: 1.113-1.210). With regard to the social characteristics, men are more likely to make inappropriate requests (OR: 1.102; 95% CI: 1038-1169); as well as youngsters are more likely to use the system incorrectly (OR = .993; 95% CI: .992 - .994). Regarding the circumstances (day and time of the call), requests in the final hours of the day and on days close to the weekend are more likely to be the inappropriate ones (OR: 1.082 for each six hour increase; 95% CI: 1.049-1.116) and weekday (OR: 1.017 for each day increase; 95% CI: 1.002-1.032). Conclusions The critical profile for the inappropriate use occurrence consists of males and youngsters, who use the health service in the final hours of the day and at weekends, and mainly want to use more complex services. A practical implication of this research is to provide health systems managers, supporting information to the most critical users in order to assist them in making a decision when asking for health care.
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Affiliation(s)
- Djalma S Guimarães
- Production Engineering Department, Federal University of Pernambuco, Recife, Brazil. .,Logistics Departament, University of Pernambuco, Nazaré da Mata, Brasil.
| | - Eduardo J O Soares
- Production Engineering Department, Federal University of Pernambuco, Recife, Brazil. .,Production Engineering Department, University of the State of Mato Grosso, Barra do Bugres, Brazil.
| | - Gileno Ferraz Júnior
- Production Engineering Department, Federal University of Pernambuco, Recife, Brazil.
| | - Denise D Medeiros
- Production Engineering Department, Federal University of Pernambuco, Recife, Brazil.
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Ek B, Svedlund M. Registered nurses' experiences of their decision-making at an Emergency Medical Dispatch Centre. J Clin Nurs 2014; 24:1122-31. [PMID: 25273221 DOI: 10.1111/jocn.12701] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe registered nurses' experiences at an Emergency Medical Dispatch Centre. BACKGROUND It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, Emergency Medical Dispatch centres cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Nurses worldwide are involved in patient triage, both before the patient's arrival to the hospital and in the subsequent emergency care. Ambulance dispatching is traditionally a duty for operators at Emergency Medical Dispatch centres, and in Sweden this duty has become increasingly performed by registered nurses. DESIGN A qualitative design was used for this study. METHODS Fifteen registered nurses with experience at Emergency Medical Dispatch centres were interviewed. The participants were asked to describe the content of their work and their experiences. They also described the most challenging and difficult situations according to the critical incidence technique. Content analysis was used. RESULTS Two themes emerged during the analysis: 'Having a profession with opportunities and obstacles' and 'Meeting serious and difficult situations', with eight sub-themes. The results showed that the decisions to dispatch ambulances were both challenging and difficult. Difficulties included conveying medical advice without seeing the patient, teaching cardio-pulmonary resuscitation via telephone and dealing with intoxicated and aggressive callers. Conflicts with colleagues and ambulance crews as well as fear of making wrong decisions were also mentioned. CONCLUSIONS Work at Emergency Medical Dispatch centres is a demanding but stimulating duty for registered nurses. RELEVANCE TO CLINICAL PRACTICE Great benefits can be achieved using experienced triage nurses, including increased patient safety and better use of medical resources. Improved internal support systems at Emergency Medical Dispatch centres and striving for a blame-free culture are important factors to attract and retain employees.
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Affiliation(s)
- Bosse Ek
- Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden
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Zargar Shoushtari S, Afshari P, Abedi P, Tabesh H. The effect of face-to-face with telephone-based counseling on sexual satisfaction among reproductive aged women in Iran. JOURNAL OF SEX & MARITAL THERAPY 2014; 41:361-367. [PMID: 24766525 DOI: 10.1080/0092623x.2014.915903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study was designed to investigate and compare the effect of face-to-face with telephone-based counseling on sexual satisfaction in women of reproductive age in Iran. This study was a randomized controlled trial in which 46 married women who got married 1-5 years ago were randomly selected and assigned to 1 of 2 groups (face-to-face and telephone-based counseling). Two groups received counseling by a trained midwife once a week for 4 weeks. The sexual satisfaction (using the Sexual Satisfaction Index) score was calculated in the beginning of the study and after 4 weeks. An independent t test, chi-square test, likelihood ratio test, Fisher's exact test, and linear-by-linear test were used for analyzing data. The mean score of sexual satisfaction in the face-to-face group was 93.6 (SD = 7.1) and improved significantly to 108.08 (SD = 5.44) after intervention (p =.001). The mean score of sexual satisfaction in the telephone-based counseling was 93.52 (SD = 5) and increased to 113 (SD = 6.07) after 4 weeks (p =.001). Telephone-based counseling could increase the sexual satisfaction better than face-to-face counseling (mean difference: 20.34 [SD = 7.38] vs. 14.47 [SD = 5.32], p =.003). The telephone-based counseling is an effective and affordable method to solve the sexual problems and could increase the sexual satisfaction. Using this method in public health centers is recommended.
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Affiliation(s)
- Shirin Zargar Shoushtari
- a Midwifery Department, Reproductive Health Promotion Research Centre , Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran
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North F, Richards DD, Bremseth KA, Lee MR, Cox DL, Varkey P, Stroebel RJ. Clinical decision support improves quality of telephone triage documentation--an analysis of triage documentation before and after computerized clinical decision support. BMC Med Inform Decis Mak 2014; 14:20. [PMID: 24645674 PMCID: PMC3994475 DOI: 10.1186/1472-6947-14-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 03/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. Methods We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Results Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p < 0.0001) and 10.2 for the cohort that was CDS-trained but not using CDS (p < 0.0001). The difference between the mean of 10.2 symptom features documented in the pre-CDS and the mean of 10.7 symptom features documented in the CDS-trained but not using was not statistically significant (p = 0.68). Conclusions CDS significantly improves triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed to determine if it results in improved care.
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Affiliation(s)
- Frederick North
- Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Locatelli SM, LaVela SL, Talbot ME, Davies ML. How do patients respond when confronted with telephone access barriers to care? Health Expect 2014; 18:2154-63. [PMID: 24612441 DOI: 10.1111/hex.12184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To gain an in-depth understanding of patient barriers to accessing telephone care, subsequent responses to telephone access issues and recommendations for system improvement within a large integrated health-care system. STUDY DESIGN Cross-sectional qualitative focus group study. METHODS One focus group was conducted at each of 17 Veterans Affairs facilities with a total of 123 Veteran users of VA health care. All facilities followed a focus group discussion guide, and purposively sampled patients receiving care at their VA facility in primary and/or specialty care. Focus groups' recordings were sent to the authors' independent evaluation centre, transcribed verbatim and analysed using qualitative content analysis methodology. RESULTS Participants described many issues with the phone system that resulted in delays to care needs being addressed, including difficulty getting someone to answer the phone, out-dated phone directories, frequent disconnections and incorrect transfers. Participants most frequently responded to access issues by doing nothing or waiting to contact at a later time, or seeking unscheduled in-person care in the emergency department or primary care clinic. Participants offered recommendations for improving telephone care, including access to direct extensions, and upgrades to the telephone system. CONCLUSIONS Telephone access issues could result in increased patient harm and/or increased wait times for in-person primary care or emergency services. Periodic evaluation of telephone systems is necessary to ensure telephone systems adequately meet patient needs while using resources efficiently to optimize the delivery of high quality, safe health care.
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Affiliation(s)
- Sara M Locatelli
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mary E Talbot
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Michael L Davies
- Office of Systems Redesign, Veterans Affairs Central Office, Washington, DC, USA
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