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Fotland SLS, Midtbø V, Vik J, Zakariassen E, Johansen IH. Factors affecting communication during telephone triage in medical call centres: a mixed methods systematic review. Syst Rev 2024; 13:162. [PMID: 38909273 PMCID: PMC11193260 DOI: 10.1186/s13643-024-02580-7] [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: 12/22/2023] [Accepted: 06/10/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Telephone triage is used to optimise patient flow in emergency primary healthcare. Poor communication can lead to misunderstandings and compromise patient safety. To improve quality, a comprehensive understanding of factors affecting communication in medical call centres in primary care is needed. The aim of this review was to identify such factors and to describe how they affect communication during telephone triage. METHOD A mixed-method systematic review was performed. In April 2021 and June 2023, MEDLINE, Embase, CINAHL, and Web of Science were searched for original studies describing communication during telephone triage in primary care medical call centres handling all types of medical problems from an unselected population. All studies were screened by two authors, blinded to each other's decisions. Disagreements were resolved by a third author. A framework was created by the thematic synthesis of the qualitative data and later used to synthesise the quantitative data. By using convergent integrated synthesis, the qualitative and quantitative findings were integrated. The Mixed Methods Appraisal Tool was used to assess methodological limitations. RESULTS Out of 5087 studies identified in the search, 62 studies were included, comprising 40 qualitative, 16 quantitative and six mixed-method studies. Thirteen factors were identified and organised into four main themes: organisational factors, factors related to the operator, factors related to the caller and factors in the interaction. Organisational factors included availability, working conditions and decision support systems. Factors related to the operator were knowledge and experience, personal qualities and communication strategies. Factors related to the caller were individual differences and the presented medical problem. Factors in the interaction were faceless communication, connection between operator and caller, third-person caller and communication barriers. The factors seem interrelated, with organisational factors affecting all parts of the conversation, and the operator's communication in particular. CONCLUSION Many factors affect the structure, content, and flow of the conversation. The operators influence the communication directly but rely on the organisation to create a working environment that facilitates good communication. The results are mainly supported by qualitative studies and further studies are needed to explore and substantiate the relevance and effect of individual factors. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022298022.
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Affiliation(s)
- Siri-Linn Schmidt Fotland
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Box 22, Bergen, NO-5838, Norway.
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Box 7804, Bergen, NO-5020, Norway.
| | - Vivian Midtbø
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Box 22, Bergen, NO-5838, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Box 7804, Bergen, NO-5020, Norway
| | - Jorunn Vik
- The Regional Centre for Emergency Medical Research and Development in Western Norway (RAKOS), Stavanger University Hospital, Box 8100, Stavanger, NO-4068, Norway
| | - Erik Zakariassen
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Box 22, Bergen, NO-5838, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Box 7804, Bergen, NO-5020, Norway
| | - Ingrid Hjulstad Johansen
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Box 22, Bergen, NO-5838, Norway
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Cooper IR, Schmaus A, Whitten TA, Bakal JA, Kurji F, Watt D, Lang E. Descriptive analysis and evaluation of Health Link referrals to the emergency department before and during the COVID-19 pandemic. Intern Emerg Med 2024; 19:1129-1137. [PMID: 38386095 DOI: 10.1007/s11739-023-03527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/27/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND In Alberta, Health Link (HL) provides a 24-h, nurse-staffed, phone resource to the public for health-care advice. HL directs callers to either seek care in the emergency department (ED), with a primary care provider or provide self-care at home. This work aims to describe HL ED referrals prior to and during the COVID-19 pandemic. METHODS Data from January 1, 2018-December 31, 2019, and July 1, 2020-June 30, 2022, were selected. HL calls were categorized as likely appropriate if the patient was referred and presented to the ED within 24 h and had a Canadian Triage and Acuity Scale (CTAS) of 1-3; or a CTAS of 4-5 and the patient was admitted, specialist consulted, or diagnostic imaging or laboratory tests were completed. The primary outcome was the percentage of likely appropriate referrals among all HL ED referrals. RESULTS In the 2018-2019 and 2020-2022 samples, respectively, there were 845,372 and 832,730 calls. Of the 211,723 and 213,486 ED referrals, only 140,614 (66.4%) and 143,322 (67.1%) presented to an ED. Of these, 84.3 and 86.7 per 100 patient visits were categorized as likely appropriate referrals. Health Link referrals account for 3.2% and 3.8% of all ED visits. IMPACT HL referrals to the ED represent only a small percentage of all ED visits. Based on our definition, most referrals by HL are likely appropriate. The COVID-19 pandemic does not appear to have altered the rates of calls to HL, the number of HL calls referred to the ED, nor the likely appropriateness of those referrals.
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Affiliation(s)
- Ian R Cooper
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Andrew Schmaus
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Tara A Whitten
- Alberta Health Services, Edmonton, AB, Canada
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, AB, Canada
- Provincial Research Data Services, Calgary, AB, Canada
| | - Jeffery A Bakal
- Alberta Health Services, Edmonton, AB, Canada
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, AB, Canada
- Provincial Research Data Services, Calgary, AB, Canada
| | - Fayaz Kurji
- Alberta Health Services, Edmonton, AB, Canada
| | - Denise Watt
- Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Eddy Lang
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
- Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
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Rebolho RC, Raupp FM. Implementation costs of telephone nurse triage service. CAD SAUDE PUBLICA 2023; 39:e00095522. [PMID: 37075414 DOI: 10.1590/0102-311xen095522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/25/2023] [Indexed: 04/21/2023] Open
Abstract
Telephone nurse triage services are becoming increasingly common in healthcare systems worldwide. Florianópolis (Santa Catarina State, Brazil) is the first municipality in the country to provide this service in its public health system. This study adopted a quantitative, descriptive, and analytical methodology to evaluate the impact of this program on overall costs of the public health system. The research examined all 33,869 calls received by the telephone triage service from March 16 to October 31 in 2020, and calculated the program costs during the period. Avoided cost were calculated by the difference between estimated consultation costs considering patient-stated first alternative and the program recommendation after triage. Analyzing only the costs for the municipality of Florianópolis, the program's costs exceeded avoided costs by almost BRL 2.5 million during the period. By expanding the analysis to include costs of emergency department consultation - not administered by the municipality - based on data from previous research, we found that the program spares BRL 34.59 per call, a 21% cost reduction for the health system. Considering the preliminary results of the study and its limitations, it is understood that the service of telephone nurse triage can reduce costs in the healthcare system.
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Patient Satisfaction With Telephone Nursing: A Call for Calm, Clarity, and Competence. J Nurs Care Qual 2020; 35:E6-E11. [PMID: 30817416 DOI: 10.1097/ncq.0000000000000392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies of patient satisfaction with telephone nursing can provide a better understanding of callers' needs and inform the improvement of services. PURPOSE This study described patients' experiences and perceptions of satisfaction with telephone nursing. METHODS The design was nonexperimental and descriptive, with an inductive approach. Data were collected using open-ended questions in a questionnaire that was dispatched to 500 randomly selected callers to the Swedish Healthcare Direct in Northern Sweden. RESULTS Patients' satisfaction with telephone nursing was related to calm, clarity, and competence. Calm referred to the nurse remaining calm and composed during the call. Clarity was described as distinct, concrete, and practical advice on how to act, what to observe, and where to seek further assistance. Competence referred to both health care knowledge and caring skills. CONCLUSION These aspects of nursing are dependent on each other and on-call telephone nursing services, which value patient satisfaction need to target all 3.
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Björkman A, Salzmann-Erikson M. Giving advice to callers with mental illness: adaptation among telenurses at Swedish Healthcare Direct. Int J Qual Stud Health Well-being 2019; 14:1633174. [PMID: 31242817 PMCID: PMC6598523 DOI: 10.1080/17482631.2019.1633174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Our aim was to describe Swedish Healthcare Direct (SHD) and its features as a complex system. Methods: Qualitative interviews were conducted with 20 SHD telenurses, covering their experiences and skills when encountering and advising callers with mental illness. Complexity science was used as an a priori theoretical framework to enhance understanding of the complex nature of telenursing. Results: SHD was described as a complex system as nurses were constantly interacting with other agents and agencies. During these interactions, dynamic processes were found between the agents in which the nurses adapted to every new situation. They were constantly aware of their impact on the care-seekers, and perceived their encounters with callers with psychiatric illness as “balancing on a thin line”. SHD was also described as both an authority and a dumping ground. The openness of the system did not give the nurses possibility to control the number of incoming calls and the callers’ intentions. Conclusions: These new insights into SHD have important implications for organization developers and nursing management in terms of overcoming linear thinking.
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Affiliation(s)
- Annica Björkman
- a Faculty of Health and Occupational Studies, Department of Health and Caring Sciences , University of Gavle , Gavle , Sweden.,b Department of Public Health and Caring Sciences , Uppsala University, Health Services Research , Uppsala , Sweden
| | - Martin Salzmann-Erikson
- a Faculty of Health and Occupational Studies, Department of Health and Caring Sciences , University of Gavle , Gavle , Sweden
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Martinsson J, Gustafsson S. Modeling the effects of telephone nursing on healthcare utilization. Int J Med Inform 2018; 113:98-105. [DOI: 10.1016/j.ijmedinf.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/23/2018] [Accepted: 02/03/2018] [Indexed: 11/26/2022]
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Gustafsson S, Sävenstedt S, Martinsson J, Wälivaara BM. Need for reassurance in self-care of minor illnesses. J Clin Nurs 2018; 27:1183-1191. [PMID: 29119676 DOI: 10.1111/jocn.14157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This study describes people's need for reassurance in self-care of minor illnesses. BACKGROUND Self-care and active surveillance are advocated as important strategies to manage minor illnesses. Reassurance influences patient satisfaction and confidence in the practicing of self-care. DESIGN This study is a descriptive and interpretive qualitative study. METHODS Twelve persons with experience in self-care and receiving self-care advice were recruited, and data were collected using semi-structured interviews between September-December 2014. Data were analysed using qualitative content analyses. RESULTS Having previous experience and the ability to actively manage symptoms using self-care interventions was described as reassuring. Participants became stressed and concerned when the symptoms persisted and interventions lacked the desired effect, which often resulted in a decision to consult. Participants wanted to feel that the nurse was an actual person, who was sympathetic, present and understanding, when they received self-care advice. The nurse's assessment and reasoning of the symptoms facilitated care-seekers' assessments of risk, and clear and concrete advice on how to manage the symptoms exerted a calming effect. Patients needed to trust that the nurse understood their situation to embrace the advice, and being invited to return created a feeling that the nurse had listened and taken them seriously. CONCLUSIONS Reassurance has the potential to allay doubts and fears to build confidence, which influences self-care and consultation behaviour. Personal presence in the encounter, receiving an assessment and an explanation of the symptoms and precise advice are reassuring. RELEVANCE TO CLINICAL PRACTICE The needs of nursing care may persist despite the absence of medical needs. The encounter between the nurse and care-seeker is a unique possibility for reassurance and confidence that a minor illness is self-limiting in its nature, and self-care interventions provide relief and comfort.
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Affiliation(s)
- Silje Gustafsson
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Stefan Sävenstedt
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Jesper Martinsson
- Department of Engineering Sciences and Mathematics, Luleå University of Technology, Luleå, Sweden
| | - Britt-Marie Wälivaara
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
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Gustafsson S, Martinsson J, Wälivaara BM, Vikman I, Sävenstedt S. Influence of self-care advice on patient satisfaction and healthcare utilization. J Adv Nurs 2016; 72:1789-99. [DOI: 10.1111/jan.12950] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Silje Gustafsson
- Division of Nursing; Department of Health Science; Luleå University of Technology; Sweden
| | - Jesper Martinsson
- Department of Engineering Sciences and Mathematics; Luleå University of Technology; Sweden
| | - Britt-Marie Wälivaara
- Division of Nursing; Department of Health Science; Luleå University of Technology; Sweden
| | - Irene Vikman
- Division of Health and Rehab; Department of Health Science; Luleå University of Technology; Sweden
| | - Stefan Sävenstedt
- Division of Nursing; Department of Health Science; Luleå University of Technology; Sweden
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A psychosocial oncology program: perceptions of the telephone-triage assessment. Support Care Cancer 2016; 24:2937-44. [PMID: 26847449 DOI: 10.1007/s00520-016-3091-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/17/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Cancer can be a significant source of distress for patients and family members, which led to the creation of psychosocial oncology (PSO) programs across Canada. To access the PSO program at this institution, individuals are first triaged over the telephone by a clinical nurse specialist (CNS) who also provides psychosocial support during the call. In our study, we explored the perceptions of cancer patients or family members about their psychosocial telephone-triage assessment conducted by a CNS for a PSO program. METHODS A qualitative descriptive design was used to explore the perceptions of nine cancer patients and family members triaged by the CNS for the PSO program. Audiotaped in-person interviews were transcribed verbatim and analyzed for themes and categories using a constant comparative method. RESULTS Three major themes emerged: (1) Triage as a bridge to care, referred to the structure of telephone-triage and link to psychosocial services; (2) feeling a supportive presence, referred to the CNS' actions to foster a therapeutic relationship; and (3) different paths to tailored care, referred to the individualized strategies targeted to the participant's unique needs. As most participants described trusting the CNS, these three themes were found to emerge through a lens of trust. CONCLUSION Overall, the telephone triage was able to address the concerns of many participants and provide individualized coping strategies and support. This study further demonstrates that psychosocial support can be provided during triage over the telephone.
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Snyder H, Engström J. The antecedents, forms and consequences of patient involvement: A narrative review of the literature. Int J Nurs Stud 2016; 53:351-78. [DOI: 10.1016/j.ijnurstu.2015.09.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 12/19/2022]
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Pasini A, Rigon G, Vaona A. A cross-sectional study of the quality of telephone triage in a primary care out-of-hours service. J Telemed Telecare 2015; 21:68-72. [PMID: 25586807 DOI: 10.1177/1357633x14566573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated the quality of telephone triage and the appropriateness of the decisions resulting from it at a primary care out-of-hours service. Four simulated clinical cases were used in the Incognito Standardized Patient method: an adult with nosebleed, an adult with fever, a child with fever and a child with vomiting. There was a set of obligatory questions for each case, translated from those used in a previous study. Quality was assessed by the proportion of questions asked by the call-handlers during telephone triage versus those that should have been asked. A total of 22 out-of-hours doctors were involved in the study, working in two different locations in the Verona city area. Over a 4-month period each of the four simulated clinical cases was used five times in calls to the two centres involved. The proportion of obligatory questions asked compared to those expected to be asked was 27-36%. On three occasions out of the 40 simulations, all of which were considered to be manageable by telephone, the patient was advised to go to an outpatient clinic for a face-to-face evaluation. The average duration of the calls was 3 min 47 s. The quality of telephone triage in the regions studied was low and provided considerable room for improvement. This is relevant to patient safety and risk management of the service.
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Affiliation(s)
- Alberto Pasini
- Primary Care Department, Azienda ULSS 22, Villafranca, Italy
| | - Giulio Rigon
- Primary Care Department, Azienda ULSS 20, Verona, Italy
| | - Alberto Vaona
- Primary Care Department, Azienda ULSS 20, Verona, Italy
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Moss EL. "Just a telephone call away": transforming the nursing profession with telecare and telephone nursing triage. Nurs Forum 2014; 49:233-239. [PMID: 24383570 DOI: 10.1111/nuf.12052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The purpose of this article is to examine the Institute of Medicine's recommendations, the National Prevention Council Action Plan, the medical home model, and the nursing standards that drive quality for telephone nursing triage. FINDINGS These guidelines require reconceptualizing nursing roles, a commitment to lifelong learning, continued competence, and transformational leadership as demonstrated in a best practice case study. CONCLUSION Given the changing climate of the healthcare system, telephone nurses are capable of improving healthcare delivery in the twenty-first century.
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