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Michel J, Manns A, Boudersa S, Jaubert C, Dupic L, Vivien B, Burgun A, Campeotto F, Tsopra R. Clinical decision support system in emergency telephone triage: A scoping review of technical design, implementation and evaluation. Int J Med Inform 2024; 184:105347. [PMID: 38290244 DOI: 10.1016/j.ijmedinf.2024.105347] [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: 12/18/2023] [Revised: 01/09/2024] [Accepted: 01/21/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Emergency department overcrowding could be improved by upstream telephone triage. Emergency telephone triage aims at managing and orientating adequately patients as early as possible and distributing limited supply of staff and materials. This complex task could be improved with the use of Clinical decision support systems (CDSS). The aim of this scoping review was to identify literature gaps for the future development and evaluation of CDSS for Emergency telephone triage. MATERIALS AND METHODS We present here a scoping review of CDSS designed for emergency telephone triage, and compared them in terms of functional characteristics, technical design, health care implementation and methodologies used for evaluation, following the PRISMA-ScR guidelines. RESULTS Regarding design, 19 CDSS were retrieved: 12 were knowledge based CDSS (decisional algorithms built according to guidelines or clinical expertise) and 7 were data driven (statistical, machine learning, or deep learning models). Most of them aimed at assisting nurses or non-medical staff by providing patient orientation and/or severity/priority assessment. Eleven were implemented in real life, and only three were connected to the Electronic Health Record. Regarding evaluation, CDSS were assessed through various aspects: intrinsic characteristics, impact on clinical practice or user apprehension. Only one pragmatic trial and one randomized controlled trial were conducted. CONCLUSION This review highlights the potential of a hybrid system, user tailored, flexible, connected to the electronic health record, which could work with oral, video and digital data; and the need to evaluate CDSS on intrinsic characteristics and impact on clinical practice, iteratively at each distinct stage of the IT lifecycle.
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Affiliation(s)
- Julie Michel
- SAMU 93-UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France
| | - Aurélia Manns
- Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France; Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou et Hôpital Necker-Enfants Malades, F-75015 Paris, France.
| | - Sofia Boudersa
- Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou et Hôpital Necker-Enfants Malades, F-75015 Paris, France
| | - Côme Jaubert
- Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France
| | - Laurent Dupic
- Régulation Régionale Pédiatrique, SAMU de Paris, Hôpital Necker - Enfants Malades, AP-HP, Paris, France
| | - Benoit Vivien
- Digital Health Program of Université de Paris Cité, Paris, France; Régulation Régionale Pédiatrique, SAMU de Paris, Hôpital Necker - Enfants Malades, AP-HP, Paris, France
| | - Anita Burgun
- Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France; Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou et Hôpital Necker-Enfants Malades, F-75015 Paris, France
| | - Florence Campeotto
- Digital Health Program of Université de Paris Cité, Paris, France; Régulation Régionale Pédiatrique, SAMU de Paris, Hôpital Necker - Enfants Malades, AP-HP, Paris, France; Faculté de Pharmacie, Université de Paris Cité, Inserm UMR S1139, Paris, France
| | - Rosy Tsopra
- Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France; Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou et Hôpital Necker-Enfants Malades, F-75015 Paris, France
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Westin E, Gustafsson IL, Svensson A, Sund-Levander M, Elmqvist C. Advising parents when their child has a fever: a phenomenographic analysis of nurses' perceptions when working at a telephone helpline, at primary care or at a paediatric emergency department in Sweden. BMJ Open 2024; 14:e074823. [PMID: 38286694 PMCID: PMC10826557 DOI: 10.1136/bmjopen-2023-074823] [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: 04/18/2023] [Accepted: 01/11/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES To describe nurses' perceptions of advising parents when their child has a fever. DESIGN/METHOD Inductive, descriptive study with a qualitative, phenomenographic approach. PARTICIPANTS AND SETTING A purposive sampling was used. To be included, the 24 online interviewed nurses had to have experience advising parents of febrile children between birth and 5 years of age. They were recruited from three different parts of the healthcare system from four regions in the south of Sweden. RESULTS The nurses described advising parents when their child has a fever as four different kinds of balancing acts: balancing between the parents' story and objective assessment, balancing between listening and teaching, balancing between self-confidence and trust in the expert, and balancing between independence and having someone by one's side. CONCLUSIONS Giving advice to parents when their child has a fever is a process where the nurse needs to listen, assess and give advice based on the situation. This requires a correct assessment that depends on the parents' story. Creating a trusting relationship is perceived as necessary for parents to assimilate the advice that is provided. What dominates are the nurses' perceptions of the inner qualities required to achieve a balance in the process, for example, the importance of experience and security in their professional role, while it is also necessary to get support from colleagues.
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Affiliation(s)
- Emma Westin
- Department of Health and Caring Sciences, Linnaeus University Faculty of Health and Life Sciences, Vaxjo, Sweden
- Department of Pediatrics, Region Kronoberg, Vaxjo, Sweden
| | - Ingrid L Gustafsson
- Department of Health and Caring Sciences, Linnaeus University Faculty of Health and Life Sciences, Vaxjo, Sweden
- Department of Caring Sciences, University College of Boras Faculty of Caring Science Work Life and Social Welfare, Boras, Sweden
| | - Anders Svensson
- Department of Health and Caring Sciences, Linnaeus University Faculty of Health and Life Sciences, Vaxjo, Sweden
- Department of Ambulance Service, Region Kronoberg, Vaxjo, Sweden
| | | | - Carina Elmqvist
- Department of Health and Caring Sciences, Linnaeus University Faculty of Health and Life Sciences, Vaxjo, Sweden
- Head of Research, Region Kronoberg, Vaxjo, Sweden
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De Guzman KR, Snoswell CL, Caffery LJ, Smith AC. Economic evaluations of videoconference and telephone consultations in primary care: A systematic review. J Telemed Telecare 2024; 30:3-17. [PMID: 34617819 DOI: 10.1177/1357633x211043380] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Telehealth services using videoconference and telephone modalities have been increasing exponentially in primary care since the coronavirus pandemic. The challenge now is ensuring that these services remain sustainable. This review investigates the cost-effectiveness of videoconference and telephone consultations in primary care settings, by summarizing the available published evidence. METHODS A systematic search of PubMed, Embase, Scopus, and CINAHL databases was used to identify articles published from January 2000 to July 2020, using keyword synonyms for telehealth, primary care, and economic evaluation. Databases were searched, and title, abstract, and full-text reviews were conducted. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS Twenty articles were selected for inclusion, with 12 describing telephone triage services, seven describing telehealth substitution services, and one describing another telehealth service in primary care. These services were delivered by nurses, doctors, and allied health clinicians. Of the 20 included studies, 11 used cost analyses, five used cost-minimization analyses, and four used one or more methods, including either a cost-consequence analysis, a cost-utility analysis, or a cost-effectiveness analysis. CONCLUSIONS Telephone and videoconference consultations in primary care were cost-effective to the health system when deemed clinically appropriate, clinician when time was used efficiently, and when overall demand on health services was reduced. The societal benefits of telehealth consultations should be considered an important part of telehealth planning and should influence funding reform decisions for telehealth services in primary care.
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Affiliation(s)
- Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, The University of Southern Denmark, Odense, Denmark
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Gelin M, Gesar B, Källberg AS, Ehrenberg A, Gustavsson C. Introducing a triage and Nurse on Call model in primary health care - a focus group study of health care staff's experiences. BMC Health Serv Res 2023; 23:1299. [PMID: 38001493 PMCID: PMC10675943 DOI: 10.1186/s12913-023-10300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND With the increased demand for health care services and with simultaneous staff shortages, new work models are needed in primary health care. In November 2015, a Swedish primary health care centre introduced a work model consisting of a structured patient sorting system with triage and Nurse on Call. The aim of this study was to describe the staff's experiences of introducing the triage and Nurse on Call model at the primary health care centre. METHODS Five focus group discussions with staff (n = 39) were conducted 4 years after the introduction of the work model. Groups were divided by profession: medical secretaries, nursing assistants, physicians, primary health care nurses, and registered nurses. The transcribed text from the discussions was analysed using qualitative inductive content analysis. RESULTS The analysis generated one overarching theme: The introduction of triage and Nurse on Call addresses changed preconditions in primary health care, but the work culture, organization, and acquisition of new knowledge are lagging behind. The overarching theme had five categories: (1) Changed preconditions in primary health care motivate new work models; (2) The triage and Nurse on Call model improves teamwork and may increase the quality of care; (3) Unclear purpose and vague leadership make introducing the work model difficult; (4) Difficulties to adopt the work model as it challenges professional autonomy; and (5) The triage and Nurse on Call model requires more knowledge and competence from nurses in primary health care. CONCLUSIONS This study contributes with knowledge about implications of a new work model in primary health care from the perspective of health care staff. The work model using triage and Nurse on Call in primary health care was perceived by participants to increase availability and optimize the use of resources. However, before introduction of new work models, it is important to identify barriers to and facilitators for successful improvements in the local health care context. Additional education for the health care staff is important if the transition is to be successful. Complementary skills and teamwork, supported by a facilitator seems important to ensure a well-prepared workforce.
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Affiliation(s)
- Maria Gelin
- Center for Clinical Research Dalarna, Uppsala University, Nissers väg 3, SE-79182, Falun, Sweden.
- School of Health and Welfare, Dalarna University, Falun, SE-79188, Sweden.
| | - Berit Gesar
- Center for Clinical Research Dalarna, Uppsala University, Nissers väg 3, SE-79182, Falun, Sweden
- School of Health and Welfare, Dalarna University, Falun, SE-79188, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ann-Sofie Källberg
- Center for Clinical Research Dalarna, Uppsala University, Nissers väg 3, SE-79182, Falun, Sweden
- School of Health and Welfare, Dalarna University, Falun, SE-79188, Sweden
| | - Anna Ehrenberg
- School of Health and Welfare, Dalarna University, Falun, SE-79188, Sweden
| | - Catharina Gustavsson
- Center for Clinical Research Dalarna, Uppsala University, Nissers väg 3, SE-79182, Falun, Sweden
- School of Health and Welfare, Dalarna University, Falun, SE-79188, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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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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Cetin AA, Bektas H, Coskun HS. The effect of telephone triage on symptom management in patients with cancer undergoing systemic chemotherapy: A randomized controlled trial. Eur J Oncol Nurs 2022; 61:102221. [DOI: 10.1016/j.ejon.2022.102221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/13/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022]
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Sundberg A, Wahlberg AC, Zethraeus N, Karampampa K. Observational study of the implementation of telephone advice nursing in Sweden: did callers follow recommendations and did the rate of healthcare visits change? BMJ Open 2021; 11:e051233. [PMID: 34413110 PMCID: PMC8378364 DOI: 10.1136/bmjopen-2021-051233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Telephone advice nursing is introduced in many countries with one key aim being a reduction of avoidable healthcare visits. The aim of this study was to explore whether callers to a telephone advice nursing service followed the telenurses' recommendations, and whether there was a change in the level and trend of the rate of healthcare visits after the introduction of telephone advice nursing. DESIGN Observational study. SETTING Primary and secondary care in Jönköping Region, Sweden. PARTICIPANTS Telephone advice nursing calls, 6:00-23:00, 2014-2015 (n=185 994) and outpatient healthcare visits 2012-2015 (n=6 877 266). PRIMARY OUTCOME Proportion of callers who visited healthcare within the time period advised by the telenurse. SECONDARY OUTCOME Change in level or trend of the overall rate of healthcare visits per 1000 persons and 4-week period after the introduction of telephone advice nursing, with subgroup analysis for primary and secondary care. RESULTS 77% of callers who were recommended either to visit healthcare within 24 hours or to 'wait and see' followed the recommendations. There was no significant change in level (-5.15; 95% CI -15.80 to 5.50; p=0.349) or trend (-0.24; 95% CI -0.86 to 0.38; p=0.448) of the overall rate of visits per 1000 persons and 4-week period after the introduction of telephone advice nursing. For the rate of primary care visits, an increase in level (8.01; 95% CI 6.36 to 9.66; p<0.001) and trend (1.28; 95% CI 1.17 to 1.39; p<0.001) were observed. For the rate of secondary care visits, a decrease in level (-8.77, 95% CI -14.41 to -3.13; p=0.004) and trend (-1.03, 95% CI -1.35 to -0.71; p<0.001) were observed. CONCLUSIONS The introduction of telephone advice nursing may have contributed to a shift in the rate of healthcare visits from secondary to primary care.
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Affiliation(s)
- Amanda Sundberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Carin Wahlberg
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Korinna Karampampa
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Strand AS, Johnsson B, Hena M, Magnusson B, Hallström IK. Developing eHealth in neonatal care to enhance parents' self-management. Scand J Caring Sci 2021; 36:969-977. [PMID: 33950534 DOI: 10.1111/scs.12994] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Discharge from a neonatal care unit is often experienced as a vulnerable time for parents. By communicating through digital technology, it may be possible to improve the support for parents and thereby make the transition from hospital to home less stressful. AIM To develop an eHealth device supporting the transition from hospital to home for parents with a preterm-born child in Sweden using participatory design. METHOD Employing a framework of complex interventions in health care using participatory design. Parents of preterm-born infants and professionals at a neonatal department identified specific technical requirements for an eHealth device to be developed in the context of neonatal care and neonatal home care. The prospective end-users - parents and professionals - were continuously involved in the process of designing solution prototypes through meetings, verbal and written feedback, and interviews. The interviews were analysed using thematic analysis. RESULTS Technical development was carried out with the perspectives of professionals and parents in mind, resulting in an eHealth application for computer tablets. The findings from the interviews with the parents and professionals revealed three categories: The tablets felt secure, easy to use and sometimes replaced visits to hospital and at home. CONCLUSION The use of participatory design to develop an eHealth device to support a safe transition from hospital to home can benefit parents, the child, the family, and professionals in neonatal care.
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Affiliation(s)
| | - Björn Johnsson
- Department of Computer Science, Faculty of Engineering, Lund University, Lund, Sweden
| | - Momota Hena
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Boris Magnusson
- Department of Computer Science, Faculty of Engineering, Lund University, Lund, Sweden
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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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Entezarjou A, Bonamy AKE, Benjaminsson S, Herman P, Midlöv P. Human- Versus Machine Learning-Based Triage Using Digitalized Patient Histories in Primary Care: Comparative Study. JMIR Med Inform 2020; 8:e18930. [PMID: 32880578 PMCID: PMC7499160 DOI: 10.2196/18930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Smartphones have made it possible for patients to digitally report symptoms before physical primary care visits. Using machine learning (ML), these data offer an opportunity to support decisions about the appropriate level of care (triage). OBJECTIVE The purpose of this study was to explore the interrater reliability between human physicians and an automated ML-based triage method. METHODS After testing several models, a naïve Bayes triage model was created using data from digital medical histories, capable of classifying digital medical history reports as either in need of urgent physical examination or not in need of urgent physical examination. The model was tested on 300 digital medical history reports and classification was compared with the majority vote of an expert panel of 5 primary care physicians (PCPs). Reliability between raters was measured using both Cohen κ (adjusted for chance agreement) and percentage agreement (not adjusted for chance agreement). RESULTS Interrater reliability as measured by Cohen κ was 0.17 when comparing the majority vote of the reference group with the model. Agreement was 74% (138/186) for cases judged not in need of urgent physical examination and 42% (38/90) for cases judged to be in need of urgent physical examination. No specific features linked to the model's triage decision could be identified. Between physicians within the panel, Cohen κ was 0.2. Intrarater reliability when 1 physician retriaged 50 reports resulted in Cohen κ of 0.55. CONCLUSIONS Low interrater and intrarater agreement in triage decisions among PCPs limits the possibility to use human decisions as a reference for ML to automate triage in primary care.
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Affiliation(s)
- Artin Entezarjou
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö/Family Medicine, Lund University, Malmö, Sweden
| | - Anna-Karin Edstedt Bonamy
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Doctrin AB, Stockholm, Sweden
| | | | - Pawel Herman
- Department of Computational Science and Technology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö/Family Medicine, Lund University, Malmö, Sweden
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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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Skogevall S, Holmström IK, Kaminsky E, Håkansson Eklund J. A survey of telephone nurses' experiences in their encounters with frequent callers. J Adv Nurs 2020; 76:1019-1026. [PMID: 31997365 DOI: 10.1111/jan.14308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/29/2019] [Accepted: 01/14/2020] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to describe telephone nurses' experiences of their encounters with frequent callers to Swedish Healthcare Direct. DESIGN A descriptive inductive design with qualitative approach. METHODS Data collection was performed during the period of September 2017 - June 2018. A total of 199 telephone nurses working at 10 Swedish Healthcare Direct sites with different geographical locations in Sweden answered a survey containing seven open-ended questions. Data analysis was performed during the period of September 2018 - June 2019. The answers were analysed using content analysis. RESULTS The telephone nurses perceived that the encounters with frequent callers were sometimes frustrating as they felt unable to help. According to the telephone nurses, the frequent callers called about the same issues several times and the calls were often about loneliness and psychiatric problems. The telephone nurses were worried about missing something urgent; one of the aspects leading to this was the perception of knowing the caller. They expressed a wish to know more about frequent callers and strategies for helping them. A common care plan for frequent callers' calls was suggested. CONCLUSION Telephone nurses often found it difficult to handle calls from frequent callers. However, they had a will to care for frequent callers and to learn more about them. Therefore, a common strategy, education and training for telephone nurses in answering calls from frequent callers could be beneficial for both callers and telephone nurses. IMPACT STATEMENT This study offers insights to researchers, telephone nurses and managers of telephone nursing, regarding telephone nurses' experiences in handling frequent caller calls. These findings can offer direction for the content of a possible intervention.
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Affiliation(s)
- Sofia Skogevall
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Elenor Kaminsky
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Abstract
Prehospital emergency telephone triages are mechanisms to verify the appropriate need for care in an emergency call by telephone. Considering the high rates of trauma and clinical cases that need prehospital care, the importance of knowing how the services that send rescue teams can guarantee improved care is highlighted. The objective of this study was to characterize the services that support effective telephone triage. Literature review was conducted in 6 phases to answer the following question: How can prehospital emergency telephone triage be performed? To search for primary studies, we used specific search strategies in the databases: LILaCs, PubMed, CINAHL, LISA, ISTA, and SCOPUS. The sample consisted of 23 studies whose information was extracted using a validated tool. Among the selected studies, 2 come from CINAHL, 2 from LISA, 4 from PubMed, 1 from ISTA, and 14 from SCOPUS, which were published between 2006 and 2016 in 17 different journals with varying types of scopes and originated from 13 countries on 3 distinct continents. The articles were nonexperimental and indicated the broad use of software constructed to support the telephone triage. The prehospital emergency telephone triages are frequently performed to identify the event, deduct the need for support, and prioritize those calls that require a rescue team. They should take place with the support of institutional protocols and technological support to guarantee dynamic data and constant training of the ambulance dispatchers.
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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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Mattisson M, Johnson C, Börjeson S, Årestedt K, Lindberg M. Development and content validation of the Telenursing Interaction and Satisfaction Questionnaire (TISQ). Health Expect 2019; 22:1213-1222. [PMID: 31513328 PMCID: PMC6882254 DOI: 10.1111/hex.12945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/07/2019] [Accepted: 07/14/2019] [Indexed: 11/28/2022] Open
Abstract
Background Caller satisfaction with telephone advice nursing (TAN) is generally high, and the interaction is essential. However, a valid questionnaire exploring caller satisfaction in TAN with focus on perceived interaction is lacking. Objective To develop and assess content validity and test‐retest reliability of a theoretically anchored questionnaire, the Telenursing Interaction and Satisfaction Questionnaire (TISQ), that explores caller satisfaction in TAN by focusing on perceived interaction between the caller and the telenurse. Methods The study was performed in three stages. First, variables relevant for patient satisfaction in health care were identified through a literature search. Variables were then structured according to the Interaction Model of Client Health Behavior (IMCHB), which provided theoretical guidance. Items relevant for a TAN context were developed through consensus discussions. Then, evaluation and refinement were performed through cognitive interviews with callers and expert ratings of the Content Validity Index (CVI). Finally, test‐retest reliability of items was evaluated in a sample of 109 individuals using intraclass correlation coefficients (ICC). Results The TISQ consists of 60 items. Twenty items cover perceived interaction in terms of health information, affective support, decisional control and professional/technical competence. Five items cover satisfaction with interaction and five items overall satisfaction. Remaining items reflect singularity of the caller and descriptive items of the call. The TISQ was found to exhibit good content validity, and test‐retest reliability was moderate to good (ICC = 0.39‐0.84). Conclusions The items in the TISQ form a comprehensive and theoretically anchored questionnaire with satisfactory content validity and test‐retest reliability.
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Affiliation(s)
- Marie Mattisson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Christina Johnson
- 1177 Medical Advisory Service and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sussanne Börjeson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Kalmar County Council, Kalmar, Sweden
| | - Malou Lindberg
- 1177 Medical Advisory Service and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Jácome M, Rego N, Veiga P. Potential of a nurse telephone triage line to direct elderly to appropriate health care settings. J Nurs Manag 2019; 27:1275-1284. [PMID: 31145491 DOI: 10.1111/jonm.12809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 11/30/2022]
Abstract
AIM To explore the potential of a nurse health triage telephone line to advise and guide elderly users' decisions regarding the appropriate health care setting and self-care. BACKGROUND Ageing is a concern in many countries and poses challenges to health care services. Triage and advice lines can play an important role for the (re)organisation of health care delivery. Discussion has been focused on the capacity of these lines to reduce inappropriate demand for acute and emergency departments. METHODS Cross-sectional descriptive analysis. RESULTS Nurses directed elders to a health care service both by downgrading their initial intentions (concurring to the most common objective) and by upgrading them (e.g., directing elders that intended to stay at home to acute and emergency care). The intention to comply with the nurse's disposition was high. CONCLUSIONS The line helped to improve the appropriateness of acute and emergency care demand and to reduce the overall demand for care by elders. There is nonetheless space for improvement given the underuse of the line by elders. IMPLICATIONS FOR NURSING MANAGEMENT Health telephone-based triage and advice should be promoted to increase the match between the needs of elderly patients and health resources, thus improving health equity.
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Affiliation(s)
- Marta Jácome
- Unidade de Saúde Familiar Bracara Augusta, Braga, Portugal
| | - Nazaré Rego
- Escola de Economia e Gestão, Universidade do Minho, Braga, Portugal.,INESC TEC, Porto, Portugal
| | - Paula Veiga
- Escola de Economia e Gestão, Universidade do Minho, Braga, Portugal.,GovJus, Universidade do Minho, Braga, Portugal
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Holmström IK, Gustafsson S, Wesström J, Skoglund K. Telephone nurses' use of a decision support system: An observational study. Nurs Health Sci 2019; 21:501-507. [PMID: 31392832 DOI: 10.1111/nhs.12632] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/08/2019] [Accepted: 06/09/2019] [Indexed: 01/10/2023]
Abstract
Telephone nurses give advice and support and make assessments based on verbal communication only. Web-based decision support systems are often used to increase patient safety and make medically correct assessments. The aim of the present this study was to describe factors affecting the use of a decision support system and experiences with this system among telephone nurses in Swedish primary health care. Observations and semistructured interviews were conducted. Six registered nurses with at least 1 year of experience of telephone nursing participated. Field notes and interviews were analyzed by qualitative content analysis. The main findings of the present this study were factors that decrease the decision support system use or promote deviation from decision support system use, factors that are positive for decision support system use and the decision support system complicates the work. Underuse and deviations from decision support systems can be a safety risk, because decisions are based on too little information. Further research with observations of telephone nurses' use of decision support systems is needed to develop both telephone nursing and decision support systems.
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Affiliation(s)
- Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | | | - Karin Skoglund
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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18
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Kaminsky E, Höglund AT. Swedish Healthcare Direct managers' views on gender (in)equity: applying a conceptual model. Int J Equity Health 2019; 18:114. [PMID: 31340821 PMCID: PMC6657095 DOI: 10.1186/s12939-019-1011-5] [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: 03/26/2019] [Accepted: 06/25/2019] [Indexed: 11/18/2022] Open
Abstract
Background Although Swedish legislation prescribes equity in healthcare, inequitable healthcare is repeatedly reported in Sweden. Telephone nursing is suggested to promote equitable healthcare, making it just one call away for anyone, at any time, irrespective of distance. However, paediatric health calls reflect that male parents are referred to other health services twice as much as female parents are. Regarding equity in healthcare, telephone nurses have expressed a continuum from Denial and Defence to Openness and Awareness. To make a change, Action is also needed, within organizational frames. The aim here was thus to investigate Swedish Healthcare Direct managers’ views on gender (in)equity in healthcare through the application of a conceptual model, developed based on empirical Swedish Healthcare Direct telephone RN data, as a baseline measure at the service’s national implementation. Methods All Swedish Healthcare Direct managers were interviewed during the period March–May 2012. They were asked how they view equitable healthcare, and how they work to achieve it. A conceptual model for attaining equity in healthcare, including Denial, Defence, Openness, Awareness and Action, was used in a deductive thematic analysis of the interview data. Results The five model concepts – Denial; Defence; Openness; Awareness and Action – were found in a variety of combinations in the manager interviews. Denial and Defence were mentioned to a higher extent than Openness and Awareness. Several informants denied inequity, arguing that the decision support tool prevented this. However, those who primarily expressed Denial and Defence were also open to learning more on the subject. Action was only mentioned twice in the informants’ answers, and then only implicitly. Conclusion Although a majority of the interviewed managers expressed a lack of awareness of (in)equity in healthcare, they also expressed an openness to learning more. While this may reflect a desire to show political correctness, it also points to the need for educational training in order to increase the awareness of (in)equity in healthcare among healthcare managers. Future follow up measurements will reveal if this has happened.
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Affiliation(s)
- Elenor Kaminsky
- Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden.
| | - Anna T Höglund
- Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden
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19
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Affiliation(s)
- Patti A Mataxen
- Patti A. Mataxen is a clinical supervisor at Envolve People Care NAL in Tyler, Tex. L. Denise Webb is a telehealth RN at Envolve People Care NAL in Pontotoc, Miss
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20
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Bjorkman A, Salzmann-Erikson M. When all other doors are closed: Telenurses' experiences of encountering care seekers with mental illnesses. Int J Ment Health Nurs 2018; 27:1392-1400. [PMID: 29383820 DOI: 10.1111/inm.12438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 11/28/2022]
Abstract
The aim of the study was to describe the telephone nurses' experiences of encountering callers with mental illnesses. Telenursing services are solely staffed with telenurses, who with the support of a decision support system (CDSS) independently triage callers based on the severity of the main symptoms presented by the care seeker. The system focuses on somatic symptoms, while information regarding mental health and mental illnesses is limited. Information about telenurses' experiences of encountering care seekers with mental illnesses is scarce, despite the increase in mental illnesses in the population. The study used a descriptive design with a qualitative approach. Twenty telenurses were interviewed, and the data were then analysed using inductive qualitative content analysis. The results are elaborated in the following three categories: (i) Experiences of encountering care seekers with mental illnesses; (ii) Experiences of facing difficulties and challenges; and (iii) Experiences of facing dissatisfaction and threats. Encountering care seekers with mental illnesses is metaphorically addressed as 'when all other doors are closed'. Encountering care seekers with mental illnesses was perceived as time-consuming and did not adequately correspond to the resources given by the service. Even though telenurses strive to achieve agreement, there is a collision between human needs and organizational structures. The study pinpoints the lack of resources for and education about mental illnesses and the limitations of the decision system, which needs to be updated in order to provide all care seekers care on equal terms.
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Affiliation(s)
- Annica Bjorkman
- Faculty of Health and Occupational Studies, University of Gavle, Gavle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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21
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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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22
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Njeru JW, Damodaran S, North F, Jacobson DJ, Wilson PM, St Sauver JL, Radecki Breitkopf C, Wieland ML. Telephone triage utilization among patients with limited English proficiency. BMC Health Serv Res 2017; 17:706. [PMID: 29121920 PMCID: PMC5679138 DOI: 10.1186/s12913-017-2651-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/02/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Communication between patients with limited English proficiency (LEP) and telephone triage services has not been previously explored. The purpose of this study was to determine the utilization characteristics of a primary care triage call center by patients with LEP. METHODS This was a retrospective cohort study of the utilization of a computer-aided, nurse-led telephone triage system by English proficiency status of patients empaneled to a large primary care practice network in the Midwest United States. Interpreter Services (IS) need was used as a proxy for LEP. RESULTS Call volumes between the 587 adult patients with LEP and an age-frequency matched cohort of English-Proficient (EP) patients were similar. Calls from patients with LEP were longer and more often made by a surrogate. Patients with LEP received recommendations for higher acuity care more frequently (49.4% versus 39.0%; P < 0.0004), and disagreed with recommendations more frequently (30.1% versus 20.9%; P = 0.0004). These associations remained after adjustment for comorbidities. Patients with LEP were also less likely to follow recommendations (60.9% versus 69.4%; P = 0.0029), even after adjusting for confounders (adjusted odds ratio [AOR] = 0.65; 95% confidence interval [CI], 0.49, 0.85; P < 0.001). CONCLUSION Patients with LEP who utilized a computer-aided, nurse-led telephone triage system were more likely to receive recommendations for higher acuity care compared to EP patients. They were also less likely to agree with, or follow, recommendations given. Additional research is needed to better understand how telephone triage can better serve patients with LEP.
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Affiliation(s)
- Jane W Njeru
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Swathi Damodaran
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Frederick North
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA
| | - Jennifer L St Sauver
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | | | - Mark L Wieland
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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24
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Tran DT, Gibson A, Randall D, Havard A, Byrne M, Robinson M, Lawler A, Jorm LR. Compliance with telephone triage advice among adults aged 45 years and older: an Australian data linkage study. BMC Health Serv Res 2017; 17:512. [PMID: 28764695 PMCID: PMC5539620 DOI: 10.1186/s12913-017-2458-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background Middle-aged and older patients are prominent users of telephone triage services for timely access to health information and appropriate referrals. Non-compliance with advice to seek appropriate care could potentially lead to poorer health outcomes among those patients. It is imperative to assess the extent to which middle-aged and older patients follow triage advice and how this varies according to their socio-demographic, lifestyle and health characteristics as well as features of the call. Methods Records of calls to the Australian healthdirect helpline (July 2008–December 2011) were linked to baseline questionnaire data from the 45 and Up Study (participants age ≥ 45 years), records of emergency department (ED) presentations, hospital admissions, and medical consultation claims. Outcomes of the call included compliance with the advice “Attend ED immediately”; “See a doctor (immediately, within 4 hours, or within 24 hours)”; “Self-care”; and self-referral to ED or hospital within 24 h when given a self-care or low-urgency care advice. Multivariable logistic regression was used to investigate associations between call outcomes and patient and call characteristics. Results This study included 8406 adults (age ≥ 45 years) who were subjects of 11,088 calls to the healthdirect helpline. Rates of compliance with the advices “Attend ED immediately”, “See a doctor” and “Self-care” were 68.6%, 64.6% and 77.5% respectively, while self-referral to ED within 24 h followed 7.0% of calls. Compliance with the advice “Attend ED immediately” was higher among patients who had three or more positive lifestyle behaviours, called after-hours, or stated that their original intention was to attend ED, while it was lower among those who lived in rural and remote areas or reported high or very high levels of psychological distress. Compliance with the advice “See a doctor” was higher in patients who were aged ≥65 years, worked full-time, or lived in socio-economically advantaged areas, when another person made the call on the patient’s behalf, and when the original intention was to seek care from an ED or a doctor. It was lower among patients in rural and remote areas and those taking five medications or more. Patients aged ≥65 years were less likely to comply with the advice “Self-care”. The rates of self-referral to ED within 24 h were greater in patients from disadvantaged areas, among calls made after-hours or by another person, and when the original intention was to attend ED. Patients who were given a self-care or low-urgency care advice, whose calls concerned bleeding, cardiac, gastrointestinal, head and facial injury symptoms, were more likely to self-refer to ED. Conclusions Compliance with telephone triage advice among middle-age and older patients varied substantially according to both patient- and call-related factors. Knowledge about the patients who are less likely to comply with telephone triage advice, and about characteristics of calls that may influence compliance, will assist in refining patient triage protocols and referral pathways, training staff and tailoring service design and delivery to achieve optimal patient compliance. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2458-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duong Thuy Tran
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia.
| | - Amy Gibson
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Deborah Randall
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Alys Havard
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Mary Byrne
- Healthdirect Australia, 133 Castlereagh Street, Sydney, NSW, 2000, Australia
| | - Maureen Robinson
- Healthdirect Australia, 133 Castlereagh Street, Sydney, NSW, 2000, Australia
| | - Anthony Lawler
- School of Medicine, University of Tasmania and Healthdirect Australia, Department of Health and Human Services, Level 2, 22 Elizabeth Street, Hobart, TAS, 7000, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
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Bjorkman A, Engstrom M, Olsson A, Wahlberg AC. Identified obstacles and prerequisites in telenurses' work environment - a modified Delphi study. BMC Health Serv Res 2017; 17:357. [PMID: 28521743 PMCID: PMC5437518 DOI: 10.1186/s12913-017-2296-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/05/2017] [Indexed: 11/29/2022] Open
Abstract
Background Telenursing is an expanding part of healthcare, staffed with registered nurses whose work environment is typical of a call centre. Work-related stress has been shown to be a major problem in nurses’ work environments and of importance to the outcome of care, patient safety, nurse job satisfaction and burnout. Today, however, we have a limited understanding of and knowledge about the work environment for telenurses. The aim of the present study is to explore and reach consensus on perceived important obstacles and prerequisites in telenurses’ work environment. Methods A modified Delphi design, using qualitative as well as quantitative data sequentially through three phases, was taken. Data were initially collected via semi-structured interviews (Phase I) and later using a web survey (Phase II-III) between March 2015 and March 2016. Results The findings present a consensus view of telenurses’ experiences of important obstacles and prerequisites in their work environment. Central to the findings are the aspects of telenurses having a demanding work, cognitive fatigue and having no opportunity for recovery during the work shift was ranked as important obstacles. Highly ranked prerequisites for managing were being able to focus on one caller at a time, working in a calm and pleasant environment and having technical support 24/7. Conclusions Managers need to enable telenurses to experience control in their work, provided with possibilities to control their work and to recover during work; shortening work time could improve their work environment. Limited possibilities to perform work might contribute to feelings of stress and inability to perform work.
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Affiliation(s)
- Annica Bjorkman
- Faculty of Health and Occupational Studies, Caring Science University of Gavle, Gavle, Sweden. .,Department of Public Health and Caring Sciences, Uppsala University, Health Services Research, Uppsala, Sweden.
| | - Maria Engstrom
- Faculty of Health and Occupational Studies, Caring Science University of Gavle, Gavle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Health Services Research, Uppsala, Sweden.,Nursing Department, Medicine and Health College, Lishui University, Lishui, People's Republic of China
| | - Annakarin Olsson
- Faculty of Health and Occupational Studies, Caring Science University of Gavle, Gavle, Sweden
| | - Anna Carin Wahlberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Dahlgren K, Holzmann MJ, Carlsson AC, Wändell P, Hasselström J, Ruge T. The use of a Swedish telephone medical advice service by the elderly - a population-based study. Scand J Prim Health Care 2017; 35:98-104. [PMID: 28277048 PMCID: PMC5361425 DOI: 10.1080/02813432.2017.1288816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The present study aimed to describe contact made by the elderly to Sweden's nationwide medical helpline, Healthcare Guide 1177 by Phone (HGP). Other objectives were to study potential gender differences and the association between different HGP referral levels and acute visits to hospital-based emergency departments and acute visits to primary care centres. DESIGN De-identified data from recorded calls to HGP was extracted for analysis (n = 7477 for the oldest age group). Information about acute visits to emergency departments and to primary care reception was extracted from the patient administration system. SETTING Västerbotten County, Sweden. SUBJECTS Patients over 80 years. MAIN OUTCOME MEASURES Calling and visiting frequencies for different age groups as well as reasons for contact and individual recommendations. RESULTS The utilisation rate of the telephone advice service for the oldest age group was high, with an incidence rate of 533 per 1000 person-years. Women had a 1.17 times higher incidence rate compared with men. The most common reason for contact was drug-related questions (17% of all contacts). Calls that were recommended to care by a medical specialist correlated with total emergency department visits (r = 0.30, p < 0.05) and calls that were given advice correlated with acute primary healthcare visits (r = 0.38, p = 0.005). CONCLUSION The high utilisation of the telephone advice service by the elderly gives the telephone advice service a unique ability to function as a gatekeeper to further healthcare. Our data suggest that with the telephone advice service's present guidelines, a significant proportion of all calls are being directed to further medical help. The high frequency of drug-related questions raises concerns about the elderly's medication regimens. Key points Patients over 80 years of age had a high utilisation of the telephone medical advice service compared with other age groups. Drug-related questions were the most common reason for contact. A significant proportion of all calls made resulted in further heatlhcare contacts.
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Affiliation(s)
- K. Dahlgren
- Department of Surgery, Emergency Care, Umeå University, Umeå, Sweden
| | - M. J. Holzmann
- Department of Emergency Medicine, Karolinska University Hospital, Sweden
| | - A. C. Carlsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - P. Wändell
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - J. Hasselström
- Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T. Ruge
- Department of Surgery, Emergency Care Umeå University, Umeå, Sweden
- CONTACT Toralph Ruge Department of Surgery, Emergency Care, Umeå University, Umeå, SE-90185 Sweden
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Holmström IK, Krantz A, Karacagil L, Sundler AJ. Frequent callers in primary health care - a qualitative study with a nursing perspective. J Adv Nurs 2016; 73:622-632. [PMID: 27650484 DOI: 10.1111/jan.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/30/2022]
Abstract
AIM To: (a) describe how telephone nurses define a frequent caller; and (b) describe their experiences with calls from frequent callers to primary healthcare centres. BACKGROUND Telephone nursing has been noted to be a cost-effective method to enhance access to and use of health care. Some patients use these services extensively and are called 'frequent callers'. Little is known about this group of callers, the reasons behind these calls and telephone nurses' experiences and strategies to manage the calls. DESIGN Descriptive design with a qualitative inductive approach. METHODS Interviews were conducted with ten telephone nurses in Sweden in 2015. Qualitative content analysis was conducted. RESULTS A main theme was established, called 'Balancing between the experienced and assessed needs', which described the telephone nurses' experiences with calls made by frequent callers to primary healthcare centres and was further described in five categories with 15 subcategories. The categories described telephone nurses' definitions of frequent callers, telephone nurses' views of the underlying reasons for the calls, challenges related to frequent callers, experiences with an increased work load and strategies used to manage and help frequent callers. CONCLUSION Frequent callers were commonly encountered by telephone nurses' in this study. Their calls were experienced as complex and demanding to manage. The findings point to needs for guidelines and routines to improve the care of frequent callers. In addition, support and training in communication skills to encounter this group of callers in an optimal and safe way may be required.
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Affiliation(s)
- Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | | | - Lena Karacagil
- Hemsjukvården, Vård och omsorg Västerås stad, Sweden.,Primärsjukvården, Västerås sjukhus, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
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Curley LE, Moody J, Gobarani R, Aspden T, Jensen M, McDonald M, Shaw J, Sheridan J. Is there potential for the future provision of triage services in community pharmacy? J Pharm Policy Pract 2016; 9:29. [PMID: 27708786 PMCID: PMC5050954 DOI: 10.1186/s40545-016-0080-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/10/2016] [Indexed: 11/22/2022] Open
Abstract
Background Worldwide the demands on emergency and primary health care services are increasing. General practitioners and accident and emergency departments are often used unnecessarily for the treatment of minor ailments. Community pharmacy is often the first port of call for patients in the provision of advice on minor ailments, advising the patient on treatment or referring the patient to an appropriate health professional when necessary. The potential for community pharmacists to act as providers of triage services has started to be recognised, and community pharmacy triage services (CPTS) are emerging in a number of countries. This review aimed to explore whether key components of triage services can be identified in the literature surrounding community pharmacy, to explore the evidence for the feasibility of implementing CPTS and to evaluate the evidence for the appropriateness of such services. Methods Systematic searches were conducted in MEDLINE, EMBASE and International Pharmaceutical Abstracts (IPA) databases from 1980 to March 2016. Results Key elements of community pharmacy triage were identified in 37 studies, which were included in the review. When a guideline or protocol was used, accuracy in identifying the presenting condition was high, with concordance rates ranging from 70 % to 97.6 % between the pharmacist and a medical expert. However, when guidelines and protocols were not used, often questioning was deemed insufficient. Where other health professionals had reviewed decisions made by pharmacists and their staff, e.g. around advice and referral, the decisions were considered to be appropriate in the majority of cases. Authors of the included studies provided recommendations for improving these services, including use of guidelines/protocols, education and staff training, documentation, improving communication between health professional groups and consideration of privacy and confidentiality. Conclusion Whilst few studies had specifically trialled triage services, results from this review indicate that a CPTS is feasible and appropriate, and has the potential to reduce the burden on other healthcare services. Questions still remain on issues such as ensuring the consistency of the service, whether all pharmacies could provide this service and who will fund the service.
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Affiliation(s)
- Louise E Curley
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Janice Moody
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Rukshar Gobarani
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Trudi Aspden
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Maree Jensen
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Maureen McDonald
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - John Shaw
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Janie Sheridan
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
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McKenzie R, Dunt D, Yates A. Patient intention and self-reported compliance in relation to emergency department attendance after using an after hours GP helpline. Emerg Med Australas 2016; 28:538-43. [DOI: 10.1111/1742-6723.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/07/2016] [Accepted: 05/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Rosemary McKenzie
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - David Dunt
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Allison Yates
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
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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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Auberry K, Cullen D. Implementation of an evidence-based seizure algorithm in intellectual disability nursing: A pilot study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2016; 20:55-64. [PMID: 26283660 DOI: 10.1177/1744629515598216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 06/04/2023]
Abstract
Based on the results of the Surrogate Decision-Making Self Efficacy Scale (Lopez, 2009a), this study sought to determine whether nurses working in the field of intellectual disability (ID) experience increased confidence when they implemented the American Association of Neuroscience Nurses (AANN) Seizure Algorithm during telephone triage. The results of the study indicated using the AANN Seizure Algorithm increased self-confidence for many of the nurses in guiding care decisions during telephone triage. The treatment effect was statistically significant -3.169(p < 0.01) for a small sample of study participants. This increase in confidence is clinically essential for two reasons. Many individuals with ID and epilepsy reside within community-based settings. ID nurses provide seizure guidance to this population living in community-based settings via telephone triage. Evidenced-based training tools provide a valuable mechanism by guiding nurses via best practices. Nurses may need to be formally trained for seizure management due to high epilepsy rates in this population.
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Ernesäter A, Engström M, Winblad U, Rahmqvist M, Holmström IK. Telephone nurses' communication and response to callers' concern—a mixed methods study. Appl Nurs Res 2016; 29:116-21. [DOI: 10.1016/j.apnr.2015.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
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Vessey JA, McCrave J, Curro-Harrington C, DiFazio RL. Enhancing Care Coordination Through Patient- and Family-Initiated Telephone Encounters: A Quality Improvement Project. J Pediatr Nurs 2015; 30:915-23. [PMID: 26048646 DOI: 10.1016/j.pedn.2015.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 05/22/2015] [Accepted: 05/23/2015] [Indexed: 11/17/2022]
Abstract
Telehealth activities are often conducted by ambulatory nurses to assist with care coordination; these activities are especially important for children with complex, chronic conditions. This quality-improvement project examines specific components of nursing care delivered to children on the neurology and gastroenterology services through patient-initiated telephone encounters. Metrics and nurse-sensitive indicators explored include the type of services requested, the nurses' ability to resolve patients' concerns while eliminating otherwise unnecessary care, and associated costs with providing this care. The usefulness of a standardized instrument, the care coordination management tool, used in this project is discussed.
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Affiliation(s)
- Judith A Vessey
- Medicine Patient Services, Boston Children's Hospital, Boston, MA; Boston College, William F. Connell School of Nursing, Chestnut Hill, MA.
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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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Kaakinen P, Kyngäs H, Tarkiainen K, Kääriäinen M. The effects of intervention on quality of telephone triage at an emergency unit in Finland: Nurses' perspective. Int Emerg Nurs 2015; 26:26-31. [PMID: 26433605 DOI: 10.1016/j.ienj.2015.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 09/04/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to investigate the effects of a nurse training intervention on the assessment of patients' care needs in telephone triage at an emergency unit. The objective of this study was to generate information about nurse training that can be utilized when developing telephone triage and health care education. BACKGROUND With the growing number of patients coming into emergency departments and a lack of resources in healthcare, it would be valuable to determine an effective training intervention in telephone triage, particularly when assessing the training needs of nurses. DESIGN The study was quasi-experimental, with a pre- and post-test design. METHODS The data were collected from the nurses at the emergency department and joint emergency service of the Central Hospital in Northern Finland (baseline n = 28, post-test n = 26). The descriptive statistic, Fisher's χ(2) test and McNemar's test were used to analyse the data. RESULTS The intervention improved nurses' skills to evaluate patients' needs and health condition via the telephone triage. There was a statistically significant difference in the resources, knowledge, skills and attitudes of the nurses between the baseline and post-test measurements. CONCLUSIONS The nurse training intervention improved the quality of telephone triage. RELEVANCE TO CLINICAL PRACTICE Nurses should receive continuous training in telephone triage in order to maintain and reinforce their professional competence. When planning the training, the age and relevant work experience of the nurses should be taken into consideration as well, since the results indicate that they lead to variation in the nurses' competence.
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Affiliation(s)
- Pirjo Kaakinen
- Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.
| | - Helvi Kyngäs
- Unit of Nursing Science and Health Management, Northern Ostrobothnia Hospital District, University of Oulu, Oulu, Finland
| | | | - Maria Kääriäinen
- Unit of Nursing Science and Health Management, University of Oulu, University Hospital of Oulu, Finland
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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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Gustafsson S, Vikman I, Sävenstedt S, Martinsson J. Perceptions of needs related to the practice of self‐care for minor illness. J Clin Nurs 2015; 24:3255-65. [DOI: 10.1111/jocn.12888] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Silje Gustafsson
- Division of Nursing Department of Health Science Luleå University of Technology Luleå Sweden
| | - Irene Vikman
- Division of Health and Rehab 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
- Mathematical Science Department of Engineering Sciences and Mathematics Luleå University of Technology Luleå Sweden
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Wheeler SQ, Greenberg ME, Mahlmeister L, Wolfe N. Safety of clinical and non-clinical decision makers in telephone triage: a narrative review. J Telemed Telecare 2015; 21:305-22. [PMID: 25761468 DOI: 10.1177/1357633x15571650] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/20/2014] [Indexed: 11/17/2022]
Abstract
Patient safety is a persistent problem in telephone triage research; however, studies have not differentiated between clinicians' and non-clinicians' respective safety. Currently, four groups of decision makers perform aspects of telephone triage: clinicians (physicians, nurses), and non-clinicians (emergency medical dispatchers (EMD) and clerical staff). Using studies published between 2002-2012, we applied Donabedian's structure-process-outcome model to examine groups' systems for evidence of system completeness (a minimum measure of structure and quality). We defined system completeness as the presence of a decision maker and four additional components: guidelines, documentation, training, and standards. Defining safety as appropriate referrals (AR) - (right time, right place with the right person), we measured each groups' corresponding AR rate percentages (outcomes). We analyzed each group's respective decision-making process as a safe match to the telephone triage task, based on each group's system structure completeness, process and AR rates (outcome). Studies uniformly noted system component presence: nurses (2-4), physicians (1), EMDs (2), clerical staff (1). Nurses had the highest average appropriate referral (AR) rates (91%), physicians' AR (82% average). Clerical staff had no system and did not perform telephone triage by standard definitions; EMDs may represent the use of the wrong system. Telephone triage appears least safe after hours when decision makers with the least complete systems (physicians, clerical staff) typically manage calls. At minimum, telephone triage decision makers should be clinicians; however, clinicians' safety calls for improvement. With improved training, standards and CDSS quality, the 24/7 clinical call center has potential to represent the national standard.
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Affiliation(s)
- Sheila Q Wheeler
- Assistant Clinical Professor Northern Arizona University 3895 N. Business Center Dr. Ste 120 Tucson, Arizona 85705, USA
| | - Mary E Greenberg
- President, Mahlmeister and Associates Clinical Professor University of California San Francisco San Francisco, California 1567 Winding Way Belmont, California 94002, USA
| | | | - Nicole Wolfe
- Department of Social and Behavioral Sciences 3333 California St, Suite 455 San Francisco, CA 94118, USA
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Knight K, Kenny A, Endacott R. Assessing clinical urgency via telephone in rural Australia. Nurs Health Sci 2014; 17:201-7. [DOI: 10.1111/nhs.12161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 06/22/2014] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Kaye Knight
- La Trobe Rural Health School; Bendigo Victoria Australia
| | - Amanda Kenny
- La Trobe Rural Health School; Bendigo Victoria Australia
| | - Ruth Endacott
- School of Nursing & Midwifery; Monash University; Melbourne Victoria Australia
- School of Nursing & Midwifery; Plymouth University; Plymouth UK
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Ernesäter A, Engström M, Winblad U, Holmström IK. A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish healthcare direct: a case-control study. BMJ Open 2014; 4:e005961. [PMID: 25280808 PMCID: PMC4187455 DOI: 10.1136/bmjopen-2014-005961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. SETTING In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. PARTICIPANTS A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. RESULTS Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. CONCLUSIONS The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.
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Affiliation(s)
- Annica Ernesäter
- Faculty of Health and Occupational Studies, Caring Science University of Gavle, Gavle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Health Services Research, Uppsala, Sweden
| | - Maria Engström
- Faculty of Health and Occupational Studies, Caring Science University of Gavle, Gavle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Health Services Research, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Health Services Research, Uppsala, Sweden
| | - Inger K Holmström
- Department of Public Health and Caring Sciences, Uppsala University, Health Services Research, Uppsala, Sweden
- Mälardalen University School of Health, Care and Social Welfare, Vasteras, Sweden
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Ramelet AS, Fonjallaz B, Rapin J, Gueniat C, Hofer M. Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol. BMC Pediatr 2014; 14:151. [PMID: 24939642 PMCID: PMC4067521 DOI: 10.1186/1471-2431-14-151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pediatric rheumatic diseases have a significant impact on children's quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families. METHODS/DESIGN This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children's and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox's Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children. DISCUSSION The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).
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Affiliation(s)
- Anne-Sylvie Ramelet
- Institute of Higher Education and Nursing Research, University of Lausanne, CHUV, Rte de la Corniche 10, Lausanne 1011, Switzerland.
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Winneby E, Flensner G, Rudolfsson G. Feeling rejected or invited: experiences of persons seeking care advice at the Swedish Healthcare Direct organization. Jpn J Nurs Sci 2013; 11:87-93. [PMID: 24698644 DOI: 10.1111/jjns.12007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
AIM Swedish Healthcare Direct is an organization staffed by registered nurses who act as telenurses and assess callers' need for care, taking both medical and personal aspects into account. They direct the care seeker to: emergency care (level I), a care center on duty (level II), their regular doctor (level III), or provide advice about self-care strategies (level IV). In this assessment process, the nurse and care seeker should reach mutual agreement. The aim and focus of the present study was to elucidate the care seeker's situation and experiences of the care received after being triaged and directed to level II, although the telenurse in fact assessed their medical problems as corresponding to level III. METHODS A total of eight recent Swedish Healthcare Direct users were interviewed in this qualitative study. Data were analyzed by means of content analysis. RESULTS Three themes emerged - "feeling trapped", "feeling disrespected", and "feeling invited" - comprising seven subthemes. CONCLUSION Care seekers experienced suffering as well as struggling to be allowed to be a patient. When not met by an ethically correct stance, they continued to seek care. In contrast, when they encountered commitment and an ethically correct attitude, their health process began and they had no further need for contact.
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García de Ribera MC, Bachiller Luque MR, Vázquez Fernández M, Barrio Alonso MP, Hernández Velázquez P, Hernández Vázquez AM. [Paediatric emergency triage in Spanish primary care using mobile phones. Analysis of a model in a health area]. ACTA ACUST UNITED AC 2013; 28:174-80. [PMID: 23274065 DOI: 10.1016/j.cali.2012.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 10/07/2012] [Accepted: 10/14/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To conduct a pilot study of telephone consultation in the paediatric population of an urban health centre. To evaluate the telephone consultation as an effective tool when it comes to exercising prior triage of patients requiring urgent attention. MATERIAL AND METHODS The study was conducted in two phases. In the first, data were collected from all calls received for six months. In a second phase, we conducted a telephone intervention study to analyse what a random sample of users remembered of the care provided. All those who requested a telephone consultation were included in the study. Demographic, social-welfare, epidemiological, and clinical features, of each patient were recorded. Data were processed using a statistical package SPSS version 17.0 for Windows. RESULTS There were 439 telephone inquiries in our pilot project, of which 35.1% were attended by residents, 36% by paediatricians, and 28.9% by paediatric nurses. There were more telephone calls in the afternoons and on weekends. Patients less than or equal to 2 years accounted for 57.9% of cases handled, and there were no differences between sexes. The most frequent reasons for consultation were gastrointestinal symptoms, fever and respiratory problems. The health problem was resolved in 85.8% of cases, requiring only home care instructions, and only 13.3% of children were referred to emergency services. We obtained a mean score of satisfaction of 9.2. CONCLUSIONS The pilot project had a high level of satisfaction and resolution, demonstrating cost savings by reducing 55% of face to face visits, with a saving of 35.2 euros per telephone consultation. A teleconsultation model for dealing with emergencies in primary care by telephone would be comparable to a practice staffed by trained paediatric nurses.
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Affiliation(s)
- M C García de Ribera
- Centro de Salud de Peñafiel, Gerencia de Atención Primaria, Valladolid Este, España.
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Spaulding AB, Radi D, Macleod H, Lynfield R, Larson M, Hyduke T, Dehnel P, Acomb C, DeVries AS. Design and implementation of a statewide influenza nurse triage line in response to pandemic H1N1 influenza. Public Health Rep 2012; 127:532-40. [PMID: 22942472 DOI: 10.1177/003335491212700509] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alicen B Spaulding
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health in Minneapolis, Minnesota, USA
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Gustafsson S, Sävenstedt S, Vikman I. Psychometric evaluation of a Swedish Self-Efficacy scale and Recovery Locus of Control scale in the context of minor illness. Scand J Caring Sci 2012; 27:765-72. [PMID: 23121442 DOI: 10.1111/j.1471-6712.2012.01084.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/20/2012] [Indexed: 11/29/2022]
Abstract
Reliable and valid instruments are essential when examining the role of self-efficacy and locus of control in the self-care context. The aim of this study was to test the validity and reliability of the Self-Efficacy Scale in Self-Care (SESSC) and the Swedish version of the Recovery Locus of Control scale (RLoC) in the context of minor illness. A descriptive correlational design was used to assess the psychometric characteristics of the scales. The study population was 317 randomly selected Swedish inhabitants aged 18-80. The results from this study showed that the RLoC has limitations in reliability and validity and should not be applied in the context of self-care of minor illness. The SESSC proved to be a reliable and valid instrument in assessing self-efficacy in self-care for minor illness.
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Affiliation(s)
- Silje Gustafsson
- Institution of Health Sciences, Lulea University of Technology, Lulea, Sweden.
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47
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Huibers L, Keizer E, Giesen P, Grol R, Wensing M. Nurse telephone triage: good quality associated with appropriate decisions. Fam Pract 2012; 29:547-52. [PMID: 22327415 DOI: 10.1093/fampra/cms005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Triage at out-of-hours GP cooperatives (GPCs) is aimed at determining medical urgency and guiding decisions. Both medical knowledge and communication skills are required for this complex task. OBJECTIVE To explore the impact of quality of consultation and estimated urgency on the appropriateness of decisions. METHODS We performed a secondary analysis of telephone triage consultations by nurses at 29 Dutch GPCs. Consultations were taped and assessed by trained observers, using a validated instrument. Measures concerned quality of consultation, nurse-estimated urgency (four levels) and appropriateness of decisions (urgency, follow-up advice and timing). Bivariate analyses and logistic multilevel regression analyses were used to explore the impact of quality of consultation (controlling for urgency) on appropriateness of decisions. RESULTS The sample included 6739 telephone contacts, most of which (90%) were non-urgent. The majority of decisions were appropriate (91% for urgency, 96% for follow-up advice and 95% for timing). In bivariate analyses, appropriateness of decisions was positively related to higher quality of consultation. Estimated urgency was negatively associated with quality of consultation. Logistic multilevel analysis showed that higher quality of consultation was related to a more appropriate estimation of urgency [odds ratio (OR) = 1.82; 95% confidence interval (CI): 1.69-1.95], follow-up advice (OR = 2.69; 95% CI: 2.41-3.01) and timing of decisions (OR = 2.41; 95% CI: 2.20-2.63). CONCLUSIONS High quality of consultation has a positive, but small, impact on the appropriateness of decisions. Quality of consultation needs to be targeted in training and support of triage nurses, especially when it concerns highly urgent contacts.
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Affiliation(s)
- L Huibers
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Blank L, Coster J, O'Cathain A, Knowles E, Tosh J, Turner J, Nicholl J. The appropriateness of, and compliance with, telephone triage decisions: a systematic review and narrative synthesis. J Adv Nurs 2012; 68:2610-21. [PMID: 22676805 DOI: 10.1111/j.1365-2648.2012.06052.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This paper is a report of the synthesis of evidence on the appropriateness of, and compliance with, telephone triage decisions. BACKGROUND Telephone triage plays an important role in managing demand for health care. Important questions are whether triage decisions are appropriate and patients comply with them. DATA SOURCES CINAHL, Cochrane Clinical Trials Database, Medline, Embase, Web of Science, and Psyc Info were searched between 1980-June 2010. DESIGN LITERATURE REVIEW Rapid Evidence Synthesis. REVIEW METHODS The principles of rapid evidence assessment were followed. RESULTS We identified 54 relevant papers: 26 papers reported appropriateness of triage decision, 26 papers reported compliance with triage decision, and 2 papers reported both. Nurses triaged calls in most of the studies (n=49). Triage decisions rated as appropriate varied between 44-98% and compliance ranged from 56-98%. Variation could not be explained by type of service or method of assessing appropriateness. However, inconsistent definitions of appropriateness may explain some variation. Triage decisions to contact primary care may have lower compliance than decisions to contact emergency services or self care. CONCLUSION Telephone triage services can offer appropriate decisions and decisions that callers comply with. However, the association between the appropriateness of a decision and subsequent compliance requires further investigation and further consideration needs to be given to the minority of calls which are inappropriately managed. We suggest that a definition of appropriateness incorporating both accuracy and adequacy of triage decision should be encouraged.
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Purc-Stephenson RJ, Thrasher C. Patient compliance with telephone triage recommendations: a meta-analytic review. PATIENT EDUCATION AND COUNSELING 2012; 87:135-142. [PMID: 22001679 DOI: 10.1016/j.pec.2011.08.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 08/17/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To systematically investigate the extent to which patients comply with triage advice from telenurses and to identify factors that potentially influence compliance. METHODS Findings from 13 studies identified through interdisciplinary research databases (1990-2010) were meta-analyzed. Separate pooled analyses compared patients' compliance rates for emergency services and office care (13 outcomes), emergency services and self care (13 outcomes), and self care and office care (12 outcomes). RESULTS Overall patient compliance was 62%, but varied by intensity of care recommended with low compliance rates for advice to see a general practitioner. Reasons for noncompliance include patients reporting to have heard a different disposition, patients' intentions and health beliefs. CONCLUSION Patient compliance to triage recommendations was influenced by the interactive role of patient perceptions and the quality of provider communication, both of which were mediated by access to health services. Further research is needed to clarify whether noncompliance is attributable to poor communication by the nurse or patient misinterpretation. PRACTICE IMPLICATIONS We highlight the need for communication-skills training in a telephone-consultation context that is patient centered, and specifically addresses building active listening and active advising skills and advantages to structuring the call.
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Rahmqvist M, Ernesäter A, Holmström I. Triage and patient satisfaction among callers in Swedish computer-supported telephone advice nursing. J Telemed Telecare 2011; 17:397-402. [DOI: 10.1258/jtt.2011.110213] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated satisfaction with a Swedish telenursing service and the health-care-seeking behaviour among callers who received a less urgent level of health care than they expected. A postal questionnaire was sent to a random selection of callers ( n = 273) to Swedish Healthcare Direct in October 2008. The ‘cases’ were 18 callers where the telenurse recommended a lower level of health care than the caller expected and who were not in complete agreement with the nurse. The ‘controls’ were 22 callers who either received a lower recommendation, or were in disagreement with the recommendation. There were no differences between cases, controls and other callers regarding background factors or the telenurse classification of emergency. However, both cases and controls considered their need for health care as more urgent than the other callers. An independent test of the nurses' reception, ability to listen and to take notice of the callers' health problem, showed that nurses who had served cases, had received a significantly lower rating than other nurses. For nurses who had served controls, there was no such difference in rating. Cases and controls had fewer subsequent care visits than other callers, in the three days following the call, although the proportion of emergency visits was higher among cases and controls compared to other callers. If the caller and the nurse disagree about the nurse's recommendations, the consequence can be a dissatisfied caller and more visits to unnecessary high levels of health care. Further training of the nurses may improve the telenurse service.
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Affiliation(s)
- Mikael Rahmqvist
- Department of Medical and Health Sciences, Centre for Medical Technology Assessment, Linköping University, Linköping, Sweden
| | - Annica Ernesäter
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | - Inger Holmström
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
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