Clinical decision support improves quality of telephone triage documentation--an analysis of triage documentation before and after computerized clinical decision support

Clinical decision support system in emergency telephone triage: A scoping review of technical design, implementation and evaluation

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.

Reliability and validity of an original nurse telephone triage tool for out-of-hours primary care calls: the SALOMON algorithm

OBJECTIVES

Due to the persistent primary care physicians shortage and the substantial increase in their workload, the organization of primary care calls during out-of-hours periods has become an everyday challenge. The SALOMON algorithm is an original nurse telephone triage tool allowing to dispatch patients to the best level of care according to their conditions. This study evaluated its reliability and criterion validity in rea-life settings.

METHODS

In this 5-year study, out-of-hours primary care calls were dispatched into four categories: Emergency Medical Services Intervention (EMSI), Emergency Department referred Consultation (EDRC), Primary Care Physician Home visit (PCPH), and Primary Care Physician Delayed visit (PCPD). We included data of patients' triage category, resources, and destination. Patients included into the primary care cohort were classified undertriaged if they had to be redirected to an emergency department (ED). Patients from the ED cohort were considered overtriaged if they did not require at least three diagnostic resources, one emergency-specific treatment or any hospitalization. In the ED cohort, only patients from the University Hospitals were considered.

RESULTS

10,207 calls were triaged using the SALOMON tool: 19.2% were classified as EMSI, 15.8% as EDRC, 62.8% as PCPH, and 2.2% as PCPD. The triage was appropriate for 85.5% of the calls with a 14.5% overtriage rate. In the PCPD/PCPH cohort, 96.9% of the calls were accurately triaged and 3.1% were undertriaged. SALOMON sensitivity and specificity reached 76.6% and 98.3%, respectively.

CONCLUSION

SALOMON algorithm is a valid triage tool that has the potential to improve the organization of out-of-hours primary care work.

Patient safety when receiving telephone advice in primary care – a Swedish qualitative interview study

Background

A lack of patient safety is a significant global public health challenge and is one of the leading causes of death and disability, entailing significant financial and economic costs. However, patient safety can be improved and patients can avoid being harmed if more knowledge could be gained about what it is that impacts patient safety. Patient safety when receiving telephone advice is an important issue given the increase in digitalization in healthcare services.

Aim

The aim of this study was to explore district nurses’ (“telenurses”) experiences and perceptions of patient safety when providing health advice over the phone.

Methods

Data collection was performed using semi-structured interviews and analyzed using qualitative content analysis. The participants (n = 12) were telnurses in primary care.

Results

The theme “Being able to make the right decision” was formed based on two categories: “Communication” and “Assessment”. Through effective communication with the right conditions to make an assessment, the correct decision can be made when a patient calls, and the district nurse feels that their telephone advice is safe for the patient.

Conclusions

Patient safety can be challenged when receiving telephone advice, particularly when they feel stressed due to organizational factors. There is a need to shift from the individual to the organization. Further, while computerized knowledge support generally results in safe decisions, there may also be problems. Hence, it is imperative to develop computerized knowledge support as a part of improved patient safety in telephone advice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00796-9.

Emergency nurse triage in the hospital information management system: A quality improvement study

BACKGROUND

Assessment of nurse triage decision accuracy and triage times is currently carried out through paper-based methods. This quality improvement study aims to develop a method that can assess the accuracy and duration of nurse triage decisions based on a computerized system and to share an example of the application of this method.

METHODS

This is a descriptive quality improvement study. The study was carried out in two stages between March and May 2019. The functionality of the developed method was examined using 3835 patients' triage data, which were obtained between June 1 and 14, 2019.

RESULTS

With this study, the determination of the accuracy and duration of nurse triage decisions was accomplished with a computerized process based on real patient outputs, and the accuracy and duration of these decisions were continuously measured, monitored, and assessed, which is different from paper-based methods. The functionality of the method was evaluated with data from 3835 real patients. The triage decision accuracy rate was 64.4%, and the average duration of triage was 81.3s. Positive feedback on the method was received from all triage nurses.

CONCLUSION

The study result outputs can be integrated into quality processes and can be used internationally as performance assessment criteria and quality indicators for triage nursing.

Telehealth Triage and Oncology Nursing Practice

OBJECTIVE

To provide an overview of telehealth and explore the roles that the registered nurse can play in the context of a telehealth setting.

DATA SOURCES

Review of articles via PubMed and CIANHL from 2009 to present and relevant telehealth websites.

CONCLUSION

The advancement of technology, the need to improve access to health care, and the changing expectations of consumers to have access to information has helped to expand telehealth as an innovative care delivery model and has created new opportunities for telehealth nursing care. The use of telehealth in the oncology setting continues to evolve and provide nurses the opportunity for new and potentially expanded roles.

IMPLICATIONS FOR NURSING PRACTICE

Registered oncology nurses need to understand the various methods used to deliver care via a telehealth environment and how establish and work in this new environment to assure that they are practicing safely and within the full scope of their license.

Telephone nurses' use of a decision support system: An observational study

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.

Telephone triage in midwifery practice: A cross-sectional survey

BACKGROUND

Childbearing women commonly access maternity services via the telephone. A midwife receiving these calls listens to the woman's concerns and then triages women according to their assessment. This may result in the provision of advice and instruction over the telephone or inviting the woman into the health service for further assessment. Midwives are responsible for all care and advice given to women, including via the telephone.

OBJECTIVES

The purpose of this study was to explore the experiences and practices of midwives regarding their management of telephone triage.

DESIGN

A cross-sectional survey.

SETTING AND PARTICIPANTS

Purposive non-probabilistic sampling of currently practising midwife members of professional organisations was used to recruit participants. From this, 242 midwives responded and 230 returned valid surveys were used in data analysis.

METHODS

Participant demographics, telephone triage processes, skills, educational preparation, confidence and anxiety levels, and external factors that influence midwives' management of telephone triage were collected via an on-line survey. Descriptive statistics and further analyses were conducted to explore relationships between variables.

RESULTS

Eighty-three percent of midwives respond to 2-5 telephone calls per shift, with only 11.7% (n = 24) of midwives reporting that this is included in their workloads. Telephone triage is frequently managed in environments with distractions. Most midwives (84%; n = 177) report receiving no training in this skill. Confidence in performing telephone triage was reported, with higher confidence levels related to midwives' increased years of experience (p < 0.05) and age (p <  0.01). Anxiety related to managing telephone triage has been experienced by 73% (n = 151) of midwives, with this being greater in midwives with less years of experience. Anxiety is reported less by midwives in rural or remote settings compared to metropolitan or regional (p <  0.05) settings in this study. A variety of standards and aids to guide practice, and document calls are utilised in a range of ways.

CONCLUSION

To the authors' knowledge, this is the first study conducted to explore midwives' practises in telephone triage. The findings suggest the need for appropriate environments to conduct telephone calls and the inclusion of telephone triage in midwifery workloads. In addition, consistent education and processes are required to reduce anxiety and support midwives provision of this service to women.

The effects of intervention on quality of telephone triage at an emergency unit in Finland: Nurses' perspective

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.