Objective To assess the quality of telephone triage by following the consecutive phases of its care process and the quality of the clinical questions asked about the patient's clinical condition, of the triage outcome, of the content of the home management advice, and of the safety net advice given at out of hours centres. Design Cross sectional national study using telephone incognito standardised patients. Setting The Netherlands. Participants 17 out of hours centres. Main outcome measures Percentages of clinical obligatory questions asked and items within home management and safety net advice, both in relation to preagreed standards, and of care advice given in relation to the required care advice. Results The telephone incognito standardised patients presented seven clinical cases three times each over a period of 12 months, making a total of 357 calls. The mean percentage of obligatory questions asked compared with the standard was 21%. Answers to questions about the clinical condition were not always correctly evaluated from a clinical viewpoint, either by triagists or by general practitioners. The quality of information on home management and safety net advice varied, but it was consistently poor for all cases and for all out of hours centres. Triagists achieved the appropriate triage outcome in 58% of calls. Conclusion In determining the outcome of the care process, triagists often reached a conclusion after asking a minimal number of questions. By analysing the quality of different phases within the process of telephone triage, evaluation of whether an appropriate triage outcome has been arrived at by means of good clinical reasoning or by an educated guess is possible. In terms of enhancing the overall clinical safety of telephone triage, apart from obtaining an appropriate clinical history, adequate home management and safety net advice must also be given.

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ObjectiveTo assess the quality of the content of reports of telephone consultations at out-of-hours centres and to investigate to what extent the reports reflect the actual telephone consultation. Design and setting Cross-sectional qualitative study; 17 out-of-hours centres in The Netherlands. Method To assess the quality of the content of reports, a focus group developed the Reason for calling, Information gathered, Care advice given, Evaluation of the care advice with the patient (RICE) report rating instrument. Telephone Incognito Standardised Patients presented seven different clinical problems three times to 17 out-of-hours centres. All calls were recorded and transcribed. The out-of-hours centres being called were asked for a copy of the report of the call. The authors assessed the quality of the content of the reports and compared this with the transcripts. Results The out-of-hours centres returned a report for 78% of the 357 calls. For the remaining 22% of the calls, no report was written. Reports contained almost always information about the medical reason for calling but little information about details of the clinical history. Patients' expectation, personal situation or perception of the care advice was seldom documented. In all but one out-ofhours centre, answers to obligatory questions were reported by triagists, although they had not been asked, varying between 1% and 54% of all questions entered. Triagists entered a subjective evaluation of a patients' condition in 12% of the reports. Conclusion Reports of telephone consultations of outof-hours centres contained little information on patients' clinical and personal condition. This could potentially endanger patients' continuity of care and might pose legal consequences for the triagist.

Context  Many countries now use call centres as an integral part of out‐of‐hours primary care. Although some research has been carried out on safety issues pertaining to telephone consultations, there has been no published research on how to train and use standardised patients calling for medical advice or on the accuracy of their role‐play. Objectives  This study aimed to assess the feasibility and validity of using telephone incognito standardised patients (TISPs), the accuracy of their role‐play and the rate of detection. Further objectives included exploring the experiences of TISPs and the difficulties encountered in self‐recording calls. Methods  Twelve TISPs were trained in role‐play by presenting their problem to a general practitioner and a nurse. They were also trained in self‐recording calls. Calls were made to 17 different out‐of‐hours centres (OOHCs) from home. Of the four or five calls made per evening, one call was assessed for accuracy of role play. Retrospectively, the OOHCs were asked whether they had detected any calls made by a TISP. The TISPs filled in a questionnaire concerning their training, the self‐recording technique and their personal experiences. Results  The TISPs made 375 calls over 84 evenings. The accuracy of role‐play was close to 100%. A TISP was called back the same evening for additional information in 11 cases. Self‐recording caused extra tension for some TISPs. All fictitious calls remained undetected. Conclusions  Using the method described, TISPs can be valuable both for training and assessment of performance in telephone consultation carried out by doctors, trainees and other personnel involved in medical services.

InleidingDe communicatie tussen artsen en patiënten is gedurende de laatste decennia veranderd onder invloed van maatschappelijke veranderingen. Verliep de communicatie in het verleden vooral Onderzoek Kwaliteit van telefonische triage op huisartsenposten in Nederland Communicatieve vaardigheden en verslaglegging Hay Derkx, Jan-Joost Rethans, Bas Maiburg, Ron Winkens, Arno Muijtjens, Harrie van Rooij, André Knottnerus ziektegericht, tegenwoordig is ze patiëntgericht; -niet de ziekte maar de patiënt staat centraal. 1-4 Dit geldt ook voor telefonische triage, het zorgproces waarbij men de mate van urgentie en de bijpassende zorg via de telefoon bepaalt. 5-10 Tevredenheid van Samenvatting Derkx HP, Rethans JJ, Maiburg HJS, Winkens RAG, Muijtjens AM, Van Rooij HG, Knottnerus JA. Kwaliteit van telefonische triage op huisartsenposten in Nederland. Communicatieve vaardigheden en verslaglegging. Huisarts Wet 2009;52 (9):455-61. Doel De kwaliteit van telefonische triage op huisartsenposten wordt behalve door het niveau van de medische inhoud ook bepaald door de kwaliteit van de communicatie en de verslaglegging van de telefonische consulten. Er is nog weinig onderzoek gedaan naar de kwaliteit van deze aspecten. We hebben de communicatieve vaardigheden van triagisten onderzocht en bepaald in hoeverre de verslagen een feitelijke weergave zijn van de gesprekken. Methode Voor de uitvoering van ons onderzoek belden twaalf telefonische simulatiepatiënten (TSP's) in de periode april 2006 tot juli 2007 naar zeventien verschillende huisartsenposten voor zeven medische problemen. Iedere huisartsenpost werd voor iedere casus driemaal gebeld. Van alle 357 opgenomen gesprekken maakten we een verbatim. Nadat alle gesprekken waren gevoerd vroegen we de betrokken huisartsenposten een kopie van de verslagen te sturen. Voor de beoordeling van de kwaliteit van de communicatie en verslaglegging ontwikkelden en gebruikten we de HAAK-scorelijst. We vergeleken de inhoud van de verslagen met de verbatims. Resultaten De gemiddelde score voor communicatie bedroeg 35% van de maximaal haalbare score. Triagisten stelden vragen over het medische probleem in het algemeen op de juiste wijze, maar vroegen weinig over de persoonlijke situatie en omstandigheden van de patiënt of over diens verwachtingen. De triagisten gaven het zorgadvies meestal zonder te controleren of de patiënt het had begrepen of had geaccepteerd. De gesprekken verliepen vaak zonder vaste structuur, samenvatting of aankondiging van de verschillende fasen van het gesprek. Er was een positieve correlatie van 0,86 (p < 0,01) tussen de gespreksduur en de kwaliteit van de communicatie. Van 78% van de 357 gesprekken stuurden de huisartsenposten een verslag. Van de overige 22% was geen verslag gemaakt. De verslagen vermeldden bijna altijd Universiteit Maastricht, afdeling Huisartsgeneeskunde, Postbus 616, 6200 MD Maastricht: dr. H.P. Derkx, arts, onderzoeker; dr. J.J. Rethans, arts, universitair hoofddocent; dr. H.J.S. Maiburg, huisarts, adjunct-hoofd huisartsopleiding; dr. R.A.G. Winkens,...