Communicative characteristics of general practitioner-led and nurse-led telephone triage at two Danish out-of-hours services: an observational study of 200 recorded calls

Vilstrup, Emil; Graversen, Dennis Schou; Huibers, Linda; Christensen, Morten Bondo; Pedersen, Anette Fischer

doi:10.1136/bmjopen-2018-028434

Cited by 8 publications

(17 citation statements)

References 27 publications

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“…The emotional feeling of worry is a catalyst for help-seeking, however, this is rarely touched upon in telephone triage [17,46]. A Danish study of 200 audio-recorded telephone triage conversations found that callers were invited to express their emotional state in less than 2% of the calls [10]. In an analysis of malpractice claim cases the authors found that a failure to respond to the callers' concern, closed biomedical questions and less information sharing characterized malpractice claims in cases compared to matched controls [15,16,47].…”

Section: Comparison With the Literaturementioning

confidence: 99%

“…Triage tools are recommended to aid health care professionals' decision making [6], but these tools generally perform well only in the low and high levels of urgency, but less so in the middle triage categories [6,7], moreover, they are criticized for not incorporating the patient's context and perception nearly enough [8,9]. In a Danish study from 2019 based on 200 calls to a medical helpline, researchers found that less than 2% of the callers were invited to express their emotional state [10]. Therefore, a need exists for a tool that systematically incorporates the patient's perception of the situation and symptoms in telephone triage.…”

Section: Introductionmentioning

confidence: 99%

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Self-rated worry is associated with hospital admission in out-of-hours telephone triage – a prospective cohort study

Gamst‐Jensen

Christensen

Lippert

et al. 2020

Scand J Trauma Resusc Emerg Med

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Objective: Telephone triage manages patient flow in acute care, but a lack of visual cues and vague descriptions of symptoms challenges clinical decision making. We aim to investigate the association between the caller's subjective perception of illness severity expressed as "degree-of-worry" (DOW) and hospital admissions within 48 h. Design and setting: A prospective cohort study was performed from January 24th to February 9th, 2017 at the Medical Helpline 1813 (MH1813) in Copenhagen, Denmark. The MH1813 is a primary care out-of-hours service. Participants: Of 38,787 calls received at the MH1813, 11,338 met the inclusion criteria (caller being patient or close friend/relative and agreement to participate). Participants rated their DOW on a 5-point scale (1 = minimum worry, 5 = maximum worry) before talking to a call handler. Main outcome measure: Information on hospitalization within 48 h after the call, was obtained from the Danish National Patient Register. The association was assessed using logistic regression in three models: 1) crude, 2) ageand-gender adjusted and 3) age, gender, co-morbidity, reason for calling and caller status adjusted. Results: A total of 581 participants (5.1%) were admitted to the hospital, of whom 170 (11.3%) presented with a maximum DOW, with a crude odds ratio (OR) for hospitalization of 6.1 (95% confidence interval (CI) 3.9 to 9.6) compared to minimum DOW. Estimates showed dose-response relationship between DOW and hospitalization. In the fully adjusted model, the ORs decreased to 3.1 (95%CI 2.0 to 5.0) for DOW = 5, 3.2 (2.0 to 5.0) for DOW = 4, 1.6 (1.0 to 2.6) for DOW = 3 and 0.8 (0.5 to 1.4) for DOW = 2 compared to minimum DOW. Conclusion: Patients' self-assessment of illness severity as DOW was associated with subsequent hospital admission. Further, it may be beneficial in supporting clinical decision making in telephone triage. Finally, it might be useful as a measure to facilitate patient participation in the triage process.

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Section: Comparison With the Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Self-rated worry is associated with hospital admission in out-of-hours telephone triage – a prospective cohort study

Gamst‐Jensen

Christensen

Lippert

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…The nurse starts this phase by asking an open and nonspeci c question to invite the caller to tell their story (2,(25)(26)(27). The caller usually presents their reason for calling as a narrative (26) and prefers to tell the story at the beginning of the call (47). It is important that the caller be allowed to tell their story in full without being interrupted by questions or unnecessary remarks (38,42,(47)(48).…”

Section: Inviting the Caller To Tell Their Storymentioning

confidence: 99%

“…The caller is given time and space to speak (28,31,36,40,47). The nurse is active and responsive in listening and encourages the full telling of the caller's story (38,52).…”

Section: Inviting the Caller To Tell Their Storymentioning

confidence: 99%

The telephone nursing dialogue process: an integrative review

Gustafsson

Wahlberg

2023

Preprint

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Background: Telephone nursing involves triage, advice, and care management provided by a nurse over the telephone. The telephone nursing dialogue process has been used clinically in telephone nursing in Sweden for several years to structure the communication and ensure a safe assessment and advice. Studies are needed to determine whether there is sufficient scientific evidence to support the method. Aim: To describe the scientific basis of the phases of the telephone nursing dialogue process. Design: This was an integrative review. Methods: The literature searches were performed in March 2021, in the PubMed, CINAHL, Cochrane Database of Systematic Reviews and SwePUB databases. Fifty-five articles were included. Data was sorted deductively according to the five phases of the telephone nursing dialogue process and categorized inductively to form subcategories describing the content of each phase. Result: All five phases in the telephone nursing dialogue process were supported by a range of articles (n=26–43): Opening (n= 26), Listening (n= 39), Analysing (n= 43), Motivating (n= 42), and Ending (n= 31). During the opening of the call, the nurse presents herself, welcomes the caller and establishes a caring relationship. In the listening phase, the nurse invites the caller to tell their story, listens actively and confirms understanding. During the analyzing phase, the nurse gathers, assesses, and verifies information. In the motivating phase, the nurse reaches a final assessment, informs the caller, gives advice and creates a mutual agreement and understanding while supporting the caller. Ultimately, the nurse ends the call after checking for mutual agreement and understanding, giving safety-net advice, deciding on whether to keep monitoring the caller and rounding off the call. Conclusion: The phases of the telephone nursing dialogue process as described in the scientific literature are well aligned with the theoretical descriptions of the telephone nursing dialogue process.

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“…This was supported in a substudy involving 200 of the calls included in this study that nurses allowed the patient to speak uninterrupted in the beginning for significantly longer time than GPs (GP median spontaneous talking time: 17.9 s vs nurse: 23.4 s). 28 Previous findings that have found CDSS use constraining and explores mostly medical information. 26 27 Moreover, indicators of efficiency could influence the patient-centredness of the communication negatively.…”

mentioning

confidence: 99%

Communication quality in telephone triage conducted by general practitioners, nurses or physicians: a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark

et al. 2020

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ObjectivesTo compare the quality of communication in out-of-hours (OOH) telephone triage conducted by general practitioners (GPs), nurses using a computerised decision support system and physicians with different medical specialities, and to explore the association between communication quality and efficiency, length of call and the accuracy of telephone triage.DesignNatural quasi-experimental cross-sectional study.SettingTwo Danish OOH services using different telephone triage models: a GP cooperative and the medical helpline 1813.Participants1294 audio-recorded randomly selected OOH telephone triage calls from 2016 conducted by GPs (n=423), nurses using CDSS (n=430) and physicians with different medical specialities (n=441).Main outcome measuresTwenty-four physicians assessed the calls. The panel used a validated assessment tool (Assessment of Quality in Telephone Triage, AQTT) to measure nine aspects of communication, overall perceived communication quality, efficiency and length of call.ResultsThe risk ofpoorquality was significantly higher in calls triaged by GPs compared with calls triaged by nurses regarding ‘allowing the caller to describe the situation’ (GP: 13.5% nurse: 9.8%), ‘mastering questioning techniques’ (GP: 27.4% nurse: 21.1%), ‘summarising’ (GP: 33.0% nurse: 21.0%) and ‘paying attention to caller’s experience’ (GP: 25.7% nurse: 17.0%). The risk ofpoorquality was significantly higher in calls triaged by physicians compared with calls triaged by GPs in five out of nine items. GP calls were significantly shorter (2 min 57 s) than nurse calls (4 min 44 s) and physician calls (4 min 1 s). Undertriaged calls were rated lower than optimally triaged calls for overall quality of communication (p<0.001) and all specific items.ConclusionsCompared with telephone triage by GPs, the communication quality was higher in calls triaged by nurses and lower in calls triaged by physicians with different medical specialities. However, calls triaged by nurses and physicians were longer and perceived less efficient. Quality of communication was associated with accurate triage.

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Communicative characteristics of general practitioner-led and nurse-led telephone triage at two Danish out-of-hours services: an observational study of 200 recorded calls

Cited by 8 publications

References 27 publications

Self-rated worry is associated with hospital admission in out-of-hours telephone triage – a prospective cohort study

Self-rated worry is associated with hospital admission in out-of-hours telephone triage – a prospective cohort study

The telephone nursing dialogue process: an integrative review

Communication quality in telephone triage conducted by general practitioners, nurses or physicians: a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark

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