Development and testing of the KERNset: an instrument to assess the quality of telephone triage in out-of-hours primary care services

Smits, Marleen; Keizer, Ellen; Ram, Paul; Giesen, Paul

doi:10.1186/s12913-017-2686-1

Cited by 24 publications

(31 citation statements)

References 13 publications

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“…Two unpublished tools, KERNset and HAAKplus, were identified through Dutch colleagues. The KERNset comprises 24 items encompassing two domains: communicative and medical quality [19]. As KERNset is a comprehensively developed assessment tool measuring both communication and medical quality in OOH-TT, the Dutch version of the KERNset was forward-backward translated into Danish in accordance with modified WHO guidelines [20] and as proposed by Sousa et al.…”

Section: Methodsmentioning

confidence: 99%

“…As the KERNset was created to assess only the quality of nurse-led telephone triage [19], major adaptations needed to be made (see Figure 1). Testing of the original KERNset revealed a ceiling effect [19]. As displayed in Figure 1, we decided to rearrange, rephrase and extend the scale.…”

Section: Methodsmentioning

confidence: 99%

“…Tools have been published assessing quality of physician-patient communication, but many tools are not suited for telephone triage or do not cover health-related quality [17,18]. Recently, a Dutch research group developed and validated the KERNset, which assesses the quality of communication, medical content and decisions in OOH-TT conducted by nurses using CDSS [19]. However, to our knowledge, a validated tool to assess the quality of both GP- and nurse-led OOH-TT does not exist.…”

Section: Introductionmentioning

confidence: 99%

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Quality of out-of-hours telephone triage by general practitioners and nurses: development and testing of the AQTT – an assessment tool measuring communication, patient safety and efficiency

Graversen

Pedersen

Carlsen

et al. 2019

Scandinavian Journal of Primary Health Care

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Objective: To develop a valid and reliable assessment tool able to measure quality of communication, patient safety and efficiency in out-of-hours (OOH) telephone triage conducted by both general practitioners (GP) and nurses. Design: The Dutch KERNset tool was translated into Danish and supplemented with items from other existing tools. Face validity, content validity and applicability in OOH telephone triage (OOH-TT) were secured through a two-round Delphi process involving relevant stakeholders. Forty-eight OOH patient contacts were assessed by 24 assessors in test-retest and inter-rater designs. Setting: OOH-TT services in Denmark conducted by GPs, nurses or doctors with varying medical specialisation. Patients: Audio-recorded OOH patient contacts. Main outcome measures: Test-retest and inter-rater reliability were analysed using ICC agreement , Fleiss’ kappa and percent agreement. Results: Major adaptations during the Delphi process were made. The 24-item assessment tool (Assessment of Quality in Telephone Triage – AQTT) measured communicative quality, health-related quality and four overall quality aspects. The test-retest ICC agreement reliability was good for the overall quality of communication (0.85), health-related quality (0.83), patient safety (0.81) and efficiency (0.77) and satisfactory when assessing specific aspects. Inter-rater reliability revealed reduced reliability in ICC agreement and in Fleiss’ kappa. Percent agreement revealed satisfactory agreements when differentiating between ‘poor’ and ‘sufficient’ quality). Conclusion: The AQTT demonstrated high face, content and construct validity, satisfactory test-retest reliability, reduced inter-rater reliability, but satisfactory percent agreement when differentiating between ‘poor’ and ‘sufficient’ quality. The AQTT was found feasible and clinically relevant for assessing the quality of GP- and nurse-led OOH-TT. KEYPOINTS Comparative knowledge is sparse regarding quality of out-of-hours telephone triage conducted by general practitioners and nurses. The assessment tool (AQTT) enables assessment of quality in OOH telephone triage conducted by nurses and general practitioners AQTT is feasible and clinically relevant for assessment of communication, patient safety and efficiency. AQTT can be used to identify areas for improvement in telephone triage

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quality of out-of-hours telephone triage by general practitioners and nurses: development and testing of the AQTT – an assessment tool measuring communication, patient safety and efficiency

Graversen

Pedersen

Carlsen

et al. 2019

Scandinavian Journal of Primary Health Care

View full text Add to dashboard Cite

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“…In addition, patients do not always expect a physical encounter with the attending physician and in some cases a telephone advice su ces. From earlier research, we know that referrals by this operator happen safe and adequate to all levels of care (9,(17)(18)(19)(20). Increasing the adequacy of referring will undoubtedly decrease the patient in ow for unplanned care, workload and waiting lists.…”

Section: Discussionmentioning

confidence: 97%

Co-location of Out of Hours Primary Care and Emergency Department in Belgium: Patients’ and Physicians’ View

Schoenmakers

Criekinge

Boeve

et al. 2020

Preprint

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Background In Belgium, General Practitioner Cooperatives (GPC) aim to improve working conditions for unplanned care and to reduce the number of inappropriate emergency visits. Although this system is well organised, the number of inappropriate visits does not decrease. Methods We explored the position of patients and physicians on the co-location of a GPC and an emergency service for unplanned care. The study was carried out in a cross section design in primary and emergency care services, including patients and physicians. Main outcome measures were the position of patients and physician on co-location a GPC and an emergency service. Results 404 patients and 488 physicians participated. 334 (82.7%) of all patients favored a co-location. The most important advantages were fast service (104, 25.7) and adequate referral (54, 13.4%). 237 (74%) of the GP’s and 38 (95%) of the emergency physicians were in favor of a co-location. The major advantage of this system was a more adequate referral of patients. 254 (79%) of the GP’s and 23 (83%) of the emergency physicians believed that a co-location would lower the workload, decrease waiting time and increase care quality (resp. 251 (78%), 224 (70%) and 37 (93%), 34 (85%). Conclusions To meet all concerns and to reach for high care quality information campaigns and development of workflows are necessary for a successful implementation of a co-location of primary and emergency care.

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“…The NTS is hierarchically ordered with key questions, and answers are linked to urgency recommendations. Linked to the nurse’s urgency allocation is the time frame within which a physician should see the patient ( 16 ): direct, within 15 minutes [by ambulance or GP (U1)]; urgently, within 1 hour (U2); less urgent, within 3 hours (U3); non-urgent, the same day (U4) or telephone advice (U5). The GP may see the patient at the patient’s home or at the OHS-PC.…”

Section: Methodsmentioning

confidence: 99%

Chest discomfort at night and risk of acute coronary syndrome: cross-sectional study of telephone conversations

et al. 2020

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Background During telephone triage, it is difficult to assign adequate urgency to patients with chest discomfort. Considering the time of calling could be helpful. Objective To assess the risk of acute coronary syndrome (ACS) in certain time periods and whether sex influences this risk. Methods Cross-sectional study of 1655 recordings of telephone conversations of patients who called the out-of-hours services primary care (OHS-PC) for chest discomfort. Call time, patient characteristics, symptoms, medical history and urgency allocation of the triage conversations were collected. The final diagnosis of each call was retrieved at the patient’s general practice. Absolute numbers of patients with and without ACS were plotted and risks per hour were calculated. The risk ratio of ACS at night (0 to 9 am) was calculated by comparing to the risk at other hours and was adjusted for gender and age. Results The mean age of callers was 58.9 (standard deviation ±19.5) years, 55.5% were women and, in total, 199 (12.0%) had an ACS. The crude risk ratio for an ACS at night was 1.80 (confidence interval 1.39–2.34, P < 0.001): 2.33 (1.68–3.22, P < 0.001) for men and 1.29 (0.83–1.99, P = 0.256) for women. The adjusted risk ratio for ACS of all people at night was 1.82 (1.07–3.10, P = 0.039). Conclusions Patients calling the OHS-PC for chest discomfort between 0 and 9 am have almost twice a higher risk of ACS than those calling other hours, a phenomenon more evident in men than in women. At night, dispatching ambulances more ‘straightaway’ could be considered for these patients with chest discomfort. Trial number NTR7331.

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Development and testing of the KERNset: an instrument to assess the quality of telephone triage in out-of-hours primary care services

Cited by 24 publications

References 13 publications

Quality of out-of-hours telephone triage by general practitioners and nurses: development and testing of the AQTT – an assessment tool measuring communication, patient safety and efficiency

Quality of out-of-hours telephone triage by general practitioners and nurses: development and testing of the AQTT – an assessment tool measuring communication, patient safety and efficiency

Co-location of Out of Hours Primary Care and Emergency Department in Belgium: Patients’ and Physicians’ View

Chest discomfort at night and risk of acute coronary syndrome: cross-sectional study of telephone conversations

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