Displaying concerns within telephone triage conversations of callers with chest discomfort in out-of-hours primary care: A conversation analytic study

Spek, Michelle; Charldorp, T.C. van; Vinck, Vera; Venekamp, Roderick P; Rutten, Frans H.; Zwart, Dorien; Groot, Esther de

doi:10.1016/j.pec.2023.107770

Cited by 3 publications

(9 citation statements)

References 47 publications

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“…However, simple questions based on yes/no and either/or could be challenging to answer if they did not suit the situation [ 54 , 63 ]. Callers tended to only answer the last question if the operators asked two or more questions immediately after each other [ 55 ].…”

Section: Resultsmentioning

confidence: 99%

“…Exploring the caller’s concern was described as a good strategy to obtain additional information [ 25 , 55 ]. Furthermore, assessment techniques such as listening for respiratory sounds and instructing a third person to perform physical examinations were described as useful [ 42 , 59 ].…”

Section: Resultsmentioning

confidence: 99%

“…Operators described how the conversation became more challenging when callers lacked knowledge about illness, normal bodily functions, and the organisation of the health services [ 27 , 47 , 56 ]. The knowledge gap acted as a barrier to shared understanding, as callers then struggled to describe their situation, held back information due to uncertainty or responded without comprehending the operators’ questions [ 49 , 55 , 56 ]. A disparity in situational awareness between operators and callers could arise when the callers had conducted online searches prior to their call and misinterpreted the information [ 34 , 43 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…A power asymmetry in the interaction was described, where the operators, as the professionals and the “door openers’” to medical help, had the most power [ 26 , 38 , 55 , 56 , 66 ]. Yet, callers described themselves as personal experts and emphasised the importance of not being devalued and considered solely as a source of information [ 7 , 38 , 39 , 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…Decision support systems were also well-documented in both qualitative and quantitative studies [ 5 , 8 , 36 , 38 , 41 , 48 – 55 , 57 , 58 , 71 ]. The DSS’s role in structuring the conversation was described particularly thoroughly [ 5 , 38 , 48 – 58 , 71 ].…”

Section: Resultsmentioning

confidence: 99%

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Factors affecting communication during telephone triage in medical call centres: a mixed methods systematic review

Fotland,

Midtbø,

Vik

et al. 2024

Syst Rev

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Background Telephone triage is used to optimise patient flow in emergency primary healthcare. Poor communication can lead to misunderstandings and compromise patient safety. To improve quality, a comprehensive understanding of factors affecting communication in medical call centres in primary care is needed. The aim of this review was to identify such factors and to describe how they affect communication during telephone triage. Method A mixed-method systematic review was performed. In April 2021 and June 2023, MEDLINE, Embase, CINAHL, and Web of Science were searched for original studies describing communication during telephone triage in primary care medical call centres handling all types of medical problems from an unselected population. All studies were screened by two authors, blinded to each other’s decisions. Disagreements were resolved by a third author. A framework was created by the thematic synthesis of the qualitative data and later used to synthesise the quantitative data. By using convergent integrated synthesis, the qualitative and quantitative findings were integrated. The Mixed Methods Appraisal Tool was used to assess methodological limitations. Results Out of 5087 studies identified in the search, 62 studies were included, comprising 40 qualitative, 16 quantitative and six mixed-method studies. Thirteen factors were identified and organised into four main themes: organisational factors, factors related to the operator, factors related to the caller and factors in the interaction. Organisational factors included availability, working conditions and decision support systems. Factors related to the operator were knowledge and experience, personal qualities and communication strategies. Factors related to the caller were individual differences and the presented medical problem. Factors in the interaction were faceless communication, connection between operator and caller, third-person caller and communication barriers. The factors seem interrelated, with organisational factors affecting all parts of the conversation, and the operator’s communication in particular. Conclusion Many factors affect the structure, content, and flow of the conversation. The operators influence the communication directly but rely on the organisation to create a working environment that facilitates good communication. The results are mainly supported by qualitative studies and further studies are needed to explore and substantiate the relevance and effect of individual factors. Systematic review registration PROSPERO CRD42022298022.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Factors affecting communication during telephone triage in medical call centres: a mixed methods systematic review

Fotland,

Midtbø,

Vik

et al. 2024

Syst Rev

View full text Add to dashboard Cite

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« Petit malaise » ou « très gros souci » ? Atténuation et intensification dans les descriptions profanes d’urgences vitales au téléphone

Giraudier,

Riou

2024

SHS Web of Conf.

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Avec une méthodologie s’inscrivant dans le cadre de la linguistique interactionnelle, cette étude porte sur un corpus d’appels d’urgence en français pour des urgences médicales. Nous analysons le degré de gravité exprimé par des appelants profanes par le biais de leur emploi de marqueurs d’intensité, tels que les adverbes de degré. Nous proposons une analyse structurale et interactionnelle des marqueurs déployés à des fins d’intensification ou d’atténuation dans les descriptions de l’état du patient. Pour ce faire, nous documentons les structures grammaticales employées et la façon dont les régulateurs y répondent et réagissent dans les tours de parole suivants. Nous proposons que cette étude des structures grammaticales employées par les appelants profanes pour des urgences avérées est une fenêtre privilégiée pour mieux comprendre les liens entre urgence ressentie, urgence exprimée, et urgence réelle.

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The Role of Language in Remote Healthcare Triage: A Meta‐Aggregative Review

Spek,

van Braak,

Erkelens

et al. 2024

Journal of Advanced Nursing

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Aim(s)To provide an overview of evidence on the role of language in remote healthcare services prioritisation, from now on termed triage. This study synthesises literature, to better understand how language affects triage interactions, aiming to improve these processes.DesignWe conducted a meta‐aggregative review.MethodsA systematic search in Scopus from inception to September 2023 identified 437 studies on language in remote healthcare triage, of which 23 were included. Information was selected using both inductive and deductive coding, focusing on six linguistic features of interaction that have been described in the literature on studies using conversation analysis: turn‐taking organisation, overall structure, sequence organisation, turn design, lexical choice, and epistemological and other forms of asymmetry. The process followed the RAMESES Publication Standards for Meta‐narrative Reviews.ResultsTwo main findings emerged. First, all six linguistic features are present in triage conversations, indicating that language involves more than just what is said. It also matters, for example, how and when a question is asked. Second, computerised decision support systems (CDSS) significantly affect conversation flow and dynamics.ConclusionLanguage in triage involves more than literal speech and is heavily influenced by CDSS.Implications for the Profession and/or Patient CareOur study suggests that quality assessments of triage conversations should consider not only what is said but cover all relevant aspects of language. The influence of computerised decision support systems (CDSS) on linguistic features highlights the need for systems to be adaptable, to improve conversation quality and better addressing caller needs rather than focusing on one‐size‐fits‐all questions.ImpactThis review highlights the complex role of language in triage conversations and its impact on interaction. It calls for a broader view of language in quality assessments, recognising that both call‐takers and callers contribute to call quality. Insights from this review can help developers enhance question types, sequence, and delivery methods of computerised decision support systems. Finally, education for call‐takers in healthcare sectors may be improved based on our findings.Patient or Public ContributionNo patient or public contribution.

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Displaying concerns within telephone triage conversations of callers with chest discomfort in out-of-hours primary care: A conversation analytic study

Cited by 3 publications

References 47 publications

Factors affecting communication during telephone triage in medical call centres: a mixed methods systematic review

Factors affecting communication during telephone triage in medical call centres: a mixed methods systematic review

« Petit malaise » ou « très gros souci » ? Atténuation et intensification dans les descriptions profanes d’urgences vitales au téléphone

The Role of Language in Remote Healthcare Triage: A Meta‐Aggregative Review

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