Patients telephoning A&E for advice: a comparison of expectations and outcomes.

Abstract

Objective-To investigate the expectations of patients when they phone the accident and emergency (A&E) department, how this relates to the advice they receive, the action they subsequently take, and their satisfaction with the service. Setting-The study was undertaken at an inner city hospital in south east London. Methods-597 calls to the department were documented during the study period, and callers for whom a phone number had been recorded were followed up by structured interviews carried out by a trained interviewer within 72 h of the call. Up to three attempts were made to contact each patient. The interviews were conducted at various times of the day to avoid excluding people with different work or social patterns. Results-The interviewer was able to contact 203 patients within 72 h of their call to the A&E department. Of these 197 (97%) agreed to participate. Almost two thirds stated that when they phoned A&E they anticipated receiving self care advice; 11% expected to be advised to see or contact their general practitioner. Only a quarter of callers stated that they had expected to be told to attend A&E. There was disagreement between the advice that nurses documented as having been given, the advice the caller recalled receiving, and the action the patient subsequently took.Even so, 107 (55%) callers were very satisfied and 62 (32%) were satisfied, while 11 (6%) were dissatisfied with the telephone consultation; 15 (8%) The general public often call accident and emergency (A&E) departments to seek medical information and advice. One recent study found that approximately 50% of the problems discussed with A&E staff over the phone were managed without the patient having to attend; those callers were either redirected to another agency or were given advice over the telephone. ' There is some evidence that the majority of patients who phone an A&E department do so for primary care or nontrauma-related problems.2 A high level of patient satisfaction with A&E telephone advice has been reported.3

Do callers to NHS Direct follow the advice to attend an accident and emergency department?

“…There is also the very real possibility that their interpretation of the advice may be different from the nurses' perception of what was said. 9 The group of callers who were given other advice and attended the A&E department is considerably smaller than found in another study, 2.4% compared with 41%. 10 However, more than would be anticipated, of this group, were advised to contact their GP 16 and they took longer to attend A&E than patients triaged to A&E. This could indicate that they tried to take other action, either self care or seeing their GP and attended A&E after failure of this action, deterioration in condition, or onward referral.…”

“…[8][9][10] However, objective measures of callers' compliance with telephone advice are more varied, 10-12 although measuring patients' compliance with advice has been shown not to be a straightforward comparison of what professionals record as the advice given and what callers' report as their actions. 9 The aim of the study was to collect objective data about callers' compliance with NHS Direct advice to attend A&E. We also sought to identify the proportion of callers who were given other advice and went to A&E with the same presenting complaint. Furthermore, did callers' characteristics, such as age, distance to nearest A&E, relationship of caller to patient, and call factors, such as time of call, influence callers following the advice?…”

Understanding of and adherence to advice after telephone counselling by nurse: a survey among callers to a primary emergency out-of-hours service in Norway

“…This corresponds to the studies from Dale et al, and Leclerc et al [17,19]. One way to ensure that the information is understood is to ask the caller to repeat the advices given by the nurse at the end of the telephone call, but this intervention has received little attention in studies in which nurse advice has been discussed.…”

An Examination of Telephone Triage in a Mental Health Context

“…There are numerous research articles that indicate a discrepancy between the advice given over the phone and the subsequent patient action (Crouch, Wood eld, Dale, & Patel, 1997;Dale, Crouch, Patel, & Williams, 1996). This discrepancy may occur because the client did not correctly understand the advice being given.…”