Phone triage nurses’ assessment of respiratory tract infections – the tightrope walk between gatekeeping and service providing. A qualitative study

Lindberg, Bent Håkan; Rebnord, Ingrid Keilegavlen; Høye, Sigurd

doi:10.1080/02813432.2021.1908715

Cited by 9 publications

(28 citation statements)

References 26 publications

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“…Four were small UK-based, mixed-methods studies with qualitative components, published between 2011 and 2019; two reported experiences of ANPs conducting home visits in Bristol and Cumbria; 11 , 19 one reported a pilot of integrating US-trained PAs into an OOH service in Scotland; 30 and one reported the evaluation of a programme to train paramedics to work in OOH in Bristol. 31 One study in Norway investigated the experiences of nurses triaging patients presenting with respiratory symptoms, 32 and one study in the Netherlands explored the views of GPs and nurse practitioners (NPs) taking part in a quasi-experimental study into optimal skill mix in OOH primary care. 33 …”

Section: Resultsmentioning

confidence: 99%

“…Nurses conducting telephone triage reported offering GP appointments to some patients who didn’t need them, because they were worried about missing serious illness, and lacked the confidence to reassure patients and their parents over the phone. 32 This led to both slower triage (as the nurses felt the need to document the history in detail) and excessive numbers of GP appointments:…”

Section: Resultsmentioning

confidence: 99%

“…Theme 2 -NMP confidence 2.1 NMP confidence is critical for an efficient service Lack of confidence was commonly reported by NMPs, leading to anxiety and inefficiencies in the service. Nurses conducting telephone triage reported offering GP appointments to some patients who didn't need them, because they were worried about missing serious illness, and lacked the confidence to reassure patients and their parents over the phone 30 . This led both to slower triage (as the nurses felt the need to document the history in detail) and to excessive numbers of GP appointments.…”

Section: Some Shifts Run Perfectly Others You Think "I Wish There Was a Third Gp Now" Especially When There Are Gps Who Pick Out Patientsmentioning

confidence: 99%

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Experiences of out-of-hours task-shifting from GPs: a systematic review of qualitative studies

et al. 2021

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BackgroundThe current GP workforce is insufficient to manage rising demand in patient care within the out-of-hours (OOH) primary care services. To meet this challenge, non-medical practitioners (NMPs) are employed to fulfil tasks traditionally carried out by GPs. It is important to learn from experiences of task-shifting in this setting to inform optimal delivery of care.AimTo synthesise qualitative evidence of experiences of task-shifting in the OOH primary care setting.Design & settingSystematic review of qualitative studies and thematic synthesisMethodElectronic searches were conducted across CINAHL, PsychInfo, Cochrane, Medline, Embase, and OpenGrey for qualitative studies of urgent or OOH primary care services, utilising task-shifting or role delegation. Included articles were quality appraised and key findings collated through thematic synthesis.Results2497 studies were screened, six met the inclusion criteria. These included interviews with 15 Advanced Nurse Practitioners, 3 Physician Assistants, 2 paramedics, and a focus group of 22 GPs and focus groups with 33 nurses. Key findings highlight the importance of clearly defining and communicating the scope of practice of NMPs and of building their confidence by appropriate training, support and mentoring.ConclusionsWhilst NMPs may have the potential to make a substantial contribution to OOH primary care services, there has been very little research on experiences of task-shifting. Evidence to date highlights the need for further training specific to OOH services. Mentorship and support to manage the sometimes-challenging cases presenting to OOH could enable more effective OOH services and better patient care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Some Shifts Run Perfectly Others You Think "I Wish There Was a Third Gp Now" Especially When There Are Gps Who Pick Out Patientsmentioning

confidence: 99%

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Experiences of out-of-hours task-shifting from GPs: a systematic review of qualitative studies

et al. 2021

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“…Telephone triage has the potential to reduce the workload of GPs [ 9 ]. Nevertheless, telephone triage nurses are reluctant to call themselves gatekeepers to the out-of-hours GP cooperatives [ 15 ]. They rather describe themselves as service providers who want to reach a consensus with the caller about the right level of care.…”

Section: Introductionmentioning

confidence: 99%

Effect of an educational intervention for telephone triage nurses on out-of-hours attendance: a pragmatic randomized controlled study

Lindberg

Rebnord

Høye

2023

BMC Health Serv Res

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Background Telephone triage has been established in many countries as a response to the challenge of non-urgent use of out-of-hours primary care services. However, limited evidence is available regarding the effect of training interventions on clinicians’ telephone consultation skills and patient outcomes. Methods This was a pragmatic randomized controlled educational intervention for telephone triage nurses in 59 Norwegian out-of-hours general practitioners’ (GPs) cooperatives, serving 59% of the Norwegian population. Computer-generated randomization was performed at the level of out-of-hours GP cooperatives, stratified by the population size. Thirty-two out-of-hours GP cooperatives were randomized to intervention. One cooperative did not accept the invitation to participate in the educational programme, leaving 31 cooperatives in the intervention group. The intervention comprised a 90-minute e-learning course and 90-minute group discussion about respiratory tract infections (RTIs), telephone communication skills and local practices. We aimed to assess the effect of the intervention on out-of-hours attendance and describe the distribution of RTIs between out-of-hours GP cooperatives and list-holding GPs. The outcome was the difference in the number of doctor’s consultations per 1000 inhabitants between the intervention and control groups during the winter months before and after the intervention. A negative binomial regression model was used for the statistical analyses. The model was adjusted for the number of nurses who had participated in the e-learning course, the population size and patients’ age groups, with the out-of-hours GP cooperatives defined as clusters. Results The regression showed that the intervention did not change the number of consultations for RTIs between the two groups of out-of-hours GP cooperatives (incidence rate ratio 0.99, 95% confidence interval 0.91–1.07). The winter season’s out-of-hours patient population was younger and had a higher proportion of RTIs than the patient population in the list-holding GP offices. Laryngitis, sore throat, and pneumonia were the most common diagnoses during the out-of-hours primary care service. Conclusions The intervention did not influence the out-of-hours attendance. This finding may be due to the intervention’s limited scope and the intention-to-treat design. Changing a population’s out-of-hours attendance is complicated and needs to be targeted at several organizational levels.

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“…Travelhet er heller ikke kvalitetsdrivende, verken på kort eller lang sikt. Studier fra norsk legevaktsammenheng viste at travelhet blant sykepleierne som prioriterer og hastevurderer pasientene på telefon fører til større forbruk legevakt (Lindberg, Rebnord, & Høye, 2021) og at legenes foreskriving av antibiotika forholdsmessig gikk opp når det var travelt på legevaktene (Lindberg, Gjelstad, Foshaug, & Høye, 2017). Tilstrekkelig tid og rammer til å gjøre jobben grundig fremmer kontinuitet og kvalitet, og er muligens også økonomisk besparende for virksomhetene på sikt.…”

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2021

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Phone triage nurses’ assessment of respiratory tract infections – the tightrope walk between gatekeeping and service providing. A qualitative study

Cited by 9 publications

References 26 publications

Experiences of out-of-hours task-shifting from GPs: a systematic review of qualitative studies

Experiences of out-of-hours task-shifting from GPs: a systematic review of qualitative studies

Effect of an educational intervention for telephone triage nurses on out-of-hours attendance: a pragmatic randomized controlled study

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