Reliability of Dutch Obstetric Telephone Triage

Engeltjes, Bernice; Rosman, Ageeth N.; Bertens, Loes C. M.; Wouters, Eveline; Cronie, Doug; Scheele, Fedde

doi:10.2147/rmhp.s319564

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…In general, a triage system that prioritizes care according to medical urgency has a favorable effect on the safety and efficiency of emergency care [ 1 , 2 ]. The DOTTS is a reliable [ 3 ] and valid [ 4 ] evidence-based guideline in which presenting symptoms are used to classify the level of urgency from acute hospital admission using transport by ambulance to self-care with advice at home. It was developed through a multiphase multicenter study in consultation with all relevant stakeholders [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Normalization After Implementation of the Digital Dutch Obstetric Telephone Triage System: Mixed Methods Study With a Questionnaire Survey and Focus Group Discussion

Engeltjes¹,

Rosman

Scheele³

et al. 2022

JMIR Form Res

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Background The Dutch Obstetric Telephone Triage System (DOTTS) was developed to improve the quality of acute obstetric care. To achieve optimal effect, the DOTTS should be adopted in the daily care process by triage staff. Objective The primary aim was to evaluate the degree of implementation (ie, normalization) of the DOTTS, and the secondary aim was to evaluate which lessons can be learned from its current implementation in Dutch hospitals. Methods An evaluation study with a mixed methods design was performed. All triage staff in 9 Dutch hospitals that implemented the DOTTS before September 1, 2019, were invited to complete the Normalization Measure Development (NoMAD) questionnaire between December 2019 and July 2020. The questionnaire is based on the Normalization Process Theory (NPT). This self-reported questionnaire provides insights into the work people do in order to integrate and embed new practice in routine care. The NPT is based on the following 4 constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Within the questionnaire, each construct is represented by 4-7 questions. Questions are scored on a 5-point normalization process scale. Descriptive statistics were used for analysis of questionnaire scores. Subsequently, the questionnaire findings were discussed during a focus group. Template analysis following the 4 constructs was used for analyzing the results of the focus group. Results Overall, 173 of 294 (58.8%) triage staff members completed the NoMAD questionnaire, and 90.2% (156/173) of the participants had used the DOTTS for over 6 months. The digital application was used as much as possible or always by 137 of 173 (79.2%) participants. The overall normalization process score was 3.77 (SD 0.36). The constructs coherence, cognitive participation, collective action, and reflexive monitoring scored 4.01 (SD 0.47), 4.05 (SD 0.45), 3.5 (SD 0.45), and 3.72 (SD 0.47), respectively. Analysis of the focus group discussion showed that the added value of the DOTTS was seen as a quality improvement for the care of pregnant women. Dedication of the complete multidisciplinary implementation team was important for facilitating normalization. Support from the medical staff and proper use by all disciplines involved in the triage were seen as facilitating factors. Participants appreciated training and evaluation, and indicated a need for ongoing training and evaluation in relation to goal achievement. Conclusions The DOTTS has been integrated into normal care in daily practice. Evaluation by the NoMAD questionnaire provided a positive overall score. These results are in line with or, in some aspects, better than the results of other evaluation studies. Key factors in the normalization process of the DOTTS in obstetric triage are the shared added value for stakeholders, the dedication of the complete multidisciplinary implementation team, and implementation plans that are tailor made in the practical context of the hospital.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Normalization After Implementation of the Digital Dutch Obstetric Telephone Triage System: Mixed Methods Study With a Questionnaire Survey and Focus Group Discussion

Engeltjes¹,

Rosman

Scheele³

et al. 2022

JMIR Form Res

Self Cite

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“…Inclusion of additional factors is supported by recent publications in the Netherlands where a new evidence-based, obstetric telephone triage system has been developed including assessment of maternal age, presence of coloured fluid loss and maternal panic 21. The guideline exhibits diagnostic validity22 and reliability23 further supporting the potential inclusion of additional factors in prehospital maternity telephone triage to enhance symptoms recognition and accurate assessment and response.…”

Section: Discussionmentioning

confidence: 96%

Emergency medical dispatchers’ experiences of using the Medical Priority Dispatch System telephone triage to identify maternity emergencies: a qualitative focus group study

Shaw,

Bannister,

Ariyibi

et al. 2024

BMJ Open

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ObjectivesThe ambulance service plays a pivotal role in the provision of care in out-of-hospital maternity emergencies. Telephone triage of this patient group is complex and must be sensitive to an emergency situation to prevent unnecessary delays in treatment. This study aimed to explore emergency medical dispatchers’ (EMDs) perceptions of the structured protocol they use.DesignVoluntary participation in semistructured phenomenological focus groups. The participants were asked to discuss their experiences of using Medical Priority Dispatch System Protocol 24 (pregnancy, childbirth and miscarriage). Thematic analysis was applied to code and group topics. Discussion between the EMDs is presented for each theme and their experiences, including quotes, are presented to offer an overview of the maternity protocol and its use.SettingA large urban UK ambulance service.Participants23 control room staff.ResultsPerceptions of maternity emergencies, challenges with key questions, the need for sensitivity surrounding miscarriage, using prearrival instructions and postdispatch instructions to help patients and ideas for additional ProQA functionality emerged as the five overarching themes. Protocol 24 was considered to reflect many of the clinical factors EMDs associate with maternity emergencies although further factors, including some non-clinical, were suggested for inclusion. Miscarriage and termination-related calls were thought to be challenging as the language of the protocol is designed for pregnancy. However, instructions were generally considered well written and user-friendly, although some were thought to be unnecessary. EMDs were largely positive regarding the ProQA software, but felt backward navigation was difficult if a situation changed.ConclusionsMaternity calls were considered rewarding but complex by EMDs. We suggest changes including the use of more sensitive language in response to miscarriage and termination and make recommendations for the omission and inclusion of specific instructions, as well as enhancements to key questions and functionality. Further research is needed to ensure focus group findings are generalisable to other services, particularly in other countries.

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“…Since 1 January 2016, emergency medical institutions have adopted and implemented a five‐step classification system based on the KTAS. The triage system includes information on symptoms and urgency (Engeltjes et al., 2021).…”

Section: Introductionmentioning

confidence: 99%

Incidence of overtriage and undertriage and associated factors: A cross‐sectional study using a secondary data analysis

Jung,

2023

Journal of Advanced Nursing

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BackgroundImproving triage accuracy for accurate patient identification and appropriate resource allocation is essential. Little is known about the trend of triage accuracy, and factors associated with mistriage vary from study to study.AimTo identify incidence and risk factors of mistriage, such as overtriage and undertriage.DesignThis is a cross‐sectional study.MethodsThe data came from the National Emergency Department Information System database in 2016–2020. All patients 15 years and older visiting emergency departments in Korea were assessed for eligibility, and 20,641,411 emergency patients' data were used. Multivariable logistic regressions were conducted to confirm the associated factors with overtriage and undertriage compared to expected triage. Demographic characteristics, disease‐related signs and triage‐related factors were independent variables.ResultsExpected triage decreased from 96.8% in 2016 to 95.7% in 2020. Overtriage (0.5%–0.7%) and undertriage (2.4%–3.3%) increased. The occupation that performed triage the most (over 85%) was nurses. Associated factors with overtriage were demographic characteristics (40–64 age group, female), disease‐related signs (known disease, direct visit) and triage‐related factors (regional emergency medical centre). Risk factors to undertriage were disease‐related signs (systolic/diastolic blood pressure and pulse rates within normal range).ConclusionsWhile the acuity degree remained within the recommended range, the accuracy of triage decreased, and there was a gradual increase in mistriaged cases. Nurses have performed most of the triage and played a key role in expected triage. Associated factors with overtriage were demographic characteristics, disease‐related signs and triage‐related factors and risk factors to undertriage were disease‐related signs.Patient or public contributionNo patient or public contribution.Implications for the professionNurses should be aware of what factors are associated with mistriage and why the factors cause mistriage to improve the triage accuracy because they are responsible for the majority of the triage assessments.

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Reliability of Dutch Obstetric Telephone Triage

Cited by 5 publications

References 31 publications

Evaluation of Normalization After Implementation of the Digital Dutch Obstetric Telephone Triage System: Mixed Methods Study With a Questionnaire Survey and Focus Group Discussion

Evaluation of Normalization After Implementation of the Digital Dutch Obstetric Telephone Triage System: Mixed Methods Study With a Questionnaire Survey and Focus Group Discussion

Emergency medical dispatchers’ experiences of using the Medical Priority Dispatch System telephone triage to identify maternity emergencies: a qualitative focus group study

Incidence of overtriage and undertriage and associated factors: A cross‐sectional study using a secondary data analysis

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