Self-rated worry in acute care telephone triage: a mixed-methods study

Gamst‐Jensen, Hejdi; Huibers, Linda; Pedersen, Kristoffer; Christensen, Erika Frischknecht; Ersbøll, Annette Kjær; Lippert, Freddy; Egerod, Ingrid

doi:10.3399/bjgp18x695021

Cited by 30 publications

(46 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This medical helpline handles on average 924 000 calls a year, of which most are answered by triage nurses 7. They pre-assess the need for the caller to access acute medical help, which makes them play a dominant role in gatekeeping the healthcare system 21 22. The triage nurses can respond with several actions such as booking an appointment at an acute admission centre, emergency clinic or psychiatric admission centre, forward the call to the EMDC-112 or a doctor, plan a home visit, recommend the patient to contact the GP on the next working day or give telephone advice for self-care 19 21…”

Section: Methodsmentioning

confidence: 99%

Satisfaction of 30 402 callers to a medical helpline of the Emergency Medical Services Copenhagen: a retrospective cohort study

et al. 2019

View full text Add to dashboard Cite

ObjectivesTo keep healthcare systems sustainable for future demands, many countries are developing a centralised telephone line for out-of-hours primary care services. To increase the quality of such services, more information is needed on factors that influence caller satisfaction. The aim of this study was to identify demographic and call-related characteristics that are associated with the patient satisfaction of callers to a medical helpline in Denmark.DesignRetrospective cohort study on patient registry data and questionnaire results.SettingNon-emergency medical helpline in the Capital Region of Denmark.ParticipantsA random sample of 30 402 callers to the medical helpline between May 2016 and May 2018.Primary and secondary outcome measuresResponses of a satisfaction questionnaire were linked to demographic and call-related dispatch data. Associations between the characteristics were analysed with multivariable logistic regression analysis with satisfaction as the dependent variable. A subgroup analysis was performed on callers for children aged between 0 and 4 years.ResultsOf the 30 402 analysed callers, 73.0% were satisfied with the medical helpline. Satisfaction was associated with calling for a somatic injury (OR: 1.96, 95% CI: 1.72 to 2.23), receiving a face-to-face consultation (OR: 2.27, 95% CI: 2.04 to 2.50) and a waiting time less than 10 min (OR: 1.82, 95% CI: 1.56 to 2.08). Callers for a 0-year to 4-year-old patient were more likely to be satisfied when they called for a somatic illness or received a telephone consultation, compared with the rest of the population (p<0.0001).ConclusionCallers were in general satisfied with the medical helpline. Satisfaction was associated with reason for encounter, triage response and waiting time. People calling for 0-year to 4-year-old patients were, compared with the rest of the population, more frequently satisfied when they called for a somatic illness or received a telephone consultation.

show abstract

Section: Methodsmentioning

confidence: 99%

Satisfaction of 30 402 callers to a medical helpline of the Emergency Medical Services Copenhagen: a retrospective cohort study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…: "you say you score four in worry, why is that?" [18]. The strength of this scale lies in the simplicity and a systematic implementation of DOW in triage could increase patient-centered communication and emphasize the focus on the patient's psychosocial resources in acute illness/injury, by simply asking the question of DOW and asking why DOW was rated to the specific number.…”

Section: Comparison With the Literaturementioning

confidence: 99%

“…Worry, or concern, is the most frequent motivator for seeking help out-of-hours, and studies of malpractice claims in telephone triage show, that a failure to listen to the patient and the use of closed questions compromise patient safety [15][16][17]. The newly developed degree-of-worry scale (DOW), which was tested on 180 callers at a medical helpline, showed promising results to aid patient centered communication, in the regard that patients volunteered more medical-and-context-related information [18]. Moreover, self-rated health has been recognized as a valid predictor of all-cause mortality for decades.…”

Section: Introductionmentioning

confidence: 99%

Self-rated worry is associated with hospital admission in out-of-hours telephone triage – a prospective cohort study

Gamst‐Jensen

Christensen

Lippert

et al. 2020

Scand J Trauma Resusc Emerg Med

Self Cite

View full text Add to dashboard Cite

Objective: Telephone triage manages patient flow in acute care, but a lack of visual cues and vague descriptions of symptoms challenges clinical decision making. We aim to investigate the association between the caller's subjective perception of illness severity expressed as "degree-of-worry" (DOW) and hospital admissions within 48 h. Design and setting: A prospective cohort study was performed from January 24th to February 9th, 2017 at the Medical Helpline 1813 (MH1813) in Copenhagen, Denmark. The MH1813 is a primary care out-of-hours service. Participants: Of 38,787 calls received at the MH1813, 11,338 met the inclusion criteria (caller being patient or close friend/relative and agreement to participate). Participants rated their DOW on a 5-point scale (1 = minimum worry, 5 = maximum worry) before talking to a call handler. Main outcome measure: Information on hospitalization within 48 h after the call, was obtained from the Danish National Patient Register. The association was assessed using logistic regression in three models: 1) crude, 2) ageand-gender adjusted and 3) age, gender, co-morbidity, reason for calling and caller status adjusted. Results: A total of 581 participants (5.1%) were admitted to the hospital, of whom 170 (11.3%) presented with a maximum DOW, with a crude odds ratio (OR) for hospitalization of 6.1 (95% confidence interval (CI) 3.9 to 9.6) compared to minimum DOW. Estimates showed dose-response relationship between DOW and hospitalization. In the fully adjusted model, the ORs decreased to 3.1 (95%CI 2.0 to 5.0) for DOW = 5, 3.2 (2.0 to 5.0) for DOW = 4, 1.6 (1.0 to 2.6) for DOW = 3 and 0.8 (0.5 to 1.4) for DOW = 2 compared to minimum DOW. Conclusion: Patients' self-assessment of illness severity as DOW was associated with subsequent hospital admission. Further, it may be beneficial in supporting clinical decision making in telephone triage. Finally, it might be useful as a measure to facilitate patient participation in the triage process.

show abstract

“… 28–30 However, EAB users were older, more often retired/unemployed, and more often anxious people of poorer health than the other groups. Citizens with these socio-demographic traits have previously been found to exhibit more frequent help-seeking 33 34 and higher degrees of worry; 35 these citizens could thus be more vulnerable and have a stronger need for increased feeling of safety, which the EAB provides. 15 Moreover, reporting an increased feeling of safety when using the EAB option could also be subject to social desirability bias, 36 and could be related to the higher proportion of EAB users triaged to an increased service level (ie, EAB users were significantly more frequently referred to a home visit, a hospital admittance or ambulance care than the other two subgroups).…”

Section: Discussionmentioning

confidence: 99%

Does an emergency access button increase the patients’ satisfaction and feeling of safety with the out-of-hours health services? A randomised controlled trial in Denmark

et al. 2020

View full text Add to dashboard Cite

ObjectiveTo investigate if the option to bypass the telephone queue can increase satisfaction and feeling of safety in callers.DesignRandomised controlled parallel superiority trial. Data from questionnaire survey.SettingTwo out-of-hours (OOH) services in Denmark.Participants217 510 citizens who called the OOH services between 4 September 2017 and 30 November 2017.RandomisationTwo-faze study period: First half with randomisation of participants based on their date of birth; even date randomised to intervention, uneven date randomised to control group. Second half with all participants included in intervention group.InterventionProviding randomised callers (intervention group n=146 355) with the option to bypass the telephone waiting line through an emergency access button (EAB), while the rest got the normal service (control group n=71 155). All EAB users were invited to a questionnaire survey as well as random participants who did not use the EAB (of whom approximately 50% did not have the EAB option).Main outcome measuresSatisfaction and feeling of safety in callers.Results2208 of 6704 (32.9%) invited callers answered the questionnaire (intervention group n=1415 (users n=621, non-users n=794); control group n=793). The OR for answering in the two categories with highest satisfaction when provided with the EAB option was 1.34 (95% CI 1.07 to 1.68) for satisfaction with the waiting time, 1.21 (95% CI 0.91 to 1.60) for overall satisfaction and 1.46 (95% CI 1.12 to 1.89) for feeling of safety. Approximately 72% (441/621) of EAB users reported that the EAB option increased their feeling of safety with the OOH services ‘to a high degree’ compared with 25% (197/794) of callers who had the EAB option without using it.ConclusionsThe EAB can provide fast access to OOH telephone advice in case of severe illness. It favours citizens perceived in most need of urgent healthcare and significantly increases both feeling of safety and patient satisfaction.Trial registration detailsNCT02572115 (5 October 2015).

show abstract

Self-rated worry in acute care telephone triage: a mixed-methods study

Abstract: ConclusionCallers were able to rate their degree of worry. The degree of worry scale is feasible for largerscale studies if incorporating a patient-centred approach in out-of-hours telephone triage.

Cited by 30 publications

References 23 publications

Satisfaction of 30 402 callers to a medical helpline of the Emergency Medical Services Copenhagen: a retrospective cohort study

Satisfaction of 30 402 callers to a medical helpline of the Emergency Medical Services Copenhagen: a retrospective cohort study

Self-rated worry is associated with hospital admission in out-of-hours telephone triage – a prospective cohort study

Does an emergency access button increase the patients’ satisfaction and feeling of safety with the out-of-hours health services? A randomised controlled trial in Denmark

Contact Info

Product

Resources

About