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

Abstract

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.

Possible associations between callers’ degree-of-worry and their socioeconomic status when contacting out-of-hours services: a prospective cohort study

“…Callers' DOW was stored in their electronic medical record. An in-depth description of this data collection has been published previously [13].…”

“…For statistical purposes, DOW was dichotomized into two groups: low (DOW = 1-3) and high (DOW = 4-5), based on the association between DOW and hospitalization, where DOW = 4-5 showed significantly higher odds for hospitalization than DOW = 1-3 [13].…”

“…DOW has previously been shown to be feasible and associated with callers' illness representation [12]. It has also been shown that high DOW is strongly associated with hospitalisation [13], but that call handlers' awareness of callers' DOW had no effect on triage response [14]. There continues to be many unexamined aspects regarding the implementation of DOW as a patient-reported outcome measure.…”

Associations between degree-of-worry, self-rated health and acute hospitalisation after contacting a medical helpline: a Danish prospective cohort study

“…However, a non-respondent analysis within the larger prospective cohort study showed that non-responders did not differ from the study population regarding age, sex and triage outcome. 13 Yet, the risk that other sociodemographic factors not adjusted for may have introduced selection bias, thus confounding the results, cannot be ruled out. For example, callers with low SES may be under-represented due to difficulties in engaging this group in survey participation, 19 resulting in an unknown effect on the association between SRH/ DOW and acute hospitalisation.…”

Malpractice claimed calls within the Swedish Healthcare Direct: a descriptive – comparative case study

“…Patient safety in telephone nursing can be enhanced by using a CDSS [7,8], but other aspects may affect the triage process. The gender of the care-seeker [3], callers self-rated worry [21] might affect the telephone nurses, and cues of physical dominance (voices with a low fundamental frequency and formant frequencies) have been shown to lead to higher evaluation of medical emergency [22]. In addition, limiting the time for each call, to increase accessibility, can result in stress [23] and, thus, negatively affect patient safety.…”