Under-triage in telephone consultation is related to non-normative symptom description and interpersonal communication: a mixed methods study

Abstract

BackgroundTelephone consultation and triage are used to limit the workload on emergency departments. Lack of visual cues and clinical tests put telephone consultations to a disadvantage compared to face-to-face consultations increasing the risk of under-triage. Under-triage occurs in telephone triage; however why under-triage happens is not explored yet. The aim of the study was to describe situations of under-triage in context, to assess the quality of under-triaged calls, and to identify communication patterns contributing to under-triage in a regional OOH service in the capital region of Denmark.MethodsExplanatory simultaneous mixed method with thematic analysis and descriptive statistics was chosen. The study was carried out in an Out-Of-Hours service (OOH) in the Capital Region of Denmark, Copenhagen. Under-triage was defined as Potentially Under-Triaged Calls (PUTC) by specific criteria to an OOH Hotline, and identification by integration of three databases: Medical Hotline database, Emergency number database, including the Ambulance database, and electronic patient records. Distribution of PUTC were carried out using ICD-10 codes to identify diagnosis and main themes identified by qualitative analysis of audio recorded under-triaged calls. Study period was October 15th to November 30th 2014.ResultsThree hundred twenty seven PUTC were identified, representing 0.04% of all calls (n = 937.056) to the OOH. Distribution of PUTC according to diagnoses was: digestive (24%), circulatory (19%), respiratory (15%) and all others (42%). Thematic analysis of the voice logs suggested that inadequate communication and non-normative symptom description contributed to under-triage.DiscussionThe incidence of potentially under-triage is low (0.04%). However, the over-representation of digestive, circulatory, and respiratory diagnoses might suggest that under-triage is related to inadequate symptom description. We recommend that caller and call-handler collaborate systematically on problem identification and negotiate non-normative symptom description.ConclusionThe incidence of under-triage is low (0.04%). However, the over-representation of digestive, circulatory, and respiratory diagnoses might suggest that under-triage is related to inadequate symptom description. We recommend that caller and call-handler collaborate systematically on problem identification and negotiate non-normative symptom description.

Relation between illness representation and self-reported degree-of-worry in patients calling out-of-hours services: a mixed-methods study in Copenhagen, Denmark

“… 2 Studies show that the quality of telephone triage improves with communication between patient and health professional being patient centred rather than disease centred 3 and that non-normative symptom description and poor communication contribute to under triage. 4 Triage tools, for example, computerised decision support systems are used to aid the triage process 5 ; however, these tools focus on medical information and less on psychosocial or affective information. 6 …”

Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study

“…Telephone contact is used variably for assessment and triage of acute problems; [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] general practice consultations; [34][35][36][37][38][39][40] to offer health education; 41,42 and to offer support for those with chronic illness 43,44 or those in need of palliative care. 45 The literature on telephone consultations consists largely of small and heterogeneous primary studies, most of which had practical challenges or methodological flaws.…”

Communication quality in telephone triage conducted by general practitioners, nurses or physicians: a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark

“…34 35 The GPC and the MH-1813 are open outside office hours, that is, from 16:00 to 08:00 on weekdays, all day on weekends, and all day on national holidays and during OOH they provide telephone triage for inhabitants of the entire region. 35 MH-1813 can also be reached during…”