Background
Methods
Design and setting
GP cooperative (GPC) | Medical helpline 1813 (MH-1813) | |
---|---|---|
Region | Central Denmark Region | Capital Region of Denmark |
Population | 1.2 m citizens [28] | 1.8 m citizens [29] |
Telephone calls in 2014 [30] | 697,000 | 911,000 |
Organiser | GPs in the region | Regional administration |
Organisation and services | ▪ Telephone triage, home visits, and face-to-face consultations at the GPC ▪ GPs are obliged to take part in the service | ▪ Telephone triage and home visits run by MH-1813 ▪ Face-to-face consultations are located in hospital facilities and managed by EDs |
Remuneration of professionals | Fee for service | Payment by the hour |
Triage professional | GPs or GP trainees in their final year of speciality; no CDSS available | Nurses who are obliged to use a CDSS and option to redirect calls to a physician Physicians with different medical specialities (a minority being GPs) |
Selection of calls
Type | Definition/clarification |
---|---|
Frequent callers | Defined as patients with ≥7 calls during the two-week inclusion period (assessment of the triage quality could be difficult as the patient’s medical record from the OOH service could include important information on these patients that was available only to the triage professional and not to the assessor) |
Call by mistake | Calls with no caller answering the triage professional. |
Daytime calls | Calls performed during daytime (the telephone triage service at MH-1813 was available during daytime) |
Other health professionals | The caller was another healthcare professional, e.g. from a nursing home |
Administrative calls | The reason for calling was administrative, e.g. calling to get the number for the acute dentist |
Simple drug prescriptions | The patient called for renewal of a prescription that required little information sharing |
Preterm termination | Calls that were ended too early, e.g. calls made by error, no sound on call, or sound interrupted in the middle of call |
Other localisation | Calls from a caller who was not in the same location as the patient, e.g. parent on the way to pick up a sick child from day care |
Poor sound quality | Calls with poor sound quality (making assessment difficult) |
Language issues | Calls in which language issues challenged the triage, i.e. caller did not speak Danish or English |
Not able to identify call | Random calls where an exact linkage to the corresponding audio-recorded call or the audio recording could not be established |
Assessment tool
Items assessing specific health-related aspects | |
1: | Collects information about location |
2: | Asks to speak to the patient when caller has briefly described the situation |
3: | Identifies and acts appropriately on signs that could be critical or life-threatening for the patient (signs of problems according to the ABCDE criteria) |
4: | Identifies and uncovers problems, including symptoms and their development |
5: | Identifies and states the purpose of the patient’s call |
6: | Prioritises the presented problems and symptoms appropriately |
7: | Asks (as a minimum) all essential questions concerning the problem(s) and symptom(s) to gain the information required for optimal triage |
8: | Asks the relevant questions concerning previous medical history and medications |
9: | Gives relevant advice on self-care |
10: | Gives relevant advice on safety netting |
11: | Selects optimal triage decision |
Items assessing overall quality: | |
22: | How would you assess the overall health-professional quality? |
23: | How would you assess the overall patient safety? |
24: | How would you assess the overall efficiency? |
Assessment panel
Assessment process
Statistical analyses
Results
Population
Triage professional | GP (n = 423) | Nurse (n = 430) | Physician (n = 441) |
---|---|---|---|
Patient characteristics | |||
Sex, % (n) £ | |||
Male | 42.8 (181) | 37.9 (163) | 47.2 (208) |
Female | 57.2 (242) | 62.1 (267) | 52.8 (233) |
Age group in years, % (n) | |||
0–4 | 20.3 (86) | 23.6 (101) | 21.9 (96) |
5–17 | 15.8 (67) | 13.3 (57) | 14.8 (65) |
18–39 | 29.6 (125) | 31.5 (135) | 30.6 (134) |
40–64 | 21.8 (92) | 20.6 (88) | 20.1 (88) |
≥65 | 12.5 (53) | 11.0 (47) | 12.6 (55) |
Call characteristics | |||
Time of calla, % (n) | |||
Weekend | 51.6 (218) | 51.2 (220) | 50.3 (222) |
Not weekend | 48.5 (205) | 48.8 (210) | 49.7 (219 |
Day | 22.2 (94) | 22.6 (97) | 21.1 (93) |
Evening | 61.5 (260) | 60.9 (262) | 61.5 (271) |
Night | 16.3 (69) | 16.5 (71) | 17.5 (77) |
Length of call, min and sec (SD - sec)£ | |||
Mean | 2 min 57 s (105) b | 4 min 44 s (168)* | 4 min 1 s (146)* |
Health-related specific items
Health-related specific items (AQTT) | Triage professional | Not applicablea (%) | Poor quality % (n) | RR for poor quality (95% CI) | Adjusted RRc poor quality (95% CI) |
---|---|---|---|---|---|
1: Collects information about locationb | GP | 70.7 | 32.3 (40) | 1 | 1 |
Nurse | 60.9 | 28.0 (47) | 0.87 (0.61–1.23)P = 0.43 | 0.91 (0.61–1.34) P = 0.62 | |
Physician | 65.1 | 23.4 (36) | 0.72 (0.49–1.01) P = 0.10 | 0.75 (0.51–1.10) P = 0.142 | |
2: Asks to speak to the patient when the caller has briefly described the situationb | GP | 87.2 | 79.6 (43) | 1 | 1 |
Nurse | 85.8 | 54.1 (33) | 0.68 (0.52–0.89)* P = 0.01 | 0.71 (0.51–0.98)* P = 0.04 | |
Physician | 83.9 | 73.2 (52) | 0.92 (0.76–1.12) P = 0.40 | 0.94 (0.75–1.17) P = 0.57 | |
3: Identifies and acts appropriately on signs that could be critical or life-threatening for the patient (signs of problems according to the ABCDE criteria) | GP | 73.5 | 42.9 (48) | 1 | 1 |
Nurse | 69.5 | 36.6 (48) | 0.85 (0.63–1.17) P = 0.32 | 0.74 (0.55–1.00) P = 0.05 | |
Physician | 68.3 | 55.0 (77) | 1.28 (0.99–1.67) P = 0.06 | 1.31 (1.00–1.70)* P = 0.05 | |
4: Identifies and uncovers problems, including symptoms and their development | GP | 1.0 | 30.3 (127) | 1 | 1 |
Nurse | 0.5 | 19.9 (85) | 0.66 (0.52–0.83)* P = 0.00 | 0.61 (0.47–0.80)* P = 0.00 | |
Physician | 0.2 | 34.1 (150) | 1.12 (0.93–1.37) P = 0.24 | 1.09 (0.89–1.34) P = 0.39 | |
5: Identifies and states the purpose of the patient’s call | GP | 20.3 | 24.3 (82) | 1 | 1 |
Nurse | 19.3 | 19.0 (66) | 0.78 (0.59–1.04) P = 0.09 | 0.76 (0.54–1.70) P = 0.12 | |
Physician | 19.1 | 28.3 (101) | 1.16 (0.91–1.49) P = 0.24 | 1.14 (0.86–1.50) P = 0.37 | |
6: Prioritises the presented problems and symptoms in an appropriate way | GP | 1.2 | 27.5 (115) | 1 | 1 |
Nurse | 0.5 | 25.9 (111) | 0.94 (0.75–1.18) P = 0.0.60 | 0.81 (0.63–1.03) P = 0.8 | |
Physician | 1.8 | 37.6 (163) | 1.37 (1.12–1.67)* P = 0.00 | 1.28 (1.05–1.57)* P = 0.02 | |
7: Asks, as a minimum, all the essential questions concerning the problem(s) and symptom(s) required for optimal triage | GP | 0.5 | 35.9 (151) | 1 | 1 |
Nurse | 0.0 | 27.7 (119) | 0.77 (0.63–0.94)* P = 0.01 | 0.74 (0.59–0.93)* P = 0.01 | |
Physician | 1.1 | 43.8 (191) | 1.22 (1.03–1.44)* P = 0.02 | 1.20 (1.01–1.42)* P = 0.04 | |
8: Asks the relevant questions concerning previous medical history and medications | GP | 32.2 | 49.5 (142) | 1 | 1 |
Nurse | 24.0 | 40.4 (132) | 0.82 (0.68–0.97)* P = 0.02 | 0.75 (0.61–0.91)* P = 0.00 | |
Physician | 28.3 | 59.2 (187) | 1.20 (1.03–1.39)* P = 0.02 | 1.15 (0.98–1.34) P = 0.09 | |
9: Gives relevant advice on self-care | GP | 34.0 | 29.8 (83) | 1 | 1 |
Nurse | 52.1 | 35.0 (72) | 1.17 (0.91–1.52) P = 0.22 | 0.93 (0.71–1.22) P = 0.60 | |
Physician | 38.6 | 42.1 (114) | 1.41 (1.13–1.78)* P = 0.00 | 1.30 (1.03–1.64)* P = 0.03 | |
10: Gives relevant advice on safety netting | GP | 36.9 | 40.5 (108) | 1 | 1 |
Nurse | 55.4 | 34.4 (66) | 0.85 (0.67–1.08) P = 0.20 | 0.75 (0.58–0.97)* P = 0.03 | |
Physician | 41.7 | 40.9 (105) | 1.01 (0.82–1.24) P = 0.93 | 0.98 (0.79–1.20) P = 0.81 |
Accuracy of triage outcome
Overall perceived quality
Overall assessed quality (AQTT)a | Triage professional | Median (10th 90th percentile) |
---|---|---|
22: How would you rate the overall health-professional quality in the telephone triage? | GP | 7 (3 to 10) |
Nurse | 6 (2 to 9)* P = 0.00 | |
Physician | 6 (2 to 9)** P = 0.00 | |
23: How would you rate the overall patient safety in the telephone triage? | GP | 8 (3 to 10) |
Nurse | 8 (3 to 10) P = 0.09 | |
Physician | 7 (2 to 10)* P = 0.03 | |
24: How would you rate the overall efficiency in the telephone triage? | GP | 8 (4 to 10) |
Nurse 1813 | 6 (2 to 9)** P = 0.00 | |
Physician 1813 | 7 (2 to 10)** P = 0.00 |