Background
Methods
Setting
The quantitative study
Data in the quantitative strand were used to identify Potentially Under-Triaged Calls (PUTCs) and to describe the distribution of diagnoses using the ICD-10 codes. For a call to be identified as a PUTC it had to meet three criteria: BOX: PUTC criteria
1) Caller used the Medical Hotline number, and was NOT offered a home visit and was NOT offered an appointment at an Emergency Department, or hospitalised,
AND
2) Caller used the Emergency number 112 for an ambulance within two hours of the first contact,
AND
3) Caller was admitted to hospital later by ambulance. |
The qualitative study
Data generation
Data analysis
Results
Quantitative results
Qualitative results
Caller | Patient, Sex/age | OOH hotline problem | Admission diagnosis | RICE rating | Other | |
---|---|---|---|---|---|---|
1 | Patient | Male, 64 | Smoke inhalation | Observation of smoke inhalation | 71% | Admission for social reasons |
2 | Patient | Female, 79 | Abdominal pain | Observation of AMI | 86% | n/a |
3 | Daughter | Female, 68 | Nose bleed | Defect of septum | 80% (a)a
77% (b) | n/a |
4 | Friend | Female, 40 | Dizziness | Vertigo | 56% | Language difficulties |
5 | Mother | male < 1 | Diarrhea and vomiting | Syncope | 89% (a) 82% (b) | n/a |
6 | Mother | Female, 4 | Laryngitis | Epiglottis | 90% (a) 79% (b) 87% (c) | n/a |
7 | Husband | Female, 75 years | Abdominal pain | Missed STEMI | 77% (a) 75% (b) 95% (c) | n/a |
8 | Mother | Female, 8 | Diarrhea and vomiting | Dehydration | 88% | n/a |
9 | Patient | Female, 53 | Allergic reaction | Perioral edema | 84% | n/a |
10 | Patient | Male, 45 | Abdominal pain | Gallstone | 94% (a) 84% (b) | n/a |
11 | Patient | Female, 81 | Abdominal pain | Gallstone | 89% | n/a |
12 | Patient | Female, 17 | Abdominal pain | Abdominal pain | 98% (a) 60% (b) | n/a |
13 | Patient | Female, 45 | Headache/ dizziness | Chronic post-traumatic headache after SAH | 96% (a) 82% (b) | Frequent caller |
14 | Patient | Male, 64 | Edema of lower extremity | Obs. DVT | 75% | n/a |
15 | Spouse | Male, 28 | Fainting | Observation for neurological problem | 88% (a) 92% (b) | n/a |
16 | Spouse | Male, 25 | Hyperglycemia and intoxication | Hyperglycemia | 94% | n/a |
17 | Friend | Male, 56 | Fever and abdominal pain | Chronic liver cirrhosis | 83% (a) 58% (b) | n/a |
18 | Patient | Female, 28 | Bleeding after vaginal delivery 5 days earlier | Small post-partum bleeding | 89% (a) 95% (b) | n/a |
19 | Daughter | Male, 52 | Fever and malaise | Sepsis | 29% | n/a |
Participant | Codes | Themes | CO-CONSTRUCTING THE PROBLEM |
Call-handler response | Clarifying history of problem Acknowledging caller experience Individualized communication Providing advice in blocks Empowering caller Educating caller Agreement of plan | The professional communication | |
Condescending, irritated, patronizing communication Ignoring patient perspective, minimizing magnitude of problem | The non-professional role | ||
Lack of control with conversation Providing unclear advice Disagreeing with caller Non-individualized communication Unable to collaborate with caller | The non-professional Communication | ||
Gate keeper Fixation error Uncharacteristic problem Lack of agreement on problem, urgency and plan | The difficult decision making | ||
Caller response | Clear description of problem Clear description of temporal progression of problem Self-evaluation of problem Agreement of plan | The constructive caller | |
Vague and/or lengthy description of actual problem Cerebrally impaired Time line Insecurity Talking down symptoms | The complicated caller | ||
Lacking problem solving/self-care before calling Contradictive information (+vocal appearance) | The un-constructive caller | ||
Caller under the influence Caller is very emotional | The caller is inebriated/intoxicated | ||
Calling during GP office hours Unrealistic expectations | The caller has unrealistic expectations of outcome | ||
Caller is not patient, caller is not with patient | Proximity to patient (physical/relative) |