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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

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  • Dennis Schou Graversen
  • Linda Huibers
  • Morten Bondo Christensen
  • Flemming Bro
  • Helle Collatz Christensen
  • Claus Høstrup Vestergaard
  • Anette Fischer Pedersen
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OBJECTIVES: To compare the quality of communication in out-of-hours (OOH) telephone triage conducted by general practitioners (GPs), nurses using a computerised decision support system and physicians with different medical specialities, and to explore the association between communication quality and efficiency, length of call and the accuracy of telephone triage.

DESIGN: Natural quasi-experimental cross-sectional study.

SETTING: Two Danish OOH services using different telephone triage models: a GP cooperative and the medical helpline 1813.

PARTICIPANTS: 1294 audio-recorded randomly selected OOH telephone triage calls from 2016 conducted by GPs (n=423), nurses using CDSS (n=430) and physicians with different medical specialities (n=441).

MAIN OUTCOME MEASURES: Twenty-four physicians assessed the calls. The panel used a validated assessment tool (Assessment of Quality in Telephone Triage, AQTT) to measure nine aspects of communication, overall perceived communication quality, efficiency and length of call.

RESULTS: The risk of poor quality was significantly higher in calls triaged by GPs compared with calls triaged by nurses regarding 'allowing the caller to describe the situation' (GP: 13.5% nurse: 9.8%), 'mastering questioning techniques' (GP: 27.4% nurse: 21.1%), 'summarising' (GP: 33.0% nurse: 21.0%) and 'paying attention to caller's experience' (GP: 25.7% nurse: 17.0%). The risk of poor quality was significantly higher in calls triaged by physicians compared with calls triaged by GPs in five out of nine items. GP calls were significantly shorter (2 min 57 s) than nurse calls (4 min 44 s) and physician calls (4 min 1 s). Undertriaged calls were rated lower than optimally triaged calls for overall quality of communication (p<0.001) and all specific items.

CONCLUSIONS: Compared with telephone triage by GPs, the communication quality was higher in calls triaged by nurses and lower in calls triaged by physicians with different medical specialities. However, calls triaged by nurses and physicians were longer and perceived less efficient. Quality of communication was associated with accurate triage.

OriginalsprogEngelsk
TidsskriftBMJ Open
Vol/bind10
Udgave nummer3
Sider (fra-til)e033528
ISSN2044-6055
DOI
StatusUdgivet - 26 mar. 2020

ID: 60009205