Tips for effective telephone triage

With the tight schedules imposed by managed care, physicians find themselves providing more initial care over the phone. These pointers will help your office staff take over the chore of determining which patients need to see you and which don't.     

After-hours telephone triage affects patient safety

OBJECTIVE: To describe the management of after-hours calls to primary care physicians and identify potential errors that might delay evaluation and treatment. STUDY DESIGN: Survey of primary care practices and audit of after-hours phone calls. Ninety-one primary care offices (family medicine, internal medicine, obstetrics, and pediatrics) were surveyed in October and November 2001. Data collected included number of persons answering the calls, information requested, instructions to patients, who decided whether to contact the on-call physician, and subsequent handling of all calls. We evaluated all after-hours calls to an index office that were not forwarded to the on-call physician. Four family physicians independently reviewed the calls while unaware that these calls had not been forwarded to the physician on call to determine the appropriate triage. POPULATION: Primary care physicians and their telephone answering services. OUTCOME MEASURES (1) Who decided to initiate immediate contact with the physician? (2) Percentage of calls identified as emergent or nonemergent by patients. (3) Independent physician ratings of nonemergent calls. RESULTS: More than two thirds of the offices used answering services to take their calls. Ninety-three percent of the practices required the patient to decide whether the problem was emergent enough to require immediate notification of the on-call physician. Physician reviewers reported that 50% (range, 22%-77%) of the calls not forwarded to the on-call physician represented an emergency needing immediate contact with the physician. CONCLUSIONS: After-hours call systems in most primary care offices impose barriers that may delay care. All clinical patient calls should be sent to appropriately trained medical personnel for triage decisions. We urge all clinicians that use an answering service to examine their policies and procedures for possible sources of medical error.     

Nurse telephone triage: good quality associated with appropriate decisions

Background Triage at out-of-hours GP cooperatives (GPCs) is aimed at determining medical urgency and guiding decisions. Both medical knowledge and communication skills are required for this complex task. Objective To explore the impact of quality of consultation and estimated urgency on the appropriateness of decisions. Methods We performed a secondary analysis of telephone triage consultations by nurses at 29 Dutch GPCs. Consultations were taped and assessed by trained observers, using a validated instrument. Measures concerned quality of consultation, nurse-estimated urgency (four levels) and appropriateness of decisions (urgency, follow-up advice and timing). Bivariate analyses and logistic multilevel regression analyses were used to explore the impact of quality of consultation (controlling for urgency) on appropriateness of decisions. Results The sample included 6739 telephone contacts, most of which (90%) were non-urgent. The majority of decisions were appropriate (91% for urgency, 96% for follow-up advice and 95% for timing). In bivariate analyses, appropriateness of decisions was positively related to higher quality of consultation. Estimated urgency was negatively associated with quality of consultation. Logistic multilevel analysis showed that higher quality of consultation was related to a more appropriate estimation of urgency [odds ratio (OR) = 1.82; 95% confidence interval (CI): 1.69-1.95], follow-up advice (OR = 2.69; 95% CI: 2.41-3.01) and timing of decisions (OR = 2.41; 95% CI: 2.20-2.63). Conclusions High quality of consultation has a positive, but small, impact on the appropriateness of decisions. Quality of consultation needs to be targeted in training and support of triage nurses, especially when it concerns highly urgent contacts.     

急腹症病人的分诊技巧

目的:使病人在正确的时间、正确的地点、得到正确的救治,以提高抢救成功率.方法:依照先重后轻、先急后缓的原则对病人进行预检分诊,重危患者开辟"绿色通道".结果:简化了就诊手续,缩短了就诊时间.结论:掌握分诊技巧,可使患者得到及时有效地救护,提高了抢救成功率.     

电话随访对精神分裂症患者康复的价值分析

目的 探讨电话随访对精神分裂症患者的康复价值.方法 将200例精神分裂症患者随机分为电话随访组和对照组,每组100例.患者临床痊愈出院后,对照组门诊随诊,随访组电话随访干预,时间2年.用阳性与阴性症状量表（PANSS）、社会功能缺陷筛查量表（SDSS）和精神分裂症生活质量量表（SQLS）分别评定患者病情、社会功能和生活质量的变化,并进行康复成本-效益分析.结果 随访组各评分时段（出院6、12、18、24月）3个量表总分减分幅度大于或增分幅度小于对照组,差异均有统计学意义（P＜0.01）,各时段累计总成本明显低于对照组,总效益和效益／成本比值均明显大于对照组,差异均有统计学意义（P＜0.01）.结论 电话随访有助于提高精神分裂症患者康复效益,降低康复成本,可极大地提高卫生资源的利用效益,比门诊随诊具有更好的康复价值.     

昏迷患者的急诊分诊护理探讨

目的旨在提高急诊护理对昏迷患者救治的效果.方法回顾分析35例急诊昏迷患者的分诊护理工作.形成积极有序的急诊分诊护理措施.结果28例昏迷患者有效分诊,其中26例患者生命体征基本稳定,2例患者病情恶化,有效分诊率为74.3%.结论积极有序的分诊护理措施是急诊昏迷救治有效保障之一.     

Computerized telephone nurse triage. An evaluation of service quality and cost

The current reimbursement structure of health care in the United States motivates the providers of health care services to deliver these services with a cost-conscious mentality without compromising quality. This has led to the development of alternative methods of delivering health care services, one of which is computerized telephone nurse triage. This study investigates service quality from the perception of callers who used this system on behalf of a pediatric client. Cost was evaluated by comparing what the caller would have done if they did not speak with nurse triage with what they actually did after their interaction. A modified version of the SERVQUAL tool was administered via telephone survey to members of a managed health care plan who recently used nurse triage services for a pediatric patient. Findings were that the majority of callers--employed female parents--rated the level of service quality very highly. Education, employment status, age of the caller, child gender, birth order among siblings, and age of child did not affect the rating of service quality. Relationship to the child had an effect on the rating of service quality as men/fathers rated the level of service quality slightly lower than their female/mother counterparts. The evaluation of cost revealed that the action taken by the caller after they spoke with the nurse resulted in significant cost savings. Computerized telephone nurse triage is a well-accepted cost-saving alternative method of health care delivery that can effectively serve a variety of callers and pediatric patients.     

电话随访对于人工流产后口服优思明患者的影响

目的探讨通过电话随访提供健康教育及指导对于提高患者人工流产（人流）后口服优思明服药依从性及其在一定程度上减少人流并发症的影响。方法将228例门诊人流后即日起开始口服优思明的患者随机分为随访组（114例）和对照组（114例）,两组患者均在手术后离开时给予常规口头及书面优思明用法以及对避孕、减少宫腔粘连、调节内分泌功能,促进子宫内膜修复。促进月经复潮等方面优点的健康教育。随访组还接受电话随访健康教育,且患者可随时咨询预约护士。结果两组患者从服药依从性、不规则阴道流血发生率、子宫内膜修复等方面比较,差异均有统计学意义（P〈0．01）,随访组优于对照组。结论对门诊人流后即日起开始口服优思明的患者实施电话随访,延续健康教育,有助于提高患者服药依从性,从而有效提高其避孕成功率,对减少并发症,提高患者生活质量有积极作用。     

Differences between surrogate telephone triage calls in an adult population and self calls

We reviewed surrogate calls (i.e. those made on behalf of the patient) to a national triage call centre to determine whether there were differences between calls made by surrogates and self calls. During a three-year period there were 14,646 calls (14% of the total) made by a surrogate on behalf of the patient. Surrogate calls, as a percentage of total calls, increased with the age of the patient from 12% in the 18-34 year age group to 43% in the 80 and over age group (P < 0.0001). The symptoms of vomiting or nausea and dizziness or light-headedness were significantly more likely to be reported by surrogate callers than self callers. Surrogates reported a higher original intention of taking patients to the hospital emergency department (ED) compared with self callers across all adult age groups (OR 1.64; 95% CI 1.57 to 1.71). A higher proportion (38%) of surrogate calls ended with the nurse recommending an ED visit compared with only 26% of self calls (OR 1.72; 95% CI 1.66 to 1.79). Calls about men accounted for 54% of surrogate calls but only 26% of self calls (OR 3.3; 95% CI 3.2 to 3.4), suggesting that surrogate calls may be a way of increasing medical access for men.     

'Dial-A-Doc' puts physicians on the line of 24-hour telephone info and triage system

Around-the-clock physician advice is a phone call away. Dial-A-Doc is a physician-staffed virtual call center being marketed directly to consumers, managed health plans, and employers.     

Nurse telephone triage in out-of-hours GP practice: determinants of independent advice and return consultation

Background

Personal continuity is a core value for family practice, but policy and performance targets emphasise other aspects of care, particularly waiting times for consultation. This study examined patient and general practitioner (GP) perceptions of the value of personal continuity and rapid access, and the relationship between them.

Methods

Qualitative analysis of semi-structured interviews with a purposive sample of 16 GPs and 32 patients in the Lothian region of Scotland, to identify whether, how, why and in which circumstances personal continuity and rapid access were valued.

Results

From the patients' perspective, what mattered was 'access to appropriate care' depending on the problem to be dealt with. For a few patients, rapid access was the only priority. For most, rapid access was balanced against greater involvement in the consultation when seeing 'their' trusted doctor, which was particularly valued for chronic, complex and emotional problems. GPs focused on the value of personal continuity in the consultation for improving the diagnosis and management of the same kinds of problem. GPs did not perceive enabling access to be a core part of their work. There was little evidence that GPs routinely discussed with patients when or how personal continuity and access should be balanced.

Conclusion

'Access to appropriate care' from the patients' perspective is not fully addressed by GPs' focus on personal continuity, nor by performance targets focused only on speed of access. GPs need to make enabling access as much a part of their core values as personal continuity, and access targets need to be based on less simplistic measures that account for the appropriateness of care as well as speed of access.     

电话访视对PICC置管患者院外延续护理的效果

目的探讨电话回访对PICC置管患者出院后延续护理的效果。方法选取我院2016年100例PICC置管首次带管出院的肿瘤患者,随机分组为干预组和对照组,每组各50例。对照组给予常规出院护理,干预组除了常规出院护理,并通过电话回访给予患者PICC置管的护理和患者自我管理的监督教育。对比分析干预实施后两组患者导管并发症和对延续护理满意度的结果。结果干预实施1个月和3个月后,干预组患者PICC置管的并发症发生率和对院外延续护理的满意度均明显优于对照组,差异具有统计学意义(P﹤0.05)。结论基于电话回访的延续性护理可以明显降低患者的PICC置管并发症,提高患者对延续护理的满意度,值得推广使用。     

多层螺旋CT与超声对急性阑尾炎的诊断价值

目的 探讨多层螺旋CT与超声对急性阑尾炎的诊断价值.方法 选取2018年7月至2020年7月东莞市南城医院收治的102例疑似急性阑尾炎患者,入院后均进行多层螺旋CT和超声检查,以手术病理检查结果为金标准,分析多层螺旋CT和超声检查对急性阑尾炎的诊断价值.结果 多层螺旋CT检查对急性阑尾炎的诊断特异度、灵敏度均高于超声检...     

Distance from practice moderates the relationship between patient management involving nurse telephone triage consulting and patient satisfaction with care

The ESTEEM trial was a randomised-controlled trial of telephone triage consultations in general practice. We conducted exploratory analyses on data from 9154 patients from 42 UK general practices who returned a questionnaire containing self-reported ratings of satisfaction with care following a request for a same-day consultation. Mode of care was identified through case notes review. There were seven main types: a GP face-to-face consultation, GP or nurse telephone triage consultation with no subsequent same day care, or a GP or nurse telephone triage consultation with a subsequent face-to-face consultation with a GP or a nurse. We investigated the contribution of mode of care to patient satisfaction and distance between the patient׳s home and the practice as a potential moderating factor. There was no overall association between patient satisfaction and distance from practice. However, patients managed by a nurse telephone consultation showed lowest levels of satisfaction, and satisfaction for this group of patients increased the further they lived from the practice. There was no association between any of the other modes of management and distance from practice.