Giesen Paul, Ferwerda Rosa, Tijssen Roelie, Mokkink Henk, Drijver Roeland, van den Bosch Wil, Grol Richard
Centre for Quality of Care Research, Radboud University Nijmegen, Nijmegen, The Netherlands.
Qual Saf Health Care. 2007 Jun;16(3):181-4. doi: 10.1136/qshc.2006.018846.
In recent years, there has been a growth in the use of triage nurses to decrease general practitioner (GP) workloads and increase the efficiency of telephone triage. The actual safety of decisions made by triage nurses has not yet been assessed.
To investigate whether triage nurses accurately estimate the urgency level of health complaints when using the national telephone guidelines, and to examine the relationship between the performance of triage nurses and their education and training.
A cross-sectional, multicentre, observational study employing five mystery (simulated) patients who telephoned triage nurses in four GP cooperatives. The mystery patients played standardised roles. Each role had one of four urgency levels as determined by experts. The triage nurses called were asked to estimate the level of urgency after the contact. This level of urgency was compared with a gold standard.
Triage nurses estimated the level of urgency of 69% of the 352 contacts correctly and underestimated the level of urgency of 19% of the contacts. The sensitivity and specificity of the urgency estimates provided by the triage nurses were found to be 0.76 and 0.95, respectively. The positive and negative predictive values of the urgency estimates were 0.83 and 0.93, respectively. A significant correlation was found between correct estimation of urgency and specific training on the use of the guidelines. The educational background (primary or secondary care) of the nurses had no significant relationship with the rate of underestimation.
Telephone triage by triage nurses is efficient but possibly not safe, with potentially severe consequences for the patient. An educational programme for triage nurses is recommended. Also, a direct second safety check of all cases by a specially trained GP telephone doctor is advisable.
近年来，使用分诊护士以减轻全科医生（GP）工作量并提高电话分诊效率的情况有所增加。分诊护士所做决策的实际安全性尚未得到评估。
调查分诊护士在使用国家电话指南时是否能准确估计健康问题的紧急程度，并研究分诊护士的表现与其教育和培训之间的关系。
一项横断面、多中心观察性研究，采用五名扮演神秘（模拟）患者的人员，他们致电四个全科医生合作社的分诊护士。这些神秘患者扮演标准化角色。每个角色由专家确定为四个紧急程度之一。被呼叫的分诊护士被要求在通话后估计紧急程度。将此紧急程度与金标准进行比较。
分诊护士在352次通话中正确估计了69%的紧急程度，低估了19%的紧急程度。发现分诊护士提供的紧急程度估计的敏感性和特异性分别为0.76和0.95。紧急程度估计的阳性预测值和阴性预测值分别为0.83和0.93。发现紧急程度的正确估计与指南使用的特定培训之间存在显著相关性。护士的教育背景（初级或二级护理）与低估率没有显著关系。
分诊护士进行的电话分诊效率高但可能不安全，对患者可能产生严重后果。建议为分诊护士开展教育项目。此外，由经过专门培训的全科医生电话医生对所有病例进行直接的二次安全检查是可取之举。
