Graversen D S, Pedersen A F, Carlsen A H, Bro F, Huibers L, Christensen M B
a Research Unit for General Practice, Aarhus, Denmark & Department of Public Health, Aarhus University , Aarhus C , Denmark.
Scand J Prim Health Care. 2019 Mar;37(1):18-29. doi: 10.1080/02813432.2019.1568712. Epub 2019 Jan 28.
To develop a valid and reliable assessment tool able to measure quality of communication, patient safety and efficiency in out-of-hours (OOH) telephone triage conducted by both general practitioners (GP) and nurses.
The Dutch KERNset tool was translated into Danish and supplemented with items from other existing tools. Face validity, content validity and applicability in OOH telephone triage (OOH-TT) were secured through a two-round Delphi process involving relevant stakeholders. Forty-eight OOH patient contacts were assessed by 24 assessors in test-retest and inter-rater designs.
OOH-TT services in Denmark conducted by GPs, nurses or doctors with varying medical specialisation.
Audio-recorded OOH patient contacts.
Test-retest and inter-rater reliability were analysed using ICC, Fleiss' kappa and percent agreement.
Major adaptations during the Delphi process were made. The 24-item assessment tool (Assessment of Quality in Telephone Triage - AQTT) measured communicative quality, health-related quality and four overall quality aspects. The test-retest ICC reliability was good for the overall quality of communication (0.85), health-related quality (0.83), patient safety (0.81) and efficiency (0.77) and satisfactory when assessing specific aspects. Inter-rater reliability revealed reduced reliability in ICC and in Fleiss' kappa. Percent agreement revealed satisfactory agreements when differentiating between 'poor' and 'sufficient' quality).
The AQTT demonstrated high face, content and construct validity, satisfactory test-retest reliability, reduced inter-rater reliability, but satisfactory percent agreement when differentiating between 'poor' and 'sufficient' quality. The AQTT was found feasible and clinically relevant for assessing the quality of GP- and nurse-led OOH-TT. KEYPOINTS Comparative knowledge is sparse regarding quality of out-of-hours telephone triage conducted by general practitioners and nurses. The assessment tool (AQTT) enables assessment of quality in OOH telephone triage conducted by nurses and general practitioners AQTT is feasible and clinically relevant for assessment of communication, patient safety and efficiency. AQTT can be used to identify areas for improvement in telephone triage.
开发一种有效且可靠的评估工具，用于衡量全科医生（GP）和护士在非工作时间（OOH）电话分诊中沟通质量、患者安全和效率。
将荷兰KERNset工具翻译成丹麦语，并补充其他现有工具中的项目。通过两轮德尔菲法，让相关利益相关者参与，确保了在OOH电话分诊（OOH-TT）中的表面效度、内容效度和适用性。24名评估人员采用重测法和评分者间设计，对48次OOH患者接触进行了评估。
丹麦由全科医生、护士或具有不同医学专业的医生提供的OOH-TT服务。
OOH患者接触的音频记录。
使用组内相关系数（ICC）、Fleiss'kappa系数和一致性百分比分析重测信度和评分者间信度。
在德尔菲过程中进行了重大调整。这个包含24个条目的评估工具（电话分诊质量评估 - AQTT）测量了沟通质量、健康相关质量和四个整体质量方面。重测ICC信度在沟通整体质量（0.85）、健康相关质量（0.83）、患者安全（0.81）和效率（0.77）方面表现良好，在评估具体方面时也令人满意。评分者间信度显示ICC和Fleiss'kappa系数的信度有所降低。在区分“差”和“足够”质量时，一致性百分比显示出令人满意的一致性。
AQTT显示出较高的表面效度、内容效度和结构效度，重测信度令人满意，评分者间信度降低，但在区分“差”和“足够”质量时一致性百分比令人满意。发现AQTT对于评估由全科医生和护士主导的OOH-TT质量是可行且与临床相关的。关键点关于全科医生和护士进行的非工作时间电话分诊质量的比较知识很少。评估工具（AQTT）能够评估护士和全科医生进行的OOH电话分诊质量。AQTT对于评估沟通、患者安全和效率是可行且与临床相关的。AQTT可用于识别电话分诊中需要改进的领域。
