Research Unit for General Practice, Aarhus, Denmark
Department of Public Health, Aarhus University, Aarhus, Denmark.
BMJ Open. 2020 Mar 26;10(3):e033528. doi: 10.1136/bmjopen-2019-033528.
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.
Natural quasi-experimental cross-sectional study.
Two Danish OOH services using different telephone triage models: a GP cooperative and the medical helpline 1813.
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).
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.
The risk of 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 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.
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.
比较普通科医生（GP）、使用计算机决策支持系统的护士和不同医学专业医生在非工作时间（OOH）电话分诊中的沟通质量，并探讨沟通质量与效率、通话时长和电话分诊准确性之间的关系。
自然准实验性横断面研究。
使用不同电话分诊模式的两个丹麦 OOH 服务：一个 GP 合作服务和医疗热线 1813。
2016 年随机抽取的 1294 个 OOH 电话分诊音频记录，由 GP（n=423）、使用 CDSS 的护士（n=430）和不同医学专业的医生（n=441）进行。
24 名医生评估了这些电话。专家组使用经过验证的评估工具（电话分诊质量评估工具，AQTT）来衡量沟通的九个方面、整体感知沟通质量、效率和通话时长。
与护士分诊的电话相比，GP 分诊的电话在“允许来电者描述情况”（GP：13.5%护士：9.8%）、“掌握提问技巧”（GP：27.4%护士：21.1%）、“总结”（GP：33.0%护士：21.0%）和“关注来电者的体验”（GP：25.7%护士：17.0%）方面的沟通质量风险更高。与 GP 分诊的电话相比，医生分诊的电话在九个项目中的五个项目中沟通质量风险更高。GP 电话（2 分 57 秒）比护士电话（4 分 44 秒）和医生电话（4 分 1 秒）短。分诊不足的电话在沟通质量的所有具体项目和整体质量上的评分都低于最佳分诊的电话（p<0.001）。
与 GP 进行电话分诊相比，护士分诊的电话沟通质量更高，而不同医学专业的医生分诊的电话沟通质量则更低。然而，护士和医生分诊的电话更长，且效率较低。沟通质量与准确分诊有关。
