Research Unit General Practice, Aarhus University, Aarhus, Denmark
Department of Public Health, Aarhus University, Aarhus, Denmark.
BMJ Open. 2023 Mar 20;13(3):e064999. doi: 10.1136/bmjopen-2022-064999.
We aim to explore undertriage and overtriage in a high-risk patient population and explore patient characteristics and call characteristics associated with undertriage and overtriage in both randomly selected and in high-risk telephone calls to out-of-hours primary care (OOH-PC).
Natural quasi-experimental cross-sectional study.
Two Danish OOH-PC services using different telephone triage models: a general practitioner cooperative with GP-led triage and the medical helpline 1813 with computerised decision support system-guided nurse-led triage.
We included audio-recorded telephone triage calls from 2016: 806 random calls and 405 high-risk calls (defined as patients ≥30 years calling with abdominal pain).
Twenty-four experienced physicians used a validated assessment tool to assess the accuracy of triage. We calculated the relative risk (RR) for undertriage and overtriage for a range of patient characteristics and call characteristics.
We included 806 randomly selected calls (44 undertriaged and 54 overtriaged) and 405 high-risk calls (32 undertriaged and 24 overtriaged). In high-risk calls, nurse-led triage was associated with significantly less undertriage (RR: 0.47, 95% CI 0.23 to 0.97) and more overtriage (RR: 3.93, 95% CI 1.50 to 10.33) compared with GP-led triage. In high-risk calls, the risk of undertriage was significantly higher for calls during nighttime (RR: 2.1, 95% CI 1.05 to 4.07). Undertriage tended to be more likely for calls concerning patients ≥60 years compared with 30-59 years (11.3% vs 6.3%) in high-risk calls. However, this result was not significant.
Nurse-led triage was associated with less undertriage and more overtriage compared with GP-led triage in high-risk calls. This study may suggest that to minimise undertriage, the triage professionals should pay extra attention when a call occurs during nighttime or concerns elderly. However, this needs confirmation in future studies.
本研究旨在探讨高危患者人群中的分诊不足和过度分诊现象，并探讨随机选择和高危电话就诊中与分诊不足和过度分诊相关的患者特征和电话特征。
自然准实验性横断面研究。
两家丹麦的非工作时间初级保健（OOH-PC）服务机构采用不同的电话分诊模式：一家是由全科医生组成的合作机构，采用由全科医生主导的分诊模式；另一家是由医疗热线 1813 提供服务，采用计算机决策支持系统引导护士主导的分诊模式。
我们纳入了 2016 年的音频记录电话分诊电话：806 个随机电话和 405 个高危电话（定义为≥30 岁、因腹痛就诊的患者）。
24 名经验丰富的医生使用经过验证的评估工具来评估分诊的准确性。我们计算了一系列患者特征和电话特征与分诊不足和过度分诊的相对风险（RR）。
我们纳入了 806 个随机选择的电话（44 个分诊不足，54 个分诊过度）和 405 个高危电话（32 个分诊不足，24 个分诊过度）。在高危电话中，与由全科医生主导的分诊相比，护士主导的分诊显著降低了分诊不足的风险（RR：0.47，95%CI 0.23 至 0.97），并增加了分诊过度的风险（RR：3.93，95%CI 1.50 至 10.33）。在高危电话中，夜间（RR：2.1，95%CI 1.05 至 4.07）的电话分诊不足风险显著升高。与 30-59 岁的患者相比，高危电话中≥60 岁的患者分诊不足的可能性更高（11.3%比 6.3%）。然而，这一结果并不显著。
与由全科医生主导的分诊相比，护士主导的分诊在高危电话中与分诊不足和过度分诊相关。本研究表明，为了尽量减少分诊不足，分诊专业人员在夜间或处理老年患者时应格外注意。然而，这需要在未来的研究中进一步证实。
