Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Languages, Literature and Communication, Faculty of Humanities, Utrecht University, Utrecht, the Netherlands.
Patient Educ Couns. 2023 Aug;113:107770. doi: 10.1016/j.pec.2023.107770. Epub 2023 May 4.
In primary care out of hours service (OHS-PC), triage nurses ask questions to assign urgency level for medical assessment. A semi-automatic decision tool (the Netherlands Triage Standard, NTS) facilitates triage nurses with key questions, but does not leave much room for paying attention to callers' concerns. We wanted to understand how callers with chest pain formulate their concerns and are helped further during telephone triage.
We conducted a conversation analytic study of 68 triage calls from callers with chest discomfort who contacted OHS-PC of which we selected 35 transcripts in which concerns were raised. We analyzed expressions of concerns and the corresponding triage nurse response.
Due to the task-oriented nature of the NTS, callers' concerns were overlooked. For callers, however, discussing concerns was relevant, stressed by the finding that the majority of callers with chest discomfort expressed concerns.
Interactional difficulties in concern-related discussions arised directly after expressed concerns if not handled adequately, or during the switch to the counseling phase.
When callers display concerns during telephone triage, we recommend triage nurses to explore them briefly and then return to the sequence of tasks described in the NTS-assisted triage process.
在初级保健门诊服务（OHS-PC）中，分诊护士通过询问问题来确定医疗评估的紧急程度。半自动化决策工具（荷兰分诊标准，NTS）为分诊护士提供了关键问题，但几乎没有为关注来电者的担忧留出空间。我们想了解胸痛患者如何表达他们的担忧，并在电话分诊过程中得到进一步帮助。
我们对来自 OHS-PC 的 68 个胸痛患者的分诊电话进行了会话分析研究，从中选择了 35 份提出关注问题的转录文本。我们分析了表达的关注问题和相应的分诊护士的反应。
由于 NTS 的任务导向性质，来电者的关注问题被忽视了。然而，对于来电者来说，讨论关注问题是相关的，这一点从大多数胸痛患者表达了关注问题这一发现中得到了强调。
如果不能妥善处理，或者在切换到咨询阶段时，与关注问题相关的讨论会直接出现互动困难。
当来电者在电话分诊中表达关注问题时，我们建议分诊护士简要探讨这些问题，然后再返回 NTS 辅助分诊过程中描述的任务序列。
