National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Box 22, Bergen, NO-5838, Norway.
Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Box 7804, Bergen, NO-5020, Norway.
Syst Rev. 2024 Jun 22;13(1):162. doi: 10.1186/s13643-024-02580-7.
Telephone triage is used to optimise patient flow in emergency primary healthcare. Poor communication can lead to misunderstandings and compromise patient safety. To improve quality, a comprehensive understanding of factors affecting communication in medical call centres in primary care is needed. The aim of this review was to identify such factors and to describe how they affect communication during telephone triage.
A mixed-method systematic review was performed. In April 2021 and June 2023, MEDLINE, Embase, CINAHL, and Web of Science were searched for original studies describing communication during telephone triage in primary care medical call centres handling all types of medical problems from an unselected population. All studies were screened by two authors, blinded to each other's decisions. Disagreements were resolved by a third author. A framework was created by the thematic synthesis of the qualitative data and later used to synthesise the quantitative data. By using convergent integrated synthesis, the qualitative and quantitative findings were integrated. The Mixed Methods Appraisal Tool was used to assess methodological limitations.
Out of 5087 studies identified in the search, 62 studies were included, comprising 40 qualitative, 16 quantitative and six mixed-method studies. Thirteen factors were identified and organised into four main themes: organisational factors, factors related to the operator, factors related to the caller and factors in the interaction. Organisational factors included availability, working conditions and decision support systems. Factors related to the operator were knowledge and experience, personal qualities and communication strategies. Factors related to the caller were individual differences and the presented medical problem. Factors in the interaction were faceless communication, connection between operator and caller, third-person caller and communication barriers. The factors seem interrelated, with organisational factors affecting all parts of the conversation, and the operator's communication in particular.
Many factors affect the structure, content, and flow of the conversation. The operators influence the communication directly but rely on the organisation to create a working environment that facilitates good communication. The results are mainly supported by qualitative studies and further studies are needed to explore and substantiate the relevance and effect of individual factors.
PROSPERO CRD42022298022.
电话分诊用于优化急诊初级保健中的患者流程。沟通不畅可能导致误解，危及患者安全。为了提高质量，需要全面了解影响初级保健医疗呼叫中心沟通的因素。本综述的目的是确定这些因素，并描述它们如何影响电话分诊期间的沟通。
进行了一项混合方法系统评价。在 2021 年 4 月和 2023 年 6 月，检索了 MEDLINE、Embase、CINAHL 和 Web of Science，以查找描述初级保健医疗呼叫中心在处理来自未选择人群的所有类型医疗问题的电话分诊期间沟通的原始研究。两位作者对所有研究进行了筛选，彼此之间的决策相互不透明。分歧由第三位作者解决。通过对定性数据的主题综合，创建了一个框架，然后用于综合定量数据。通过使用收敛综合综合方法，整合了定性和定量发现。使用混合方法评估工具评估方法学局限性。
在搜索中确定了 5087 项研究，其中纳入了 62 项研究，包括 40 项定性研究、16 项定量研究和 6 项混合方法研究。确定了 13 个因素，并组织成四个主题：组织因素、与操作员相关的因素、与呼叫者相关的因素和交互因素。组织因素包括可用性、工作条件和决策支持系统。与操作员相关的因素是知识和经验、个人素质和沟通策略。与呼叫者相关的因素是个体差异和呈现的医疗问题。交互因素包括无面孔沟通、操作员和呼叫者之间的联系、第三方呼叫者和沟通障碍。这些因素似乎相互关联，组织因素影响会话的各个部分，特别是操作员的沟通。
许多因素影响着对话的结构、内容和流程。操作员直接影响沟通，但依赖组织创造有利于良好沟通的工作环境。结果主要得到定性研究的支持，需要进一步研究以探索和证实个别因素的相关性和影响。
PROSPERO CRD42022298022。
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