Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
DigiFinland Ltd., University of Helsinki, Helsinki, Finland.
Scand J Trauma Resusc Emerg Med. 2024 Aug 13;32(1):69. doi: 10.1186/s13049-024-01243-9.
There has been a significant expansion in the measurement of healthcare system performance. However, there is a lack of a comprehensive performance measurement framework to assess the effects of telephone triage services on the urgent care system. The aim of our Delphi study was to construct and validate a performance measurement framework designed explicitly for telephone triage services.
This study was conducted in Finland with a group of eight experienced senior physicians from the country's 20 largest joint emergency departments, serving over 90% of the population for urgent care. The Nominal Group Technique (NGT) was utilised to achieve consensus on measuring telephone triage performance. Initially, performance indicators (PIs) were identified through Delphi method rounds from December 10th to December 27th, 2021, with eight experts participating, and from December 29th, 2021, to January 23rd, 2022, where five of these experts responded. NGT further deepened these themes and perspectives, aiding in the development of a comprehensive performance measurement framework. The final framework validation began with an initial round from February 13th to March 3rd, 2022, receiving five responses. Due to the limited number of responses, an additional validation round was conducted from October 29th to November 7th, 2023, resulting in two more responses, increasing the total number of respondents in the validation phase to seven.
The study identified a strong desire among professionals to implement a uniform framework for measuring telephone triage performance. The finalised framework evaluates telephone triage across five dimensions: service accessibility, patient experience, quality and safety, process outcome, and cost per case. Eight specific PIs were established, including call response metrics, service utility, follow-up care type and distribution, ICPC-2 classified encounter reasons, patient compliance with follow-up care, medical history review during assessment, and service cost per call.
This study validated a performance measurement framework for telephone triage services, utilising existing literature and the NGT method. The framework includes five key dimensions: patient experience, quality and safety, outcome of the telephone triage process, cost per case, and eight PIs. It offers a structured and comprehensive approach to measuring the overall performance of telephone triage services, enhancing our ability to evaluate these services effectively.
医疗系统绩效的衡量已经有了显著的扩展。然而，目前缺乏一个全面的绩效衡量框架来评估电话分诊服务对紧急护理系统的影响。我们的德尔菲研究旨在构建和验证一个专门为电话分诊服务设计的绩效衡量框架。
这项研究在芬兰进行，由该国 20 家最大的联合急诊部的 8 名经验丰富的高级医生组成，为超过 90%的紧急护理人群提供服务。名义小组技术（NGT）用于就电话分诊绩效的衡量达成共识。最初，通过 2021 年 12 月 10 日至 12 月 27 日的德尔菲法轮次和 2021 年 12 月 29 日至 2022 年 1 月 23 日的 8 位专家参与，确定了绩效指标（PIs），随后 5 位专家参与了 2022 年 1 月 29 日至 2 月 23 日的进一步德尔菲法轮次。NGT 进一步深化了这些主题和观点，有助于开发一个全面的绩效衡量框架。最终框架的验证始于 2022 年 2 月 13 日至 3 月 3 日的第一轮，收到了 5 份回复。由于回复数量有限，在 2023 年 10 月 29 日至 11 月 7 日进行了额外一轮验证，增加了两名回复者，使验证阶段的回复者总数达到 7 人。
研究发现专业人员非常希望实施一个统一的电话分诊绩效衡量框架。最终确定的框架评估了电话分诊的五个方面：服务可及性、患者体验、质量和安全、流程结果和每个病例的成本。确定了 8 个特定的 PIs，包括接听响应指标、服务实用性、后续护理类型和分布、ICPC-2 分类的就诊原因、患者对后续护理的依从性、评估期间的病史回顾以及每次通话的服务成本。
本研究利用现有文献和 NGT 方法验证了一个电话分诊服务的绩效衡量框架。该框架包括五个关键维度：患者体验、质量和安全、电话分诊流程结果、每个病例的成本和 8 个 PIs。它提供了一种结构化和全面的方法来衡量电话分诊服务的整体绩效，提高了我们有效评估这些服务的能力。
