Communication quality in telephone triage conducted by general practitioners, nurses or physicians: a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark

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@article{30d8ca9eacc9498eba1c20cff364d090,
title = "Communication quality in telephone triage conducted by general practitioners, nurses or physicians: a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark",
abstract = "OBJECTIVES: 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. DESIGN: Natural quasi-experimental cross-sectional study. SETTING: Two Danish OOH services using different telephone triage models: a GP cooperative and the medical helpline 1813. PARTICIPANTS: 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). MAIN OUTCOME MEASURES: 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. RESULTS: The risk of poor 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 poor 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. CONCLUSIONS: 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.",
keywords = "clinical audit, organisation of health services, primary care, quality in health care",
author = "Graversen, {Dennis Schou} and Linda Huibers and Christensen, {Morten Bondo} and Flemming Bro and {Collatz Christensen}, Helle and Vestergaard, {Claus H{\o}strup} and Pedersen, {Anette Fischer}",
year = "2020",
doi = "10.1136/bmjopen-2019-033528",
language = "English",
volume = "10",
journal = "B M J Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "3",

}

RIS

TY - JOUR

T1 - Communication quality in telephone triage conducted by general practitioners, nurses or physicians

T2 - a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark

AU - Graversen, Dennis Schou

AU - Huibers, Linda

AU - Christensen, Morten Bondo

AU - Bro, Flemming

AU - Collatz Christensen, Helle

AU - Vestergaard, Claus Høstrup

AU - Pedersen, Anette Fischer

PY - 2020

Y1 - 2020

N2 - OBJECTIVES: 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. DESIGN: Natural quasi-experimental cross-sectional study. SETTING: Two Danish OOH services using different telephone triage models: a GP cooperative and the medical helpline 1813. PARTICIPANTS: 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). MAIN OUTCOME MEASURES: 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. RESULTS: The risk of poor 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 poor 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. CONCLUSIONS: 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.

AB - OBJECTIVES: 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. DESIGN: Natural quasi-experimental cross-sectional study. SETTING: Two Danish OOH services using different telephone triage models: a GP cooperative and the medical helpline 1813. PARTICIPANTS: 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). MAIN OUTCOME MEASURES: 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. RESULTS: The risk of poor 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 poor 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. CONCLUSIONS: 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.

KW - clinical audit

KW - organisation of health services

KW - primary care

KW - quality in health care

UR - http://www.scopus.com/inward/record.url?scp=85082535419&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2019-033528

DO - 10.1136/bmjopen-2019-033528

M3 - Journal article

C2 - 32220912

AN - SCOPUS:85082535419

VL - 10

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 3

M1 - e033528

ER -