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Background: Childbearing women commonly access maternity services via the telephone. A midwife receiving these calls listens to the woman's concerns and then triages women according to their assessment. This may result in the prov...
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Background: Childbearing women commonly access maternity services via the telephone. A midwife receiving these calls listens to the woman's concerns and then triages women according to their assessment. This may result in the provision of advice and instruction over the telephone or inviting the woman into the health service for further assessment. Midwives are responsible for all care and advice given to women, including via the telephone.
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Introduction : Telephone advice service (TAS) operates through consulting with callers, using a computerised decision support system and empowering people towards appropriate emergency care. There is a need to assess TAS’s influe...
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Introduction : Telephone advice service (TAS) operates through consulting with callers, using a computerised decision support system and empowering people towards appropriate emergency care. There is a need to assess TAS’s influence in emergency department (ED) attendance to facilitate integrated care, including understanding integration along clinical, functional and system dimensions. This study addresses the question: what influence does a TAS have on patient’s attendance at an ED? Methods : Records of 12,741 calls from Healthdirect (HD), a national TAS, were checked against 72,577 ED presentations to a regional hospital, resulting in 2,857 unique matches. The data was matched using the criteria: presentation between January 2016 to December 2017; location; time of call; gender; age; and, diagnosis. TAS callers’ initial care plan, their compliance with TAS’s recommendation to attend ED and TAS’ direction for urgency of care was assessed. Additionally, appropriateness of ED attendance between TAS callers versus non-callers was evaluated. Analysis was through using descriptive statistics. Results : Callers complied with TAS’s recommendations between 40-53% of the time. TAS advised only one third of callers seek ED care, when they were initially inclined to do so. TAS recommended lower urgency care for all care options, in majority of cases (64-82%). The unique match of 2857 ED presentations had 61% assessed as appropriate, whereas, the non-callers of TAS had 57% appropriate presentations. TAS’s influence on callers’ care seeking behaviour can be summarised as below: For the 3534 callers who just sought advide from TAS, not having any prior plan, TAS recommended 50% to go to ED. For the 2851 callers who wanted to visit ED, TAS recommended only 32% to go to ED. . For the 2563 callers who wanted to see GP, TAS recommended 15% to go to ED. For the 1525 callers who wanted to see GP, TAS recommended 21% to go to ED. Discussions : TAS is adding value in the management of individual patient’s clinical needs by positively influencing patient’s decision-making regarding access, timing and appropriate care. However, many callers, for unknown reasons, opt to act against the TAS advice. The TAS is empowering individual and the cohort of patients at the intersection of clinical, functional and system dimensions of integration. This we label ‘patient integration’, which is a new dimension of integration driven by patient’s seeking advice and enabled by the availability of the TAS. Conclusions : The TAS is effective in facilitating appropriate and timely access to ED. Lessons learned : The TAS is empowering patient decision-making and integration across the continuum of care. Limitations : The study has used data from only one organisation. Suggestions for Future research Investigate why callers decide to act for or against TAS professional advice.
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Radiology is increasingly used in the clinical management of patients, many of whom are at risk for complications. Nurses in this setting are often responsible for patient screening, preparation, and postproce-dure follow-up, much...
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Radiology is increasingly used in the clinical management of patients, many of whom are at risk for complications. Nurses in this setting are often responsible for patient screening, preparation, and postproce-dure follow-up, much of which takes place over the telephone. This article will focus on patient care standards, common clinical pitfalls, and critical elements of care delivery over the telephone to help radiology nurses reduce the risks inherent in this practice.
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Telephone nursing involves triage, advice, and care management provided by a nurse over the telephone. The telephone nursing dialogue process has been used clinically in telephone nursing in Sweden for several years to structure t...
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Telephone nursing involves triage, advice, and care management provided by a nurse over the telephone. The telephone nursing dialogue process has been used clinically in telephone nursing in Sweden for several years to structure the communication and ensure a safe assessment and advice. Studies are needed to determine whether there is sufficient scientific evidence to support the method.To describe the scientific basis of the phases of the telephone nursing dialogue process.This was an integrative review.The literature searches were performed in August 2023, in the PubMed, CINAHL, Cochrane Database of Systematic Reviews and SwePUB databases. Sixty-two articles were included. Data was sorted deductively according to the five phases of the telephone nursing dialogue process and categorized inductively to form subcategories describing the content of each phase.All five phases in the telephone nursing dialogue process were supported by a range of articles (n = 32–50): Opening (n = 32), Listening (n = 45), Analysing (n = 50), Motivating (n = 48), and Ending (n = 35). During the opening of the call, the nurse presents herself, welcomes the caller and establishes a caring relationship. In the listening phase, the nurse invites the caller to tell their story, listens actively and confirms understanding. During the analyzing phase, the nurse gathers, assesses, and verifies information. In the motivating phase, the nurse reaches a final assessment, informs the caller, gives advice and creates a mutual agreement and understanding while supporting the caller. Ultimately, the nurse ends the call after checking for mutual agreement and understanding, giving safety-net advice, deciding on whether to keep monitoring the caller and rounding off the call.The phases of the telephone nursing dialogue process as described in the scientific literature are well aligned with the theoretical descriptions of the telephone nursing dialogue process.
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Objectives: To examine the perceptions that those working in primary care have about the purpose and impact that telephone triage by nurses may have on their clinical roles and identities.
Methods: Twenty-six semi-structured int...
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Objectives: To examine the perceptions that those working in primary care have about the purpose and impact that telephone triage by nurses may have on their clinical roles and identities.
Methods: Twenty-six semi-structured interviews were carried out with general practitioners (GPs), practice nurses and practice managers from a purposive sample of nine practices in one health district in the North West of England. Analysis drew on the techniques of constant comparison and discourse analysis.
Results: Four themes emerged from the data: justifying triage - the respondents justify the introduction of telephone triage by emphasising the managerial benefits of controlling access and by suggesting the benefits this may bring to the patient-clinician relationship; categorising patients - patients are categorised and allocated on the basis of their biomedical diagnoses to the nurses or GPs in the practice; changing roles and identities - the hierarchy of patients and conditions created by allocating patients in this way strengthens and extends the professional hierarchy within a practice; and achieving a balance between conflicting aims - there is tension between the managerial need to triage patients according to their biomedical diagnosis and the aspirations that health care professionals have to personal and patient-centred care.
Conclusion: Telephone triage by nurses may be effective at managing patient access to GPs but the need to categorise patients according to biomedical and managerial criteria needs to be balanced against the professional roles and identities that those working in general practice aspire to.
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Objective: To determine the level of agreement between the advice given to an obstetric patient calling an obstetric call center and the advice given by health care providers with varying degrees of knowledge and experience. Study...
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Objective: To determine the level of agreement between the advice given to an obstetric patient calling an obstetric call center and the advice given by health care providers with varying degrees of knowledge and experience. Study design: This is a retrospective quality improvement project which evaluates the level of agreement between advice from nurses at an obstetric call center using software with obstetric triage protocols compared with advice given by women's health advanced practice nurse (APN), a fourth year obstetrics and gynecology (OB-GYN) resident, and a maternal fetal medicine (MFM) specialist on the same call scenarios. Results: The call center nurses advised emergency care more frequently (51.7%) than the MFM (44%) and the APN (31.9%) but less frequently than the OB-GYN resident (57.1%). The levels of agreement between the call center nurse and the MFM were good (kappa = 0.71; 95% CI: 0.57-0.85). The levels of agreement between the call center nurses and the resident and APN were considered moderate with kappa = 0.60 (95% CI: 0.42-0.77) and kappa = 0.60 (95% CI: 0.45-0.76). Conclusion: Advice given by nurses at an obstetric call center was highly consistent with the most skilled specialist (MFM) followed closely by OB-GYN resident or an APN.
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BackgroundMidwives use telephone triage to provide advice and support to childbearing women, and to manage access to maternity services. Telephone triage practises are important in the provision of accurate, timely and appropriate...
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BackgroundMidwives use telephone triage to provide advice and support to childbearing women, and to manage access to maternity services. Telephone triage practises are important in the provision of accurate, timely and appropriate health care. Despite this, there has been very little research investigating this area of midwifery practice. AimTo explore midwives and telephone triage practises; and to discuss the relevant findings for midwives managing telephone calls from women. MethodsA five-stage process for conducting scoping reviews was employed. Searches of relevant databases as well as grey literature, and reference lists from included studies were carried out. FindingsA total of 11 publications were included. Thematic analysis was used to identify key concepts. We grouped these key concepts into four emergent themes: purpose of telephone triage, expectations of the midwife, challenges of telephone triage, and achieving quality in telephone triage. DiscussionTelephone triage from a midwifery perspective is a complex multi-faceted process influenced by many internal and external factors. Midwives face many challenges when balancing the needs of the woman, the health service, and their own workloads. Primary research in this area of practice is limited. ConclusionFurther research to explore midwives’ perceptions of their role, investigate processes and tools midwives use, evaluate training programs, and examine outcomes of women triaged is needed.
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Telephone triage (TT) is a method whereby medical professionals speak by telephone to patients to assess their symptoms or health concerns and offer advice. These services are often administered through an electronic TT system, wh...
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Telephone triage (TT) is a method whereby medical professionals speak by telephone to patients to assess their symptoms or health concerns and offer advice. These services are often administered through an electronic TT system, which guides TT professionals during the encounter through the use of structured protocols and algorithms to help determine the severity of the patients' health issue and refer them to appropriate care. TT is also an emerging data source for public health surveillance of infectious and noninfectious diseases, including influenza. We calculated Spearman correlation coefficients to compare the weekly number of US Department of Veterans Affairs (VA) TT calls with other conventional influenza measures for the 2011-2012 through 2014-2015 influenza seasons, for which there were a total of 35666 influenza-coded TT encounters. Influenza-coded calls were strongly correlated with weekly VA influenza-coded hospitalizations (0.85), emergency department visits (0.90), influenza-like illness outpatient visits (0.92), influenza tests performed (0.86), positive influenza tests (0.82), and influenza antiviral prescriptions (0.89). The correlation between VA-TT and Centers for Disease Control and Prevention (CDC) national data for weekly influenza hospitalizations, influenza tests performed, and positive influenza tests was also strong. TT correlates well with VA health care use and CDC data and is a timely data source for monitoring influenza activity.
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Objective: The study aimed to determine which self-reported vulvovaginal symptoms are most consistent with candidiasis confirmed by yeast culture and to establish guidelines to determine who can be appropriately treated by telepho...
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Objective: The study aimed to determine which self-reported vulvovaginal symptoms are most consistent with candidiasis confirmed by yeast culture and to establish guidelines to determine who can be appropriately treated by telephone triage versus office examination for women with vulvovaginal symptoms. MATERIALS AND Methods: A retrospective chart review of 105 patients seen in the Saint Louis University Vulvar and Vaginal Disorders Specialty Center during a 14-month period was performed after institutional review board approval. Patient's age, medication use, symptom scores on a Likert rating scale for vaginal/vulvar pain, burning, itching, dyspareunia, wet-mount results, and yeast culture results were recorded. Differences in the occurrence of vaginal/vulvar symptoms of any severity between women with positive and with negative yeast culture results were calculated using χ and Fisher exact tests. Differences in symptom scores of any severity were compared between women with positive and with negative yeast culture results using nonparametric Kolmogorov-Smirnov test, owing to a lack of normality of the distributions. Sensitivity of 75% or greater and specificity of 67% or greater were sought for all 9 recorded symptoms.Multiple logistic regression analysis was used to determine which symptoms and their cutoff values were significant independent predictors of a positive yeast culture result. Receiver operating characteristic curve analysis was used to determine the efficacy of individual symptoms and combinations of symptoms for predicting a positive yeast culture result. A value of p < 0.05 was used to denote statistical significance. Results: Four vulvovaginal symptoms met cutoff criteria for analysis to predict a positive yeast culture result: vaginal burning, vulvar burning, vulvar itching, and clitoral pain. Vaginal burning with a score of 6 or greater (p < 0.001) and vulvar itching with a score of 5 or greater (p < 0.05) were significant independent predictors of a positive yeast culture result. Women with both a vaginal burning score of 6 or greater and a vulvar itching score 5 or greater had a positive predictive value of 91.7% (22/24). Vaginal discharge was not shown to be predictive of candidiasis. Conclusions: Diagnosis of candidiasis using self-reported vulvovaginal symptoms by telephone triage is difficult. Self-reported scores for vaginal burning of 6 or greater and for vulvar itching of 5 or greater are significant indicators of a positive yeast culture result. Vaginal discharge was not predictive of a diagnosis of candidiasis. A symptom chart can aid office staff in telephone triage of symptomatic women.
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Purpose: The study aims to identify and articulate how mental health telephone triage (MHTT) clinicians manage psychiatric crisis and emergency via the telephone. Design and Methods: An observational design was employed in the stu...
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Purpose: The study aims to identify and articulate how mental health telephone triage (MHTT) clinicians manage psychiatric crisis and emergency via the telephone. Design and Methods: An observational design was employed in the study. Wireless headsets were used to observe 197 occasions of MHTT. Findings: Clinicians use a range of practical strategies, therapeutic skills, and psychosocial interventions to manage psychiatric crises and emergencies via the telephone. Practice Implications: The evidence base for managing psychiatric crisis/emergency in MHTT is minimal. These findings contribute to the MHTT knowledge base and provide evidence-based strategies for high-quality emergency mental health care.
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