title: Seeking advice from NHS direct on common childhood complaints: does it matter who answers the phone?
abstract: BACKGROUND
  National Health Services (NHS) Direct is a national nurse-led, call-centre based, telephone triage, health information and advice service in the United Kingdom (UK). Forty percent of calls to NHS Direct are about children. There is a need to identify whether there is a difference in the time taken for nurses to triage calls about children.
  
  
  OBJECTIVE
  The aim of the study was to determine if the call length and outcomes of Registered Sick Children's Nurses and Registered Nurses were different when triaging children who presented with 'rash' or 'fever' by telephone.
  
  
  METHODS
  This study was carried out at NHS Direct, West Midlands, and involved analysis of 1281 calls taken by 22 nurses.
  
  
  METHODS
  This study examined the frequency of referral by the two nurse groups to five triage outcome groups. Information about the calls was extracted from routinely collected data generated by the computerized clinical decision support software. The data were used for secondary analysis.
  
  
  METHODS
  The data were analysed using Statistics Package for Social Sciences version 10 and nonparametric Mann-Whitney U -tests were performed to compare call lengths of the two groups. The chi-square test was used to analyse differences in frequency of triage to outcome groups.
  
  
  RESULTS
  The mean call length of the Registered Sick Children's Nurses was statistically significantly shorter than that of the Registered Nurses (P < 0.001). With the exception of referral for a routine appointment with a general medical practitioner, both Registered Sick Children's Nurses and Registered Nurses referred to other triage outcomes groups with equal frequency.
  
  
  CONCLUSIONS
  Inaccuracy of call length measurement of less than 1 minute and more than 20 minutes was because of the limitations of the data extraction software. This system-led definition and measured length of a call limits both the analysis and conclusions that could be drawn about the content of NHS Direct nurse consultation.
  
  
  CONCLUSIONS
  Registered Sick Children's Nurses take less time than Registered Nurses to triage calls about children presenting with 'rash' or 'fever'. Further investigation is required into the content and consultation process of the nurses, and also the safety and appropriateness of referral.
authors.affiliation: Education, Training and Development Lead, Worcestershire Health Informatics Programme, Department of Psychology, Health and Social Care, University College Worcester, Worcester, UK. r.monaghan@worc.ac.uk
authors.forename: Rosey
authors.initials: R
authors.lastname: Monaghan
authors.forename: Collette
authors.initials: C
authors.lastname: Clifford
authors.forename: Paul
authors.initials: P
authors.lastname: McDonald
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006266:Health Education; D015277:Hotlines / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010371:Pediatric Nursing; D019114:Remote Consultation / Q000379:methods*; D013689:Telephone; D014218:Triage / Q000458:organization & administration; D006113:United Kingdom