Nurse telephone triage: good quality associated with appropriate decisions.
BACKGROUND
Triage at out-of-hours GP cooperatives (GPCs) is aimed at determining medical urgency and guiding decisions. Both medical knowledge and communication skills are required for this complex task.


OBJECTIVE
To explore the impact of quality of consultation and estimated urgency on the appropriateness of decisions.


METHODS
We performed a secondary analysis of telephone triage consultations by nurses at 29 Dutch GPCs. Consultations were taped and assessed by trained observers, using a validated instrument. Measures concerned quality of consultation, nurse-estimated urgency (four levels) and appropriateness of decisions (urgency, follow-up advice and timing). Bivariate analyses and logistic multilevel regression analyses were used to explore the impact of quality of consultation (controlling for urgency) on appropriateness of decisions.


RESULTS
The sample included 6739 telephone contacts, most of which (90%) were non-urgent. The majority of decisions were appropriate (91% for urgency, 96% for follow-up advice and 95% for timing). In bivariate analyses, appropriateness of decisions was positively related to higher quality of consultation. Estimated urgency was negatively associated with quality of consultation. Logistic multilevel analysis showed that higher quality of consultation was related to a more appropriate estimation of urgency [odds ratio (OR) = 1.82; 95% confidence interval (CI): 1.69-1.95], follow-up advice (OR = 2.69; 95% CI: 2.41-3.01) and timing of decisions (OR = 2.41; 95% CI: 2.20-2.63).


CONCLUSIONS
High quality of consultation has a positive, but small, impact on the appropriateness of decisions. Quality of consultation needs to be targeted in training and support of triage nurses, especially when it concerns highly urgent contacts.
Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. l.huibers@iq.umcn.nl
L
L
Huibers
E
E
Keizer
P
P
Giesen
R
R
Grol
M
M
Wensing
D039602:After-Hours Care / Q000592:standards*; D003657:Decision Making; D058006:General Practice; D006801:Humans; D009426:Netherlands; D057184:Practice Patterns, Nurses' / Q000592:standards*; D011320:Primary Health Care; D011787:Quality of Health Care; D013637:Tape Recording; D013689:Telephone; D014218:Triage / Q000592:standards*