title: Question design in nurse-led and GP-led telephone triage for same-day appointment requests: a comparative investigation.
abstract: OBJECTIVE
  To compare doctors' and nurses' communication with patients in primary care telephone triage consultations.
  
  
  METHODS
  Qualitative comparative study of content and form of questions in 51 telephone triage encounters between practitioners (general practitioners (GPs)=29; nurses=22) and patients requesting a same-day appointment in primary care. Audio-recordings of nurse-led calls were synchronised with video recordings of nurse's use of computer decision support software (CDSS) during triage.
  
  
  METHODS
  2 GP practices in Devon and Warwickshire, UK.
  
  
  METHODS
  4 GPs and 29 patients; and 4 nurses and 22 patients requesting a same-day face-to-face appointment with a GP.
  
  
  METHODS
  Form and content of practitioner-initiated questions and patient responses during clinical assessment.
  
  
  RESULTS
  A total of 484 question-response sequences were coded (160 GP; 324 N). Despite average call lengths being similar (GP=4 min, 37 s, (SD=1 min, 26 s); N=4 min, 39 s, (SD=2 min, 22 s)), GPs and nurses differed in the average number (GP=5.51, (SD=4.66); N=14.72, (SD=6.42)), content and form of questions asked. A higher frequency of questioning in nurse-led triage was found to be due to nurses' use of CDSS to guide telephone triage. 89% of nurse questions were oriented to asking patients about their reported symptoms or to wider-information gathering, compared to 54% of GP questions. 43% of GP questions involved eliciting patient concerns or expectations, and obtaining details of medical history, compared to 11% of nurse questions. Nurses using CDSS frequently delivered questions designed as declarative statements requesting confirmation and which typically preferred a 'no problem' response. In contrast, GPs asked a higher proportion of interrogative questions designed to request information.
  
  
  CONCLUSIONS
  Nurses and GPs emphasise different aspects of the clinical assessment process during telephone triage. These different styles of triage have implications for the type of information available following nurse-led or doctor-led triage, and for how patients experience triage.
authors.affiliation: Faculty of Medicine and Health Sciences, School of Nursing Sciences, Edith Cavell Building, University of East Anglia, Norwich Research Park, Norwich, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: Murdoch
authors.forename: Rebecca
authors.initials: R
authors.lastname: Barnes
authors.forename: Jillian
authors.initials: J
authors.lastname: Pooler
authors.forename: Val
authors.initials: V
authors.lastname: Lattimer
authors.forename: Emily
authors.initials: E
authors.lastname: Fletcher
authors.forename: John L
authors.initials: JL
authors.lastname: Campbell
mesh_terms: D001071:Appointments and Schedules; D003142:Communication; D003658:Decision Making, Computer-Assisted; D058005:General Practitioners; D006801:Humans; D007407:Interviews as Topic; D009726:Nurses; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires; D014218:Triage / Q000379:methods*