Abstract Body

Background:

Practicing person-centered care can be challenging for triage nurses during telephone triage at out-of-hours services in primary care (OHS-PC). In the Netherlands triage nurses use a computer decision support system (CDSS) called the Netherlands Triage Standard (NTS), which is intended to support clinical reasoning and decision making of triage nurses. Yet, this CDSS may also trigger interactional workability dilemmas if there is incongruence between the tool and the triage nurses’ decision making. Furthermore, the CDSS can give rise to interactional difficulties due to inefficient use of multiple choice either/or-questions by triage nurses.

Aim and learning objectives:

This workshop will provide insight into the difficulties of working with a CDSS while at the same time trying to provide person-centered care during telephone triage.

The learning objectives of this workshop are:

(i) Awareness on the occurrence of interactional workability dilemmas;

(ii) Knowledge of adaptive work strategies applied by triage nurses;

(iii) Awareness of undesirable implications of either/or-questions on the interaction.

Methods and timetable:

Results of an audio-stimulated recall interview study with 24 triage nurses, and a conversation analysis of 68 triage conversations will be presented (±30min). Based on these results, we will interactively discuss the similarities and differences in triagists’ working strategies among various countries when applying a CDSS (±30min), and brainstorm about possible solutions aiming at increasing person-centered care (±30min).

Conclusions:

This workshop focuses on struggles with CDSS when providing person-centered care, and will interactively discuss possible solutions for improvement of telephone triage at OHS-PC.

Abstract Body

Objectives To assess the accuracy of semi-automatic assisted telephone triage in patients with acute chest discomfort against the diagnosis acute coronary syndrome (ACS) or other life threatening events (LTEs).

Methods Cross-sectional study with telephone conversations of 2,023 patients with acute chest discomfort (pain, pressure, tightness, or discomfort) who called out-of-hours services for primary care (OHS-PC) between 2014 and 2016. Sensitivity, specificity, positive and negative predicted values were calculated for a high urgency (patient seen within one hour) against the diagnoses ACS and other LTEs. Diagnoses were retrieved from the patient’s medical records in general practice, including hospital specialists discharge letters.

Results Of 2,023 patients who called for chest discomfort, 227 (11.2%) had an ACS (men 14.9%, women 8.2%) and 58 (2.9%) had another LTE (men 3.6%, women 2.3%). The sensitivity and specificity of a high Netherlands Triage Standard (NTS) urgency allocation against ACS/other LTEs were 0.73 (95% CI 0.68-0.78) and 0.43 (95% CI 0.40-0.45). In 13.2% of the calls, the triage nurse overruled the NTS urgency, mostly by upscaling (11.0%). The sensitivity and specificity of the final urgency allocation were 0.86 (95% CI 0.81-0.90) and 0.34 (95% CI 0.32-0.37). The positive and negative predictive values of the final urgency were 0.18 (95% CI 0.17-0.19) and 0.94 (95% CI 0.92-0.95).

Conclusions The semi-automatic triage NTS tool underestimated the urgency in 27% of patients with ACS/other LTEs. Overruling by triage nurses improved safety, but still 14% of men and women with ACS/other LTEs received a too low urgency, while efficiency remained poor.