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General practice / Family practice
Original research
Communication quality in telephone triage conducted by general practitioners, nurses or physicians: a quasi-experimental study using the AQTT to assess audio-recorded telephone calls to out-of-hours primary care in Denmark
  1. Dennis Schou Graversen1,2,
  2. Linda Huibers1,
  3. Morten Bondo Christensen1,2,
  4. Flemming Bro1,2,
  5. Helle Collatz Christensen3,4,
  6. Claus Høstrup Vestergaard1,
  7. Anette Fischer Pedersen1,5
  1. 1Research Unit for General Practice, Aarhus, Denmark
  2. 2Department of Public Health, Aarhus University, Aarhus, Denmark
  3. 3Emergency Medical Services, Copenhagen, Copenhagen, Denmark
  4. 4Danish Clinical Quality Program (RKKP), Copenhagen, Denmark
  5. 5Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dennis Schou Graversen; d.graversen{at}ph.au.dk

Abstract

Objectives To compare the quality of communication in out-of-hours (OOH) telephone triage conducted by general practitioners (GPs), nurses using a computerised decision support system and physicians with different medical specialities, and to explore the association between communication quality and efficiency, length of call and the accuracy of telephone triage.

Design Natural quasi-experimental cross-sectional study.

Setting Two Danish OOH services using different telephone triage models: a GP cooperative and the medical helpline 1813.

Participants 1294 audio-recorded randomly selected OOH telephone triage calls from 2016 conducted by GPs (n=423), nurses using CDSS (n=430) and physicians with different medical specialities (n=441).

Main outcome measures Twenty-four physicians assessed the calls. The panel used a validated assessment tool (Assessment of Quality in Telephone Triage, AQTT) to measure nine aspects of communication, overall perceived communication quality, efficiency and length of call.

Results The risk of poor quality was significantly higher in calls triaged by GPs compared with calls triaged by nurses regarding ‘allowing the caller to describe the situation’ (GP: 13.5% nurse: 9.8%), ‘mastering questioning techniques’ (GP: 27.4% nurse: 21.1%), ‘summarising’ (GP: 33.0% nurse: 21.0%) and ‘paying attention to caller’s experience’ (GP: 25.7% nurse: 17.0%). The risk of poor quality was significantly higher in calls triaged by physicians compared with calls triaged by GPs in five out of nine items. GP calls were significantly shorter (2 min 57 s) than nurse calls (4 min 44 s) and physician calls (4 min 1 s). Undertriaged calls were rated lower than optimally triaged calls for overall quality of communication (p<0.001) and all specific items.

Conclusions Compared with telephone triage by GPs, the communication quality was higher in calls triaged by nurses and lower in calls triaged by physicians with different medical specialities. However, calls triaged by nurses and physicians were longer and perceived less efficient. Quality of communication was associated with accurate triage.

  • clinical audit
  • organisation of health services
  • quality in health care
  • primary care
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-033528

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    Footnotes

    • Contributors All authors contributed to the development of the study protocol and design. DSG produced the first draft of the manuscript. DSG, AFP, MBC, LH and CHV contributed to the interpretation of data and critically revised the manuscript. DSG collected the calls and DSG and CHV conducted the statistical analyses. FB and HCC contributed to the writing of the manuscript. All authors contributed with proofreading of the manuscript.

    • Funding This study was supported by the Danish foundation TrygFonden, Primary Healthcare Research Foundation of the Central Denmark Region (Praksisforskningsfonden), the Committee for Quality Improvement and Continuing Medical Education in general practice in the Central Denmark Region (Kvalitets- og Efteruddannelsesudvalget) and the Committee of Multipractice Studies in General Practice (Multipraksisudvalget). Researchers were independent from funders.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The National Committee on Health Research Ethics in the Central Denmark Region was consulted and found that no approval was required for this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Anonymised data are available on reasonable request.