Impact of caller's degree-of-worry on triage response in out-of-hours telephone consultations: a randomized controlled trial

TY - JOUR

T1 - Impact of caller's degree-of-worry on triage response in out-of-hours telephone consultations

T2 - a randomized controlled trial

AU - Gamst-Jensen, Hejdi

AU - Frishknecht Christensen, Erika

AU - Lippert, Freddy

AU - Folke, Fredrik

AU - Egerod, Ingrid

AU - Brabrand, Mikkel

AU - Tolstrup, Janne Schurmann

AU - Thygesen, Lau Caspar

AU - Huibers, Linda

PY - 2019/4/11

Y1 - 2019/4/11

N2 - BACKGROUND: Telephone triage entails assessment of urgency and direction of flow in out-of-hours (OOH) services, while visual cues are inherently lacking. Triage tools are recommended but current tools fail to provide systematic assessment of the caller's perspective. Research demonstrated that callers can scale their degree-of-worry (DOW) in a telephone contact with OOH services, but its impact on triage response is undetermined. The aim of this study was to investigate the association between call-handlers' awareness of the caller's DOW and the telephone triage response.METHODS: A randomized controlled trial at a Danish OOH service using telephone triage with quantitative analyses and qualitative process evaluation. Prior to contact with a call-handler, callers were asked to rate their DOW on a five-point scale. Calls were randomized to show or not show DOW on the call-handlers' screens. Triage response (telephone consultation or face-to-face consultation) was analysed using Chi-square tests. Process evaluation incorporated a quantitative and qualitative assessment of intervention implementation and fidelity.RESULTS: Of 11,413 calls, 5705 were allocated to the intervention and 5708 to the control group. No difference in number of face-to-face consultations was detected between the two groups (OR 1.05, 95% CI 0.98 to 1.14, p = 0.17). The process evaluation showed that call-handlers did not use the DOW systematically and were reluctant to use DOW.CONCLUSION: Awareness of DOW did not affect the triage response, but this finding could reflect a weak implementation strategy. Future studies should emphasise the implementation strategy to determine the effect of DOW on triage response.TRIAL REGISTRATION: Registration number, Clinicaltrials.gov NCT02979457 .

AB - BACKGROUND: Telephone triage entails assessment of urgency and direction of flow in out-of-hours (OOH) services, while visual cues are inherently lacking. Triage tools are recommended but current tools fail to provide systematic assessment of the caller's perspective. Research demonstrated that callers can scale their degree-of-worry (DOW) in a telephone contact with OOH services, but its impact on triage response is undetermined. The aim of this study was to investigate the association between call-handlers' awareness of the caller's DOW and the telephone triage response.METHODS: A randomized controlled trial at a Danish OOH service using telephone triage with quantitative analyses and qualitative process evaluation. Prior to contact with a call-handler, callers were asked to rate their DOW on a five-point scale. Calls were randomized to show or not show DOW on the call-handlers' screens. Triage response (telephone consultation or face-to-face consultation) was analysed using Chi-square tests. Process evaluation incorporated a quantitative and qualitative assessment of intervention implementation and fidelity.RESULTS: Of 11,413 calls, 5705 were allocated to the intervention and 5708 to the control group. No difference in number of face-to-face consultations was detected between the two groups (OR 1.05, 95% CI 0.98 to 1.14, p = 0.17). The process evaluation showed that call-handlers did not use the DOW systematically and were reluctant to use DOW.CONCLUSION: Awareness of DOW did not affect the triage response, but this finding could reflect a weak implementation strategy. Future studies should emphasise the implementation strategy to determine the effect of DOW on triage response.TRIAL REGISTRATION: Registration number, Clinicaltrials.gov NCT02979457 .

KW - Adolescent

KW - Adult

KW - After-Hours Care/organization & administration

KW - Aged

KW - Child

KW - Child, Preschool

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Male

KW - Middle Aged

KW - Primary Health Care/organization & administration

KW - Process Assessment (Health Care)

KW - Referral and Consultation/organization & administration

KW - Telephone

KW - Triage/methods

KW - Young Adult

U2 - 10.1186/s13049-019-0618-2

DO - 10.1186/s13049-019-0618-2

M3 - Journal article

C2 - 30975160

SN - 1757-7241

VL - 27

JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

M1 - 44

ER -