A comparison of calls subjected to a malpractice claim versus ‘normal calls’ within the Swedish Healthcare Direct: a case–control study

Abstract

ObjectivesThe purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls.SettingIn many countries, telephone advice nursing is patients’ first contact with healthcare. Telenurses’ assessment of callers’ symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported.ParticipantsA total sample of all reported medical errors (n=33) during the period 2003–2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected.ResultsMale patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases.ConclusionsThe present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.

It is important that they care – older persons’ experiences of telephone advice nursing

“…The telephone advice nurses’ communicative competence was important to build the relationships and mutual understanding of the older persons’ health problems, which is consistent with Wahlberg and Wredling () and Ernesäter et al . (). The older persons were confident in terms of the telephone nurses’ competence and that their experience accessing telephone advice nursing was mostly good.…”

Development and content validation of the Telenursing Interaction and Satisfaction Questionnaire (TISQ)

“…In TAN, reported satisfaction with calls is generally high, but, as described above, the degree of satisfaction is not necessarily a measure of high quality of care. It could, for example, be the result of low expectations and is affected by gender and age, as described by Chow et al Parallel to this, there is in literature on TAN a documented need for improvements in health‐care quality in terms of telenurses’ communication competence, and it has been suggested that patient satisfaction surveys designed for a TAN context should monitor improvements in telenurses’ communication competence . To our knowledge, there is no survey available that examines both the perception of and the satisfaction with the different parts of the interaction with the telenurses accompanied by the large number of potential influencing variables presented in the IMCHB.…”

Telephone nursing in Sweden: A narrative literature review

“…Ernesäter et al () used the Roter interaction analysis system (Roter & Larson ) to compare the communication patterns from a study on actual malpractice‐claimed calls with matched controls (26 cases and 26 control calls) (Ernesäter et al ). RNs in the malpractice‐claimed cases used fewer open‐ended medical questions than those in the control cases ( P < 0.001).…”

“…Swedish TN might be considered safe because only 33 malpractice claimed calls were found from 2003 to 2010 (Ernesäter et al , ). However, these cases were severe: one‐third of the patients died, and one‐third were admitted to the intensive care unit.…”