Computer-supported telephone nurse triage: an evaluation of medical quality and costs

Marklund, Bertil; Ström, Mayvor; Månsson, Jörgen; Borgqúist, Lars; Baigi, Amir; Fridlund, Bengt

doi:10.1111/j.1365-2834.2007.00659.x

Cited by 78 publications

(112 citation statements)

References 34 publications

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“…NTLs are also beneficial in that they reduce strain on the HCS, offer high levels of patient satisfaction, and serve as a safe, efficient, and cost-effective method of information dissemination. [19][20][21][22][23][24] Benefits can also be seen in reduced travel costs, reduced time away from school/work, and reduced childcare expenses. 17 …”

Section: Discussionmentioning

confidence: 99%

Design and Implementation of a Statewide Influenza Nurse Triage Line in Response to Pandemic H1N1 Influenza

Spaulding¹,

Radi²,

MacLeod³

et al. 2012

Public Health Rep

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The 2009 H1N1 influenza pandemic created a demand for health-care services that many health-care systems and providers were unprepared to meet in a timely way. One state used a public-private partnership to address this increased demand for information and services, including offering a prescription for those whose symptoms warranted treatment with an antiviral medication. Spaulding et al. describe how the Minnesota Department of Health worked with a variety of partners, including the Minnesota Hospital Association and the Minnesota Council of Health Plans, to establish a coordinated statewide nurse triage line-the Minnesota FluLine. This effort could serve as a model for other local public health departments when a rapid response to a health-care threat is needed.

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Section: Discussionmentioning

confidence: 99%

Design and Implementation of a Statewide Influenza Nurse Triage Line in Response to Pandemic H1N1 Influenza

Spaulding¹,

Radi²,

MacLeod³

et al. 2012

Public Health Rep

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“…72 57 also reported on appropriateness and 11 of the studies identified here were included in the review by Blank et al 73,[75][76][77][80][81][82]84,88,90 This review identified that triage decisions rated as appropriate varied between 44% and 98%. However, many different definitions of appropriateness were used, which leads to difficulty when trying to compare results.…”

Section: Service Impactsmentioning

confidence: 99%

“…93,94 Costs Nine studies reported costs or cost savings. 75,79,86,101,[108][109][110][111][112]126 The most common method of calculating and reporting costs was to report costs saved from callers' change in subsequent health-care-seeking behaviour as a result of the call. 75,79,108,110 These were not consistently reported and were reported as average per patient savings, cost savings per call recommendation type, annual net savings and overall reduction, making comparison difficult.…”

Section: Safetymentioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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“…Services provided at these call centres can in this way prevent unnecessary medical visits and result in financial savings for healthcare systems. They also have the potential to improve self-care for the public [5,8,9] .…”

Section: Introductionmentioning

confidence: 99%

“…Nurse-led telephone triage has been introduced in many Western countries, for example Holland, Australia, UK and Sweden [2][3][4][5] . Competent telenurses at well-organised call centres estimate the urgency of callers' health problems, recommend the best course of action for each individual caller, and try to steer the callers to optimal care levels [5][6][7] . Services provided at these call centres can in this way prevent unnecessary medical visits and result in financial savings for healthcare systems.…”

Section: Introductionmentioning

confidence: 99%

Educating Swedish telenurses to improve caller experience: Reflections on a pilot study

Holmström¹,

Röing

Vég³

et al. 2014

Clinical Nursing Studies

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Telenurses employed at Swedish Healthcare Direct offer triage recommendations and self-care advice to the general public over the telephone on a wide range of health problems. Their understanding of work and ability to communicate are essential for callers' adherence to recommendations and satisfaction with the service. This paper presents and reflects upon an educational intervention for Swedish telenurses which aimed to improve caller experience. Twelve telenurses participated. Six were randomised to an intervention group, the other six to a reference group. The nurses in the intervention group individually listened to, and reflected on their authentic calls together with one of the researchers on five to six separate occasions. Callers' experiences were surveyed using a postal questionnaire sent within 48 hours of their call, both before and after the intervention. Descriptive and comparative statistics as well as content analysis were used in the analysis of the questionnaires. The most striking finding was that the educational intervention did not seem to have any effect on outcomes of the telenurses calls. Other findings revealed that a large group of callers, about 20%, did not find the call useful and only 50% to 60% of the callers reported that they had learned something from the call. Callers' most frequent unfulfilled expectations centred on not being referred to a physician, and a perceived low level of competence among telenurses. The modest impact of the intervention on the services of telenursing may have been due to the participating nurses, the organisation, or the design of the intervention. Lessons have been learned that need to be taken into account in future and more large scale studies.

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Computer-supported telephone nurse triage: an evaluation of medical quality and costs

Abstract: The telephone nurse triage model showed adequate guidance for the patients concerning level of care and released resources for the benefit of both patients and the health care system.

Cited by 78 publications

References 34 publications

Design and Implementation of a Statewide Influenza Nurse Triage Line in Response to Pandemic H1N1 Influenza

Design and Implementation of a Statewide Influenza Nurse Triage Line in Response to Pandemic H1N1 Influenza

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Educating Swedish telenurses to improve caller experience: Reflections on a pilot study

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