Incident reporting in nurse-led national telephone triage in Sweden: the reported errors reveal a pattern that needs to be broken

Ernesäter, Annica; Engström, Maria; Holmström, Inger; Winblad, Ulrika

doi:10.1258/jtt.2009.090813

Cited by 27 publications

(35 citation statements)

References 21 publications

(32 reference statements)

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“…Their choice of emergency as the appropriate care level may have been correct due to an impairment of the health status, but it might also reflect the long waiting lists in Swedish primary healthcare. [11] The outcome was about the same for cases and controls regarding expectation of care level and the outcome of the visit. It is reasonable to wonder why there is such a difference between cases and controls in their satisfaction with the telenursing service.…”

Section: Discussionmentioning

confidence: 99%

Triage and patient satisfaction among callers in Swedish computer-supported telephone advice nursing

2011

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SummaryWe investigated satisfaction with a Swedish telenursing service, and the healthcare seeking behaviour among callers who received a less urgent level of healthcare than they expected. A postal questionnaire was sent to a random selection of callers (n=273) to Swedish Healthcare Direct in October 2008. The "cases" were 18 callers where the telenurse recommended a lower level of health care than the caller expected and who were not in complete agreement with the nurse. The "controls" were 22 callers who either received a lower recommendation, or were in disagreement with the recommendation. There were no differences between cases, controls and other callers regarding background factors or the telenurse classification of emergency. However, both cases and controls considered their need for health care as more urgent than the other callers. An independent test of the nurses' reception, ability to listen and to take notice of the callers' health problem, showed that nurses who had served cases, had received a significantly lower rating than other nurses. For nurses who had served controls, there was no such difference in rating. Cases and controls had fewer subsequent care visits than other callers, in the three days following the call, although the proportion of emergency visits was higher among cases and controls compared to other callers. If the caller and the nurse disagree about the nurse's recommendations, the consequence can be a dissatisfied caller and more visits to unnecessary high levels of health care. Further training of the nurses may improve the telenurse service.

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Section: Discussionmentioning

confidence: 99%

Triage and patient satisfaction among callers in Swedish computer-supported telephone advice nursing

2011

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“…Of eight additional studies 68,92,103,104,133,[140][141][142] not included in the Huibers et al review, 62 one study also found that more safety issues were associated with higher-urgency calls 140 and two studies, one set in primary care 68 and one set in emergency medical service (EMS) care, 103 both reported no adverse outcomes or differences in suboptimal outcomes for high-urgency calls.…”

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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“…According to the telenurses, stress and fatigue were involved in the malpractice claims and were described as contributing factors [34]. The identified problem with lacking availability among other healthcare providers has been described in a previous study [23], where it was the most common reason for an incident report within SHD.…”

Section: Discussionmentioning

confidence: 99%

“…Secondary findings from previous studies conducted within the research team have indicated deficiencies in these factors for telenurses working within SHD [14, 15, 22–24]. The telenurses experience conflicts within their work, stressful situations and problems referring the caller to the appropriate healthcare provider [23]. Access to essential structural conditions has shown fewer stress symptoms, higher job satisfaction [25] and improved work effectiveness [26–28].…”

Section: Introductionmentioning

confidence: 99%

Identified obstacles and prerequisites in telenurses’ work environment – a modified Delphi study

Björkman

Engström

Olsson

et al. 2017

BMC Health Serv Res

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BackgroundTelenursing is an expanding part of healthcare, staffed with registered nurses whose work environment is typical of a call centre. Work-related stress has been shown to be a major problem in nurses’ work environments and of importance to the outcome of care, patient safety, nurse job satisfaction and burnout. Today, however, we have a limited understanding of and knowledge about the work environment for telenurses. The aim of the present study is to explore and reach consensus on perceived important obstacles and prerequisites in telenurses’ work environment.MethodsA modified Delphi design, using qualitative as well as quantitative data sequentially through three phases, was taken. Data were initially collected via semi-structured interviews (Phase I) and later using a web survey (Phase II-III) between March 2015 and March 2016.ResultsThe findings present a consensus view of telenurses’ experiences of important obstacles and prerequisites in their work environment. Central to the findings are the aspects of telenurses having a demanding work, cognitive fatigue and having no opportunity for recovery during the work shift was ranked as important obstacles. Highly ranked prerequisites for managing were being able to focus on one caller at a time, working in a calm and pleasant environment and having technical support 24/7.ConclusionsManagers need to enable telenurses to experience control in their work, provided with possibilities to control their work and to recover during work; shortening work time could improve their work environment. Limited possibilities to perform work might contribute to feelings of stress and inability to perform work.

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Incident reporting in nurse-led national telephone triage in Sweden: the reported errors reveal a pattern that needs to be broken

Cited by 27 publications

References 21 publications

Triage and patient satisfaction among callers in Swedish computer-supported telephone advice nursing

Triage and patient satisfaction among callers in Swedish computer-supported telephone advice nursing

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

Identified obstacles and prerequisites in telenurses’ work environment – a modified Delphi study

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