Malpractice claims regarding calls to Swedish telephone advice nursing: what went wrong and why?

Abstract

We analysed the characteristics of all malpractice claims arising out of telephone calls to Swedish Healthcare Direct (SHD) during 2003-2010 (n = 33). The National Board of Health and Welfare's (NBHW) investigations describing the causes of the malpractice claims and the healthcare providers' reported measures were analysed using Qualitative Content Analysis. The original telephone calls themselves, which had been recorded, were analysed using the Roter Interaction Analysis System (RIAS). Among the 33 cases, 13 patients died and 12 were admitted to intensive care. Failure to listen to the caller (n = 12) was the most common reason for malpractice claims, and work-group discussion (n = 13) was the most common measure taken to prevent future re-occurrence. Male patients (n = 19) were in the majority, and females (n = 24) were the most common callers. The most common symptoms were abdominal (n = 11) and chest pain (n = 6). Telenurses followed up on caller understanding in six calls, and mainly used closed-ended questions. Despite the severity of these malpractice claims, the measures taken mainly addressed active failure, rather than the latent conditions. Third-party communication should be regarded as a risk. When callers make repeated contacts, telenurses need to re-evaluate their need for care.

‘If I didn’t trust Swedish Healthcare Direct, I would never call’ – views of making pediatric health calls

“…This can be due to earlier contentment with the service or linking the telenursing power [37] with a trust in telenurses' correct assessment. However, telenurses are not infallible, and parents' blind adherence to a telenurse's recommendations may in some cases delay children's treatments and possibly lead to adverse events [55] . In these situations, minority ethnic groups are possibly at higher risk due to reports of ethnic disparities in access to timely, high-quality emergency care [56] .…”

“…This has however not been explored in the present study. To assure safer pediatric care and avoid the risk of malpractice claims [55] , telenurses' usage of safety netting advice, that is to encourage parents to call back or contact emergency services whenever necessary, is specifically important.…”

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

“…Anxiety, aggravating factors in the caller's previous medical history, or surrounding environment (such as long distance to medical attention) can be one reason for such a request. From a patient safety point of view, such callers identify a need for medical attendance which might be correct, and which needs to be explored by telenurses [18] .…”

“…It has recently been shown that in a group of callers with a preconception of care level, surprisingly few callers were asked about their own opinion of being triaged to a lower level of care. This could be regarded as a nurse-driven agenda in contrast to a patient-centred agenda [18] . Callers in the present study openly requested a change in this direction in their free written comments.…”

“…A recent study of telenurses' calls involved in malpractice claims revealed that the communication between telenurses and callers seemed to be nurse-driven, with few open-ended questions and a lack of exploration of callers' understanding of given advice [18] . Overall, situations in telenursing experienced as difficult by nurses are characterised by uncertainty, communication problems and insufficient resources [15,17,19] .…”