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Is computer-assisted telephone triage safe? A prospective surveillance study in walk-in patients with non-life-threatening medical conditions
  1. Andreas Meer1,
  2. Thomas Gwerder1,
  3. Lutz Duembgen2,
  4. Niki Zumbrunnen2,
  5. Heinz Zimmermann1
  1. 1Inselspital Bern Emergency Centre, Bern University, Bern, Switzerland
  2. 2Institute for Mathematical Statistics and Actuarial Science, Bern University, Bern, Switzerland
  1. Correspondence to In4medicine AG, Andreas Meer, Pavillonweg, 3012 Bern, Switzerland; a.meer{at}in4medicine.ch

Abstract

Background Patients often establish initial contact with healthcare institutions by telephone. During this process they are frequently medically triaged.

Purpose To investigate the safety of computer-assisted telephone triage for walk-in patients with non-life-threatening medical conditions at an emergency unit of a Swiss university hospital.

Methods This prospective surveillance study compared the urgency assessments of three different types of personnel (call centre nurses, hospital physicians, primary care physicians) who were involved in the patients' care process. Based on the urgency recommendations of the hospital and primary care physicians, cases which could potentially have resulted in an avoidable hazardous situation (AHS) were identified. Subsequently, the records of patients with a potential AHS were assessed for risk to health or life by an expert panel.

Results 208 patients were enrolled in the study, of whom 153 were assessed by all three types of personnel. Congruence between the three assessments was low. The weighted κ values were 0.115 (95% CI 0.038 to 0.192) (hospital physicians vs call centre), 0.159 (95% CI 0.073 to 0.242) (primary care physicians vs call centre) and 0.377 (95% CI 0.279 to 0.480) (hospital vs primary care physicians). Seven of 153 cases (4.57%; 95% CI 1.85% to 9.20%) were classified as a potentially AHS. A risk to health or life was adjudged in one case (0.65%; 95% CI 0.02% to 3.58%).

Conclusion Medical telephone counselling is a demanding task requiring competent specialists with dedicated training in communication supported by suitable computer technology. Provided these conditions are in place, computer-assisted telephone triage can be considered to be a safe method of assessing the potential clinical risks of patients' medical conditions.

  • Telemedicine
  • medical call centres
  • computer-assisted telephone triage
  • safety
  • walk-in patients
  • emergency care systems
  • primary care
  • management
  • risk management
  • quality assurance
  • nursing
  • pre-hospital
  • emergency departments

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Footnotes

  • Funding The study was sponsored with funding from the Adult Emergency Centre of Bern University Hospital. The nurse counselling was provided by Medi24 (Mondial Service Switzerland AG) at no charge.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Bern Cantonal Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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