Background Around 10% of calls to ambulance services in England are resolved over the phone (referred to as telephone advice or hear and treat). These calls are generally dealt with by clinicians following initial call-handler assessment. A systematic review concluded that telephone advice is a safe alternative for patients categorised as low priority but recommended the need to understand the skills required. Our research explores the non-technical skills (cognitive, social and personal) required.
Methods Non-participant observation of telephone advice in three ambulance services involved 40 hours of observation per service, (total n=27 clinicians and 20 call-handlers) and semi-structured interviews with clinicians (n=7), call-handlers (n=7) and managers (n=3). A framework approach and NVIVO qualitative data analysis software were used to analyse the data.
Findings Situation awareness was a necessary skill in gathering information by telephone. Strategies included visualisation, attending to tone of voice and listening to Background noise. Decision making skill was needed to select an appropriate course of action. For clinicians this involved reference to prior experience and risk judgement that the available information supported a safe decision. Call-handlers were more reliant on computerised triage systems. Communication skill required rephrasing technical questions, providing reassurance and assertiveness in managing expectations. Call-handlers had less discretion to rephrase computerised scripts. Personal resources were required to manage role demands that included dealing with high call volumes, task conflict and difficult conversations with callers expecting an ambulance response.
Conclusions The findings have implications for the recruitment, training and ongoing development of call-handlers and clinicians involved in the delivery of telephone advice. There is scope for further research to provide a more detailed understanding of non-technical skills in the delivery of telephone advice to ensure the consistent delivery of appropriate and safe care that is acceptable to patients.
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