Optimisation of telephone triage of callers with symptoms suggestive of acute cardiovascular disease in out-of-hours primary care: observational design of the Safety First study
| Autor: | Loes Wouters, Dorien L.M. Zwart, Frans H. Rutten, Daphne C. Erkelens, Roger A M J Damoiseaux, Esther de Groot, Arno W. Hoes |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Acute coronary syndrome Netherlands triage standard Time Factors after hours care Cardiovascular Medicine Logistic regression acute coronary syndrome 03 medical and health sciences 0302 clinical medicine After-Hours Care medicine Protocol Humans 030212 general & internal medicine Adverse effect Stroke Netherlands Retrospective Studies out of hours services in primary care Primary Health Care business.industry 030503 health policy & services General Medicine medicine.disease Triage Quality Improvement stroke Telephone telephone triage Cardiovascular Diseases transient ischemic attack Acute Disease Observational study Female Medical emergency 0305 other medical science business Medical ethics Qualitative research |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | IntroductionIn the Netherlands, the ‘Netherlands Triage Standard’ (NTS) is frequently used as digital decision support system for telephone triage at out-of-hours services in primary care (OHS-PC). The aim of the NTS is to guarantee accessible, efficient and safe care. However, there are indications that current triage is inefficient, with overestimation of urgency, notably in suspected acute cardiovascular disease. In addition, in primary care settings the NTS has only been validated against surrogate markers, and diagnostic accuracy with clinical outcomes as the reference is unknown. In the Safety First study, we address this gap in knowledge by describing, understanding and improving the diagnostic process and urgency allocation in callers with symptoms suggestive of acute cardiovascular disease, in order to improve both efficiency and safety of telephone triage in this domain.Methods and analysisAn observational study in which 3000 telephone triage recordings (period 2014–2016) will be analysed. Information is collected from the recordings including caller and symptom characteristics and urgency allocation. The callers’ own general practitioners are contacted for the final diagnosis of each contact. We included recordings of callers with symptoms suggestive of acute coronary syndrome (ACS) or transient ischaemic attack (TIA)/stroke. With univariable and multivariable logistic regression analyses the diagnostic accuracy of caller and symptom characteristics will be analysed in terms of predictive values with urgency level, and ACS and TIA/stroke as outcomes, respectively. To further improve our understanding of the triage process at OHS-PC, we will carry out additional studies applying both quantitative and qualitative methods: (i) case-control study on serious adverse events (SAE), (ii) conversation analysis study and (iii) interview study with triage nurses.Ethics and disseminationThe Medical Ethics Committee Utrecht, the Netherlands endorsed this study (National Trial Register identification: NTR7331). Results will be disseminated at scientific conferences, regional educational sessions and publication in peer-reviewed journals. |
| Databáze: | OpenAIRE |
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