Quality of clinical aspects of call handling at Dutch out of hours centres: cross sectional national study

doi:10.1136/bmj.a1264

Published 12 September 2008, doi:10.1136/bmj.a1264
Cite this as: BMJ 2008;337:a1264

Research

Quality of clinical aspects of call handling at Dutch out of hours centres: cross sectional national study

Hay P Derkx, researcher¹, Jan-Joost E Rethans, associate professor², Arno M Muijtjens, assistant professor ³, Bas H Maiburg, vocational trainer⁴, Ron Winkens, assistant professor⁵, Harrie G van Rooij, head of quality management ⁶, J André Knottnerus, professor of general practice and epidemiology¹

¹ Department of General Practice, Maastricht University, Maastricht, Netherlands, ² Skillslab, Maastricht University, ³ Department of Educational Development and Research, Maastricht University , ⁴ Department of General Practitioner Vocational Training, Maastricht University , ⁵ Centre for Quality of Care Research, Department of General Practice, Maastricht University, ⁶ Primary Care Out-of-hours Centre, Tilburg, Netherlands

Correspondence to: H P Derkx hay.derkx{at}medicinfo.nl

Objective To assess the quality of telephone triage by followingthe consecutive phases of its care process and the quality ofthe clinical questions asked about the patient’s clinicalcondition, of the triage outcome, of the content of the homemanagement advice, and of the safety net advice given at outof hours centres.

Design Cross sectional national study using telephone incognitostandardised patients.

Setting The Netherlands.

Participants 17 out of hours centres.

Main outcome measures Percentages of clinical obligatory questionsasked and items within home management and safety net advice,both in relation to pre-agreed standards, and of care advicegiven in relation to the required care advice.

Results The telephone incognito standardised patients presentedseven clinical cases three times each over a period of 12 months,making a total of 357 calls. The mean percentage of obligatoryquestions asked compared with the standard was 21%. Answersto questions about the clinical condition were not always correctlyevaluated from a clinical viewpoint, either by triagists orby general practitioners. The quality of information on homemanagement and safety net advice varied, but it was consistentlypoor for all cases and for all out of hours centres. Triagistsachieved the appropriate triage outcome in 58% of calls.

Conclusion In determining the outcome of the care process, triagistsoften reached a conclusion after asking a minimal number ofquestions. By analysing the quality of different phases withinthe process of telephone triage, evaluation of whether an appropriatetriage outcome has been arrived at by means of good clinicalreasoning or by an educated guess is possible. In terms of enhancingthe overall clinical safety of telephone triage, apart fromobtaining an appropriate clinical history, adequate home managementand safety net advice must also be given.

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