Verpleegkundige telefonische triage in de Nederlandse eerstelijnszorg buiten kantooruren

Huibers L, Giesen P, Smits M, Mokkink H, Grol R, Wensing M. Nurse telephone triage in Dutch out-of-hours primary care: the relation between history taking and urgency estimation. Eur J Emerg Med 2011 Oct 15.

DOEL: In Nederland is het eerste contact van een patiënt met een huisartsencoöperatie buiten kantooruren, doorgaans met een triage verpleegkundige. Eerder onderzoek wees uit dat verpleegkundigen soms het niveau van urgentie onderschatten, hetgeen veroorzaakt kan worden door onvolledige medische anamnese. Het doel van deze studie was het onderzoeken van de relatie tussen volledigheid van medische anamnese en bekwaamheid van urgentie schatting.

CONCLUSIE: Het onvolledig stellen van aanbevolen vragen via telefonische triage werd niet geassocieerd met onderschatting van urgentie. Het herkennen van patronen kan belangrijker zijn voor het identificeren van urgente gezondheidsproblemen door verpleegkundigen dan het stellen van alle cruciale vragen tijdens de medische anamnese.

OBJECTIVE: In the Netherlands, a patient's first contact with a general practitioner cooperative, an out-of-hours primary-care center, is usually with a triage nurse. Previous research has shown that nurses sometimes underestimate the level of urgency, which may be caused by incomplete history taking. The aim of this study was to examine the relation between comprehensiveness of history taking and appropriateness of urgency estimation.

METHODS: Simulated patients, presenting 20 standardized vignettes, called four general practitioner cooperatives in different regions in the Netherlands that used the national telephone guidelines. We assessed the questions triage nurses asked in 304 audio-taped contacts, distinguishing between discriminating and general recommended questions. Discriminating questions help to confirm or reject a specific urgency level, whereas general questions are used to collect additional information regarding context. We calculated the percentage of recommended questions asked and made plots of the patterns of questions asked for chest pain and dyspnea.

RESULTS: Mean numbers of discriminating and general questions per telephone contact were 4.4 and 3.2, respectively. There were no differences between the number of discriminating questions asked for contacts with correctly estimated urgency and contacts with underestimated urgency. We identified clusters of frequently asked questions, which were similar for contacts with correctly estimated and contacts with underestimated urgency.

CONCLUSION: Incomplete asking of recommended questions through telephone triage was not associated with underestimation of urgency. Pattern recognition may be more important for identification of urgent health problems by nurses than asking all crucial questions during history taking.

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