Factors affecting medical file documentation during telephone triage at an emergency call centre: a cross-sectional study of out-of-hours home visits by general practitioners in France

Eric Lecarpentier,Julien Vaux,Paul-Georges Reuter,Eric Tapiero,Matthieu Heidet,Jean Marty,Charles Binetruy,Florence Canoui-Poitrine,Michel Nguyen,Maeva Bertin,Thomas Perennou,François Revaux,Julien Palazzi

doi:10.1186/s12913-019-4350-4

Abstract

BackgroundIn France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre. The quality of a systematic physician-led triage has not been determined in France and may affect the efficiency of the OOH-HV process. The objectives of this study were first, to evaluate the quality of reporting in the electronic patient’s file after such triage and second, to analyse the factors associated with altered reporting.MethodsCross-sectional study in a French urban emergency call centre (district of Paris area) from January to December 2015. For a random selection of 30 days, data were collected from electronic medical files that ended with an OOH-HV decision. Missing key quality criteria (medical interrogation, diagnostic hypothesis or ruled-out severity criteria) were analysed by univariate then multivariate logistic regression, adjusted on patient, temporal and organizational data.ResultsAmong 10,284 OOH-HVs performed in 2015, 748 medical files were selected. Reasons for the encounter were digestive tract symptoms (22%), fever (19%), ear nose and throat symptoms, and cardiovascular and respiratory problems (6% each). Medical interrogation was not reported in 2% of files (n = 16/748) and a diagnostic hypothesis in 58% (n = 432/748); ruled-out severity criteria were not reported in 60% (n = 449/748). On multivariate analysis, altered reporting was related to the work overload of triage assistants (number of incoming calls, call duration, telephone occupation rate; p < 0.03).ConclusionIn the electronic files of patients requiring an OOH-HV by a GP in a French urban area, quality in medical reporting appeared to depend on organizational factors only, especially the triage assistants-related work factors. Corrective measures are needed to ensure good quality of triage and care.

Highlights

In France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre
Population Among the 10,284 OOH-HVs performed from January 1, 2015 to December 31, 2015, we selected for analysis 748 unique electronic medical files with an OOH-HV performed during the randomly selected 30 days (19 holiday or public holiday days, 2 weekend days and 9 weekdays of worked weeks) (Fig. 1)
For 708 records (95%), medical triage was performed by GPs and for the other 5% by Emergency physician (EP)

Summary

Introduction

In France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre. The quality of a systematic physician-led triage has not been determined in France and may affect the efficiency of the OOH-HV process. In France, public emergency call centres receive all health-related incoming calls and coordinate access to OOH-PC providers, including mobile general practitioners (GPs) performing semi-urgent OOH home visits (OOH-HVs; i.e., visits that cannot wait until the reopening of primary care practices). In French public emergency call centres, the call handling is two-tiered: first, non-medical assistants collect the initial information and can provide basic support. Despite lack of high-level evidence, physician-led triage is believed to be a good model for the triage process, patient access to healthcare structures, safety and costs [6]

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