Abstract
ObjectiveTelephone triage manages patient flow in acute care, but a lack of visual cues and vague descriptions of symptoms challenges clinical decision making. We aim to investigate the association between the caller’s subjective perception of illness severity expressed as “degree-of-worry” (DOW) and hospital admissions within 48 h.Design and settingA prospective cohort study was performed from January 24th to February 9th, 2017 at the Medical Helpline 1813 (MH1813) in Copenhagen, Denmark. The MH1813 is a primary care out-of-hours service.ParticipantsOf 38,787 calls received at the MH1813, 11,338 met the inclusion criteria (caller being patient or close friend/relative and agreement to participate). Participants rated their DOW on a 5-point scale (1 = minimum worry, 5 = maximum worry) before talking to a call handler.Main outcome measureInformation on hospitalization within 48 h after the call, was obtained from the Danish National Patient Register. The association was assessed using logistic regression in three models: 1) crude, 2) age-and-gender adjusted and 3) age, gender, co-morbidity, reason for calling and caller status adjusted.ResultsA total of 581 participants (5.1%) were admitted to the hospital, of whom 170 (11.3%) presented with a maximum DOW, with a crude odds ratio (OR) for hospitalization of 6.1 (95% confidence interval (CI) 3.9 to 9.6) compared to minimum DOW. Estimates showed dose-response relationship between DOW and hospitalization. In the fully adjusted model, the ORs decreased to 3.1 (95%CI 2.0 to 5.0) for DOW = 5, 3.2 (2.0 to 5.0) for DOW = 4, 1.6 (1.0 to 2.6) for DOW = 3 and 0.8 (0.5 to 1.4) for DOW = 2 compared to minimum DOW.ConclusionPatients’ self-assessment of illness severity as DOW was associated with subsequent hospital admission. Further, it may be beneficial in supporting clinical decision making in telephone triage. Finally, it might be useful as a measure to facilitate patient participation in the triage process.
Highlights
Telephone triage is widely used in acute care and emergency medicine
Patients’ self-assessment of illness severity as DOW was associated with subsequent hospital admission. It may be beneficial in supporting clinical decision making in telephone triage
All acute non-life-threatening contacts to the health care system within the region are pre-assessed by a registered nurse or physician, who triage the caller to either advice and self-care, own general practitioner (GP), clinic consultation at an emergency department, home visit, hospital admission, or dispatch of an ambulance
Summary
Telephone triage is widely used in acute care and emergency medicine It encompasses both emergency calls and non-life-threatening acute situations. Most calls to medical helplines are for non-life-threatening conditions, often presented with an array of symptoms that might not fit textbook descriptions [4, 5]. Triage tools are recommended to aid health care professionals’ decision making [6], but these tools generally perform well only in the low and high levels of urgency, but less so in the middle triage categories [6, 7], they are criticized for not incorporating the patient’s context and perception nearly enough [8, 9]. A need exists for a tool that systematically incorporates the patient’s perception of the situation and symptoms in telephone triage
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