Advertisement

Consistency of Triage Decisions by Call Center Nurses

  • Shira Belman
    Correspondence
    Address correspondence to Shira Belman, MD, Children's Hospital, 1056 E 19th Ave, B032, Denver, CO 80218
    Affiliations
    Search for articles by this author
  • James Murphy
    Affiliations
    From the Departments of Pediatrics (Drs Belman and Kempe) and Medicine (Dr Steiner), University of Colorado Health Science Campus, Denver, Colo; and the Division of Biostatistics (Dr Murphy), National Jewish Medical and Research Center, Denver, Colo
    Search for articles by this author
  • John F. Steiner
    Affiliations
    From the Departments of Pediatrics (Drs Belman and Kempe) and Medicine (Dr Steiner), University of Colorado Health Science Campus, Denver, Colo; and the Division of Biostatistics (Dr Murphy), National Jewish Medical and Research Center, Denver, Colo
    Search for articles by this author
  • Allison Kempe
    Affiliations
    From the Departments of Pediatrics (Drs Belman and Kempe) and Medicine (Dr Steiner), University of Colorado Health Science Campus, Denver, Colo; and the Division of Biostatistics (Dr Murphy), National Jewish Medical and Research Center, Denver, Colo
    Search for articles by this author
      Objectives.To 1) assess consistency in triage disposition among pediatric telephone triage nurses using computer-based algorithms and 2) determine agreement between nurse dispositions and protocol dispositions.
      Design/Methods.Fifteen nurses from the After Hours Telephone Care Program in Denver were randomly selected to receive mock calls from standardized patients. Each nurse received the same 15 scenarios. Reliability in triage disposition was assessed using the κ statistic. Audiotapes of cases were reviewed if an urgent referral was warranted by the protocol but not given 20% or more of the time.
      Results.Mean agreement among nurses for individual cases was 83% (range, 64%–100%). Overall interrater reliability among nurses for triage disposition was 0.46 (95% confidence interval, 0.43–0.49). Mean agreement between nurses' dispositions and protocol dispositions was 81% (range, 33%–100%). Audio review revealed no differences in length of call or information elicited between cases receiving urgent and nonurgent dispositions. Reasons for incorrect dispositions were 1) information necessary to make the disposition directed by the protocol was given and ignored and 2) nurses did not elicit the necessary information prescribed by the protocol.
      Conclusions.Agreement regarding disposition decisions among call center nurses and between nurses and protocols was close to 80%. Disagreement with protocol dispositions occurred when nurses 1) did not follow protocols or 2) did not act on information provided by the parent. Our data suggest a need for additional attention to communication skills and to protocol adherence in training and ongoing quality improvement practices.

      KEY WORDS

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Aronson SH
        The Lancet on the telephone 1876–1975.
        Med Hist. 1977; 21: 69-87
        • Hessel SJ
        • Haggerty RJ
        General pediatrics: a study of practice in the mid-1960's.
        J Pediatr. 1968; 73: 271-279
        • Fosarelli P
        • Schmitt B
        Telephone dissatisfaction in pediatric practice: Denver and Baltimore.
        Pediatrics. 1987; 80: 28-31
        • Poole SR
        • Schmitt BD
        • Carruth T
        • et al.
        After-hours telephone coverage: the application of an area-wide telephone triage and advice system for pediatric practices.
        Pediatrics. 1993; 92: 670-679
        • Kempe A
        • Dempsey C
        • Whitefield J
        • et al.
        Appropriateness of urgent referrals by nurses at a hospital-based pediatric call center.
        Arch Pediatr Adolesc Med. 2000; 154: 355-360
        • Barber JW
        • King WD
        • Monroe KW
        • Nichols MH
        Evaluation of emergency department referrals by telephone triage.
        Pediatrics. 2000; 105: 819-821
        • Schmitt B
        Pediatric Telephone Protocols. Decision Press, Denver, Colo2000
        • Landis JR
        • Koch GG
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Ishmail AA
        • Wing S
        • Ferguson J
        • et al.
        Interobserver agreement by auscultation in the presence of a third heart sound in patients with congestive heart failure.
        Chest. 1987; 91: 870-873
        • Rubenfeld GD
        • Caldwell E
        • Granton J
        • et al.
        Interobserver variability in applying a radiographic definition for ARDS.
        Chest. 1999; 116: 1347-1353
        • Koran LM
        The reliability of clinical methods, data and judgments (second of two parts).
        N Engl J Med. 1975; 293: 695-701
        • Grilli R
        • Lomas J
        Evaluating the message: the relationship between compliance rate and the subject of a practice guideline.
        Med Care. 1994; 32: 202-213
        • Grimshaw JM
        • Russell IT
        Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations.
        Lancet. 1993; 342: 1317-1322
        • Nazarian LF
        Pediatrician's perspective: odd thoughts on well-child care.
        Pediatr Rev. 1990; 11: 227-228
        • Wachter DA
        • Brillman JC
        • Lewis J
        • Sapien RE
        Pediatric telephone triage protocols: standardized decisionmaking or a false sense of security?.
        Ann Emerg Med. 1999; 33: 388-394
        • Ott JE
        • Bellaire J
        • Machotka P
        • Moon JB
        Patient management by telephone by child health associates and pediatric house officers.
        J Med Educ. 1974; 49: 596-600
        • Yanovski SZ
        • Yanovski JA
        • Malley JD
        • et al.
        Telephone triage by primary care physicians.
        Pediatrics. 1992; 89: 701-706
        • Greitzer L
        • Stapleton FB
        • Wright L
        • Wedgwood RJ
        Telephone assessment of illness by practicing pediatricians.
        J Pediatr. 1976; 88: 880-882
        • Perrin EC
        • Goodman HC
        Telephone management of acute pediatric illnesses.
        N Engl J Med. 1978; 298: 130-135