scholarly journals Optimisation of telephone triage of callers with symptoms suggestive of acute cardiovascular disease in out-of-hours primary care: observational design of the Safety First study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027477 ◽  
Author(s):  
Daphne CA Erkelens ◽  
Loes TCM Wouters ◽  
Dorien LM Zwart ◽  
Roger AMJ Damoiseaux ◽  
Esther De Groot ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
The Netherlands ◽  
Diagnostic Accuracy ◽  
Diagnostic Process ◽  
Telephone Triage ◽  
Predictive Values ◽  
Out Of Hours ◽  
Coronary Syndrome ◽  
Safety First

IntroductionIn the Netherlands, the ‘Netherlands Triage Standard’ (NTS) is frequently used as digital decision support system for telephone triage at out-of-hours services in primary care (OHS-PC). The aim of the NTS is to guarantee accessible, efficient and safe care. However, there are indications that current triage is inefficient, with overestimation of urgency, notably in suspected acute cardiovascular disease. In addition, in primary care settings the NTS has only been validated against surrogate markers, and diagnostic accuracy with clinical outcomes as the reference is unknown. In the Safety First study, we address this gap in knowledge by describing, understanding and improving the diagnostic process and urgency allocation in callers with symptoms suggestive of acute cardiovascular disease, in order to improve both efficiency and safety of telephone triage in this domain.Methods and analysisAn observational study in which 3000 telephone triage recordings (period 2014–2016) will be analysed. Information is collected from the recordings including caller and symptom characteristics and urgency allocation. The callers’ own general practitioners are contacted for the final diagnosis of each contact. We included recordings of callers with symptoms suggestive of acute coronary syndrome (ACS) or transient ischaemic attack (TIA)/stroke. With univariable and multivariable logistic regression analyses the diagnostic accuracy of caller and symptom characteristics will be analysed in terms of predictive values with urgency level, and ACS and TIA/stroke as outcomes, respectively. To further improve our understanding of the triage process at OHS-PC, we will carry out additional studies applying both quantitative and qualitative methods: (i) case-control study on serious adverse events (SAE), (ii) conversation analysis study and (iii) interview study with triage nurses.Ethics and disseminationThe Medical Ethics Committee Utrecht, the Netherlands endorsed this study (National Trial Register identification: NTR7331). Results will be disseminated at scientific conferences, regional educational sessions and publication in peer-reviewed journals.

scholarly journals Rationale and design of a cohort study evaluating triage of acute chest pain in out-of-hours primary care in the Netherlands (TRACE)

2020 ◽  
Vol 21 ◽  
Author(s):  
Amy Manten ◽  
Cuny J.J. Cuijpers ◽  
Remco Rietveld ◽  
Emma Groot ◽  
Freek van de Graaf ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Chest Pain ◽  
The Netherlands ◽  
Clinical Outcomes ◽  
Acute Chest Pain ◽  
Urgent Care ◽  
Triage System ◽  
Out Of Hours ◽  
Coronary Syndrome

Abstract The aims of this study are (1) to evaluate the performance of current triage for chest pain; (2) to describe the case mix of patients undergoing triage for chest pain; and (3) to identify opportunities to improve performance of current Dutch triage system for chest pain. Chest pain is a common symptom, and identifying patients with chest pain that require urgent care can be quite challenging. Making the correct assessment is even harder during telephone triage. Temporal trends show that the referral threshold has lowered over time, resulting in overcrowding of first responders and emergency services. While various stakeholders advocate for a more efficient triage system, careful evaluation of the performance of the current triage in primary care is lacking. TRiage of Acute Chest pain Evaluation in primary care (TRACE) is a large cohort study designed to describe the current Dutch triage system for chest pain and subsequently evaluate triage performance in regard to clinical outcomes. The study consists of consecutive patients who contacted the out-of-hours primary care facility with chest pain in the region of Alkmaar, the Netherlands, in 2017, with follow-up for clinical outcomes out to August 2019. The primary outcome of interest is ‘major event’, which is defined as the occurrence of death from any cause, acute coronary syndrome, urgent coronary revascularization, or other high-risk diagnoses in which delay is inadmissible and hospitalization is necessary. We will evaluate the performance of the triage system by assessing the ability of the triage system to correctly classify patients regarding urgency (accuracy), the proportion of safe actions following triage (safety) as well as rightfully deployed ambulances (efficacy). TRACE is designed to describe the current Dutch triage system for chest pain in primary care and to subsequently evaluate triage performance in regard to clinical outcomes.

scholarly journals Accuracy of telephone triage in primary care patients with chest discomfort: a cross-sectional study

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001376 ◽  
Author(s):  
Loes TCM Wouters ◽  
Frans H Rutten ◽  
Daphne CA Erkelens ◽  
Esther De Groot ◽  
Roger AMJ Damoiseaux ◽  
...  
Keyword(s):  
Primary Care ◽  
Sensitivity And Specificity ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Telephone Triage ◽  
Chest Discomfort ◽  
Cross Sectional ◽  
Predictive Values ◽  
Coronary Syndrome ◽  
High Urgency

ObjectiveTo assess the accuracy of semi-automatic assisted telephone triage in patients with acute chest discomfort against the diagnosis of acute coronary syndrome (ACS) or other life-threatening events (LTEs).MethodsA cross-sectional study was performed of telephone conversations with 2023 patients with acute chest discomfort (pain, pressure, tightness or discomfort) who called out-of-hours services for primary care (OHS-PC) between 2014 and 2016. Sensitivity, specificity, positive and negative predicted values were calculated for a high urgency (patient seen within one hour) against the diagnoses of ACS and other LTEs. Diagnoses were retrieved from the patients' medical records in general practice, including hospital specialists' discharge letters.ResultsOf 2023 patients who called because of chest discomfort, 227 (11.2%) had an ACS (men 14.9%, women 8.2%) and 58 (2.9%) had another LTE (men 3.6%, women 2.3%). The sensitivity and specificity of a high Netherlands Triage System (NTS) urgency allocation against ACS/other LTEs were 0.73 (95% CI 0.68 to 0.78) and 0.43 (95% CI 0.40 to 0.45), respectively. In 13.2% of the calls the triage nurse overruled the NTS urgency, mostly by upscaling (11.0%). The sensitivity and specificity of the final urgency allocation were 0.86 (95% CI 0.81 to 0.90) and 0.34 (95% CI 0.32 to 0.37). The positive and negative predictive values of the final urgency were 0.18 (95% CI 0.17 to 0.19) and 0.94 (95% CI 0.92 to 0.95), respectively.ConclusionsThe semi-automatic triage NTS tool underestimated the urgency in 27% of patients with ACS/other LTEs. Overruling by triage nurses improved safety, but still 14% of men and women with ACS/other LTEs received too low urgency, while efficiency remained poor.Trial registration numberNTR7331.

scholarly journals Missed Acute Coronary Syndrome During Telephone Triage at Out-of-Hours Primary Care

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Daphne C. Erkelens ◽  
Frans H. Rutten ◽  
Loes T. Wouters ◽  
Harmke G. Kirkels ◽  
Judith M. Poldervaart ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Coronary Syndrome ◽  
Telephone Triage ◽  
Out Of Hours ◽  
Coronary Syndrome

Reliability and validity of an original nurse telephone triage tool for out-of-hours primary care calls: the SALOMON algorithm

2021 ◽  
pp. 1-7
Author(s):  
Edmond Brasseur ◽  
Allison Gilbert ◽  
Anne-Françoise Donneau ◽  
Justine Monseur ◽  
Alexandre Ghuysen ◽  
...  
Keyword(s):  
Primary Care ◽  
Reliability And Validity ◽  
Telephone Triage ◽  
Out Of Hours

scholarly journals Frequent attendance of primary care out-of-hours services in The Netherlands: characteristics of patients and presented morbidity

2009 ◽  
Vol 27 (2) ◽  
pp. 129-134 ◽  
Author(s):  
D. den Boer-Wolters ◽  
M. J Knol ◽  
K. Smulders ◽  
N. J de Wit
Keyword(s):  
Primary Care ◽  
The Netherlands ◽  
Out Of Hours ◽  
Frequent Attendance

Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study

2019 ◽  
Vol 36 (10) ◽  
pp. 613-616 ◽  
Author(s):  
Anniek C Epema ◽  
Mariëlle J B Spanjer ◽  
Lieselotte Ras ◽  
Johannes C Kelder ◽  
Marieke Sanders
Keyword(s):  
The Netherlands ◽  
Diagnostic Accuracy ◽  
Conventional Radiography ◽  
Point Of Care Ultrasound ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Predictive Values ◽  
Pain Scores ◽  
Fractures In Children ◽  
Distal Forearm Fractures

BackgroundDistal forearm fractures are common in children. The reference standard to diagnose these fractures is by conventional radiography, which exposes these patients to harmful radiation. Ultrasound (US) seems to be a good alternative. However, emergency physicians (EPs) in the Netherlands have limited experience in using US for diagnosing fractures in children.ObjectiveThe primary objective was to determine the accuracy of US, performed by a Dutch EP, compared with conventional radiography, in diagnosing distal forearm fractures in children. As a secondary objective, differences in pain scores during the performance of both US and plain radiography were determined.MethodsChildren, aged between 0 and 14 years old, suspected of having a distal forearm fracture were enrolled at the Emergency Department. US and radiographic findings were compared. Statistics for accuracy were calculated. Pain scores were recorded during US and radiography and compared as well. All participating operators received an hour-long pretrial training.Results100 patients were enrolled. The mean age was 9.5 years (SD, 3.6), and 50% were women. Overall diagnostic accuracy was 92% (95% CI 85%-96%). The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios for US were 95% (95% CI 87% to 99%), 86% (95% CI 71% to 95%), 92% (95% CI 83% to 97%), 91% (95% CI 76% to 98%), 6.86 (95% CI 3.04 to 15.51) and 0.05 (95% CI 0.02 to 0.17), respectively. The pain scores during US and radiographic imaging were 3.3 and 4.6, respectively (p<0.01).ConclusionsIn this study, we showed that US is an accurate method for diagnosing distal forearm fractures in children. The main advantages are that it is radiation-free and rapidly practicable, and that patients experience it as less painful than radiography. Moreover, this study has proven that with minimal experience in US, good diagnostic accuracy can be achieved after brief training.

scholarly journals Telephone triage by GPs in out-of-hours primary care in Denmark: a prospective observational study of efficiency and relevance

2016 ◽  
Vol 66 (650) ◽  
pp. e667-e673 ◽  
Author(s):  
Linda Huibers ◽  
Grete Moth ◽  
Anders H Carlsen ◽  
Morten B Christensen ◽  
Peter Vedsted
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Telephone Triage ◽  
Out Of Hours

scholarly journals Cognitive screening test in primary care

2018 ◽  
Vol 52 ◽  
pp. 88 ◽  
Author(s):  
Juliana Emy Yokomizo ◽  
Katrin Seeher ◽  
Glaucia Martins de Oliveira ◽  
Laís dos Santos Vinholi e Silva Silva ◽  
Laura Saran ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Accuracy ◽  
Educational Level ◽  
High Sensitivity ◽  
Cognitive Screening ◽  
Operating Characteristics ◽  
Predictive Values ◽  
Brazilian Version ◽  
Logistic Regressions ◽  
State Examination

OBJECTIVE: To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS: Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS: Sixty-eight patients with 0–4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%–80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS: The GPCOG-Br is clinically well-suited for use in primary care.

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