Revision of the Protocol of the Telephone Triage System in Tokyo, Japan

Introduction. The Emergency Telephone Consultation Center in Tokyo (#7119) was the first telephone triage system in Japan and has operated since 2007. This study examined the revision of the #7119 protocol by referring the linked data to each code of the triage protocol. Methods. We selected candidates based on the medical codes targeted by the revision, linking data from the nurses’ decisions in triage and the patients’ condition severity when the ambulance arrived at the hospital, gathering data from June 1, 2016, to December 31, 2017. Then, several emergency physicians evaluated the cases and decided whether the code should be moved to the more or less urgent category or if new protocols and codes would be established. Results. In this revision, 371 codes were moved to the less urgent category, 35 codes were moved to the more urgent category, and 128 codes were newly established. In all, 59 red codes (transfer to the ambulance dispatcher) were reduced, while 254 orange codes (attendance at hospital within 1 hour) and yellow codes (within 6 hours) were moved to less urgent, and 12 yellow and green codes (within 24 hours) were moved to more urgent. Conclusion. We adjusted the triage codes for the revision by linking the call data with the case data. This revision should decrease the inappropriate use of ambulances and reduce the primary care workload. To achieve a more accurate revision, we need to refine the process of evaluating the validity of patients’ acuity over the telephone during triage.

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829 Is There an Ongoing Role For 'Telephone Triage Clinics' Post COVID-19?

British Journal of Surgery ◽

10.1093/bjs/znab134.092 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

B Holmes ◽

U Mirza ◽

C Manning ◽

R Cooke ◽

R Jugdey

Keyword(s):

Common Theme ◽

Telephone Triage ◽

Telephone Consultation ◽

Face To Face ◽

Clinician Satisfaction ◽

Set Up ◽

Local Protocol ◽

Telephone Questionnaire

Abstract Introduction COVID-19 has placed unprecedented demand on services at ELHT and it has become necessary to have telephone clinics to reduce the number of face-to-face clinics. A ‘telephone triage clinic’ was set up for referrals from A&E. Our project evaluated patient and clinician satisfaction on this. Method We carried out a retrospective telephone questionnaire with patients over a one-week period during the pandemic. We focussed on overall satisfaction of the consultation and quality of communication. Consultants were also surveyed for their opinion on the clinics. Results From 30 patients, 77% said they were ‘very satisfied’ with the overall experience. 80% of patients were ‘very satisfied’ with the overall length of the telephone consultation. 50% of patients felt the clinician was only ‘adequately’ able to assess them over the telephone. The consultants were less satisfied with the overall experience of telephone consultation. A common theme was that they felt ED documentation could be improved to help inform ongoing management. Conclusions Overall, patients were satisfied with the consultations. It has been successful in minimising face to face consultations however some presentations necessitate further evaluation. We need to identify those injuries appropriate for virtual follow up and design a local protocol for these.

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

Acta Clinica Belgica ◽

10.1080/17843286.2021.1936353 ◽

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

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An audit of acute oncology services: patient experiences of admission procedures and staff utilisation of a new telephone triage system

Supportive Care in Cancer ◽

10.1007/s00520-016-3370-4 ◽

2016 ◽

Vol 24 (12) ◽

pp. 5041-5048 ◽

Cited By ~ 14

Author(s):

Lorraine Warrington ◽

Patricia Holch ◽

Lucille Kenyon ◽

Ceri Hector ◽

Krystina Kozlowska ◽

...

Keyword(s):

Patient Experiences ◽

Telephone Triage ◽

Triage System

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Telephone triage by nurses in primary care: what is it for and what are the consequences likely to be?

Journal of Health Services Research & Policy ◽

10.1258/135581903322029502 ◽

2003 ◽

Vol 8 (3) ◽

pp. 154-159 ◽

Cited By ~ 10

Author(s):

Huw Charles-Jones ◽

Carl May ◽

Joanna Latimer ◽

Martin Roland

Keyword(s):

Primary Care ◽

Telephone Triage

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Initiatives to reduce the inappropriate use of proton pump inhibitors in an outpatient primary care clinic

Annales Pharmaceutiques Françaises ◽

10.1016/j.pharma.2020.05.002 ◽

2020 ◽

Vol 78 (6) ◽

pp. 497-498

Author(s):

P. Kudaravalli ◽

R. Doobay ◽

C. Carvounis ◽

C. Toomey ◽

A. Dhamoon

Keyword(s):

Primary Care ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Primary Care Clinic ◽

Care Clinic ◽

Inappropriate Use

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An exploration of the attitudes and views of general practitioners on the use of video consultations in a primary healthcare setting: a qualitative pilot study

Primary Health Care Research & Development ◽

10.1017/s1463423618000361 ◽

2018 ◽

Vol 20 ◽

Cited By ~ 13

Author(s):

Ratan S. Randhawa ◽

Joht S. Chandan ◽

Tom Thomas ◽

Surinder Singh

Keyword(s):

Primary Care ◽

General Practitioners ◽

Healthcare Setting ◽

List Type ◽

Structured Interviews ◽

Convenience Sample ◽

Telephone Consultation ◽

Video Consultation ◽

Mixed Feelings ◽

The Government

AbstractBackgroundIn 2014, in the United Kingdom, the government made a commitment to spend £3.6 million on the introduction of Skype video calling consultations in general practice, however the efficacy of such technology has not yet been explored fully.AimThe study aimed to explore the views and attitudes of General Practitioners (GPs) towards video consultation in primary care; specifically, in three broad areas∙The benefits of video consultations to patients and healthcare professionals.∙Potential problems with video consultation and its implementation.∙The cost-effectiveness of video consultation in this setting.MethodA convenience sample of the views of 12 general practitioners across two primary care centres in North London were identified using topic guide based semi-structured interviews. A thematic framework approach was used to analyse the data collected to isolate main and sub-themes.FindingsThree main themes were identified1.Technology – GPs expressed concerns about the ability of patients to use technology, the availability of technology and the quality of technology available.2.Utility – encompassing GP’s ideas about the usefulness of video consultations to patients, practitioners and the doctor–patient relationship. GPs presented mixed views on the extent to which video consultation would be useful.3.Practicality – covering the views of GPs on implementation and effects on workload. GPs unanimously felt that it was not a practical substitute for face-to-face consultation. There were mixed feelings about it being used as an alternative to telephone consultation.ConclusionGPs did see potential benefits to using video consultations but also expressed concerns that need to be addressed if they are to have full confidence in the system. The views of those who are going to use video consultation as a means of increasing patient access are paramount if such tools are to be a core part of primary care.

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Checklists to prevent diagnostic errors: a pilot randomized controlled trial

Diagnosis ◽

10.1515/dx-2015-0008 ◽

2015 ◽

Vol 2 (3) ◽

pp. 163-169 ◽

Cited By ~ 8

Author(s):

John W. Ely ◽

Mark A. Graber

Keyword(s):

Primary Care ◽

Usual Care ◽

Error Rate ◽

Primary Care Physicians ◽

Diagnostic Errors ◽

Diagnostic Error ◽

Diagnostic Process ◽

Emergency Physicians ◽

Mean Error ◽

Premature Closure

AbstractMany diagnostic errors are caused by premature closure of the diagnostic process. To help prevent premature closure, we developed checklists that prompt physicians to consider all reasonable diagnoses for symptoms that commonly present in primary care.We enrolled 14 primary care physicians and 100 patients in a randomized clinical trial. The study took place in an emergency department (5 physicians) and a same-day access clinic (9 physicians). The physicians were randomized to usual care vs. diagnostic checklist. After completing the history and physical exam, checklist physicians read aloud a differential diagnosis checklist for the chief complaint. The primary outcome was diagnostic error, which was defined as a discrepancy between the diagnosis documented at the acute visit and the diagnosis based on a 1-month follow-up phone call and record review.There were 17 diagnostic errors. The mean error rate among the seven checklist physicians was not significantly different from the rate among the seven usual-care physicians (11.2% vs. 17.8%; p=0.46). In a post-hoc subgroup analysis, emergency physicians in the checklist group had a lower mean error rate than emergency physicians in the usual-care group (19.1% vs. 45.0%; p=0.04). Checklist physicians considered more diagnoses than usual-care physicians during the patient encounters (6.5 diagnoses [SD 4.2] vs. 3.4 diagnoses [SD 2.0], p<0.001).Checklists did not improve the diagnostic error rate in this study. However further development and testing of checklists in larger studies may be warranted.

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900 Effects Of COVID-19 Pandemic Restrictions on the 2ww Breast Referrals in A UK Specialist Breast Service

British Journal of Surgery ◽

10.1093/bjs/znab259.213 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

O Tokode ◽

S Rastall

Keyword(s):

Breast Cancer ◽

Waiting Times ◽

Age Groups ◽

Breast Cancer Diagnosis ◽

Hospital Staff ◽

Breast Cancers ◽

Telephone Triage ◽

Telephone Consultation ◽

Mean Waiting Time ◽

Delays In Diagnosis

Abstract Aim Recommendations were issued to the hospital Trusts to configure service delivery to balance cancer care with patient and hospital staff safety during the COVID-19 pandemic. It was felt the service restrictions might lead to delays in diagnosis and treatment of cancer patients. We conducted an audit to compare 2ww breast referrals in our center between May to July of 2019 and 2020. Method We triaged all referrals to face-face consultation or telephone consultation in our center during the pandemic. Patients with suspicious symptoms were offered face-face consultation after the telephone triage. Results Data analysis showed that the referrals fell by 28.3% (N 1569 versus N 1125). The largest reduction was noted in May (34.4% versus 24.2%). Mean waiting time in 2019 was 19.86 (± 7.14) and 11.43 (± 3.48) in 2020. The proportion of patients referred for suspected breast cancers increased across all age groups in 2020 (range +10.4% to 16.2%). Significantly more breast cancers were diagnosed in 2020 (7.1% versus 5.1%). No breast cancer was diagnosed in under 25 patients. 29.1% of the 522 patients telephoned were discharged, and others were seen in the clinic. Conclusions The COVID-19 infection’s management caused a fall in 2ww referrals and shortened waiting times but increased breast cancer diagnosis. Many 2ww referrals during the COVID-19 infection were unnecessary. The telephone consultation reduced waiting times but may have deferred clinic visitation for most patients.

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