DECISION-MAKING STRATEGIES FOR TELEPHONE TRIAGE IN EMERGENCY MEDICAL-SERVICES

Decision-making strategies used by nurses in telephone triage involvin g public emergency calls for medical help were investigated as a funct ion of task urgency and complexity in the real-world dynamic environme nt. The sample included 34 nurses as call receivers. Transcripts of 50 nurse-client dialogues and 50 explanations of the decision-making pro cess, elicited immediately after completion of the calls, were analyze d using methods of discourse and protocol analyses. In high-urgency si tuations, heuristic rules based on symptoms were used, and the decisio ns were mostly accurate. With the increase in problem complexity, more causal explanations were found, and the decisions were more often ina ccurate. Furthermore, the explanations supporting the accurate decisio ns were often inaccurate, showing a decoupling of knowledge and action . Alternate strategies were used in moderate- to low-urgency condition s, where contextual knowledge of the situations was exploited to ident ify the needs of the clients and to negotiate the best plan of action to meet these needs, resulting in more accurate decisions.