An evaluation of the safety and effectiveness of telephone triage as a method of patient prioritization in an ophthalmic accident and emergency service
J. Marsden, An evaluation of the safety and effectiveness of telephone triage as a method of patient prioritization in an ophthalmic accident and emergency service, J ADV NURS, 31(2), 2000, pp. 401-409
Service changes in the accident and emergency service at Manchester Royal E
ye Hospital in England resulted in a telephone triage-based referral servic
e for health care professionals. It became clear that this service needed e
valuation in order to assure both providers and users of the service that t
his referral strategy, based on experienced nurse practitioners making deci
sions about patient priority, was safe and effective. The evaluation was ex
tended to encompass the other area of the service where telephone referrals
tend to be directly from patients. A mixed method was used. Information ga
ined within the telephone triage conversation was compared with a final dia
gnosis through retrospective analysis of secondary data; the documentation
of those patients who were not given access to the service initially was fo
llowed-up to ensure that this decision was safe and a number of nurses were
questioned about telephone information gathering, using partially structur
ed interviews. The study showed that nurse practitioners within the acciden
t and emergency service were able to elicit accurate information from the t
elephone triage conversation on which to base a decision about patient acce
ss in most cases (76% over the whole service). This resulted in the appropr
iate prioritization of patients. No patient who needed urgent access to the
service was denied it. The decisions made to deny urgent appointments to a
number of patients were safe in all cases. It appears that one of the prob
lem areas in the gathering of information for prioritization purposes is in
the nurses' telephone triage discussions with some, but by no means all, d
octors. Some general practitioners seemed unwilling to discuss the patient
and give accurate information to a nurse and this is an area which appears
to need some further work.