| 1. |
- Ernesäter, Annica, et al.
(författare)
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Incident reporting in nurse-led national telephone triage in Sweden : The reported errors reveal a pattern that needs to be broken
- 2010
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Ingår i: Journal of Telemedicine and Telecare. - : SAGE Publications. - 1357-633X .- 1758-1109. ; 16:5, s. 243-247
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Tidskriftsartikel (refereegranskat)abstract
- We conducted a retrospective study of incident reports concerning the national, nurse-led telephone triage system in Sweden. The Swedish Health Care Direct organization (SHD) is staffed by registered nurses who act as telenurses and triage the callers' need for care, using a computerized decision support system. Data were collected during 2007 from all county councils that participated in the SHD and were analysed using content analysis. Incident reports were then compared concerning differences in reported categories and who reported the errors. The 426 incident reports included 452 errors. Of the analysed incident reports, 41% concerned accessibility problems, 25% incorrect assessment, 15% routines/guidelines, 13% technical problems and 6% information and communication. The most frequent outgoing incident reports (i.e. sent from SHD to other health-care providers) concerned accessibility problems and the most frequently incoming reports (i.e. sent to SHD from other health-care providers) concerned incorrect assessment. There was a significant difference (P < 0.001) between outgoing and incoming reports regarding the main category. Telenurses have limited possibilities for referring the caller to their primary health-care provider or specialist, which may cause them to over-triage or under-triage the callers' need for care. This over-triage or under-triage may in turn cause other health-care providers to report incorrect assessment to SHD. The implications for practice are that poor accessibility is a matter that should be addressed and that the reasons for incorrect assessment should be explored.
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| 2. |
- Ernesäter, Annica, 1970-, et al.
(författare)
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Malpractice claims regarding calls to Swedish telephone advice nursing : what went wrong and why?
- 2012
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Ingår i: Journal of Telemedicine and Telecare. - London, United Kingdoms : Sage Publications. - 1357-633X .- 1758-1109. ; 18:7, s. 379-383
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Tidskriftsartikel (refereegranskat)abstract
- We analysed the characteristics of all malpractice claims arising out of telephone calls to Swedish Healthcare Direct (SHD) during 2003-2010 (n = 33). The National Board of Health and Welfare's (NBHW) investigations describing the causes of the malpractice claims and the healthcare providers' reported measures were analysed using Qualitative Content Analysis. The original telephone calls themselves, which had been recorded, were analysed using the Roter Interaction Analysis System (RIAS). Among the 33 cases, 13 patients died and 12 were admitted to intensive care. Failure to listen to the caller (n = 12) was the most common reason for malpractice claims, and work-group discussion (n = 13) was the most common measure taken to prevent future re-occurrence. Male patients (n = 19) were in the majority, and females (n = 24) were the most common callers. The most common symptoms were abdominal (n = 11) and chest pain (n = 6). Telenurses followed up on caller understanding in six calls, and mainly used closed-ended questions. Despite the severity of these malpractice claims, the measures taken mainly addressed active failure, rather than the latent conditions. Third-party communication should be regarded as a risk. When callers make repeated contacts, telenurses need to re-evaluate their need for care.
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| 3. |
- Rahmqvist, Mikael, et al.
(författare)
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Triage and patient satisfaction among callers in Swedish computer-supported telephone advice nursing
- 2011
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Ingår i: Journal of Telemedicine and Telecare. - : Royal Society of Medicine Press. - 1357-633X .- 1758-1109. ; 17:7, s. 397-402
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Tidskriftsartikel (refereegranskat)abstract
- We investigated satisfaction with a Swedish telenursing service and the health-care-seeking behaviour among callers who received a less urgent level of health care than they expected. A postal questionnaire was sent to a random selection of callers (n = 273) to Swedish Healthcare Direct in October 2008. The cases were 18 callers where the telenurse recommended a lower level of health care than the caller expected and who were not in complete agreement with the nurse. The controls were 22 callers who either received a lower recommendation, or were in disagreement with the recommendation. There were no differences between cases, controls and other callers regarding background factors or the telenurse classification of emergency. However, both cases and controls considered their need for health care as more urgent than the other callers. An independent test of the nurses reception, ability to listen and to take notice of the callers health problem, showed that nurses who had served cases, had received a significantly lower rating than other nurses. For nurses who had served controls, there was no such difference in rating. Cases and controls had fewer subsequent care visits than other callers, in the three days following the call, although the proportion of emergency visits was higher among cases and controls compared to other callers. If the caller and the nurse disagree about the nurses recommendations, the consequence can be a dissatisfied caller and more visits to unnecessary high levels of health care. Further training of the nurses may improve the telenurse service.
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