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Seeking advice from NHS direct on common childhood complaints: does it matter who answers the phone?
Rosey Monaghan1, Collette Clifford, Paul McDonald
1Education, Training and Development Lead, Worcestershire Health Informatics Programme, Department of Psychology, Health and Social Care, University College Worcester, Worcester, UK. r.monaghan@worc.ac.uk
Insights
Registered Sick Children's Nurses significantly reduce call times when triaging pediatric cases of rash or fever compared to Registered Nurses. Further research is needed on consultation content and referral safety.
Area of Science:
- Healthcare Management
- Nursing Practice
- Pediatric Triage
Background:
- National Health Services (NHS) Direct provides telephone triage and health advice in the UK.
- Children constitute 40% of calls to NHS Direct.
- A need exists to compare triage times for pediatric calls between different nursing groups.
Purpose of the Study:
- To determine if call length and outcomes differ between Registered Sick Children's Nurses (RSCNs) and Registered Nurses (RNs) when triaging pediatric patients with 'rash' or 'fever' via telephone.
Main Methods:
- Analysis of 1281 calls handled by 22 nurses at NHS Direct, West Midlands.
- Secondary analysis of routinely collected data from computerized clinical decision support software.
- Statistical comparison using Mann-Whitney U-tests for call lengths and chi-square tests for triage outcomes.
Main Results:
- RSCNs had statistically significantly shorter mean call lengths than RNs (P < 0.001).
- Both RSCNs and RNs demonstrated equal frequency in referrals to most triage outcome groups, except for routine GP appointments.
Conclusions:
- RSCNs are more time-efficient than RNs in triaging pediatric calls for 'rash' or 'fever'.
- Limitations in data extraction software affected call length measurements.
- Further investigation into consultation processes and referral safety is recommended.
Background:
National Health Services (NHS) Direct is a national nurse-led, call-centre based, telephone triage, health information and advice service in the United Kingdom (UK). Forty percent of calls to NHS Direct are about children. There is a need to identify whether there is a difference in the time taken for nurses to triage calls about children.
Aim:
The aim of the study was to determine if the call length and outcomes of Registered Sick Children's Nurses and Registered Nurses were different when triaging children who presented with 'rash' or 'fever' by telephone.
Sample:
This study was carried out at NHS Direct, West Midlands, and involved analysis of 1281 calls taken by 22 nurses.
Methods:
This study examined the frequency of referral by the two nurse groups to five triage outcome groups. Information about the calls was extracted from routinely collected data generated by the computerized clinical decision support software. The data were used for secondary analysis.
Data Analysis:
The data were analysed using Statistics Package for Social Sciences version 10 and nonparametric Mann-Whitney U -tests were performed to compare call lengths of the two groups. The chi-square test was used to analyse differences in frequency of triage to outcome groups.
Results:
The mean call length of the Registered Sick Children's Nurses was statistically significantly shorter than that of the Registered Nurses (P < 0.001). With the exception of referral for a routine appointment with a general medical practitioner, both Registered Sick Children's Nurses and Registered Nurses referred to other triage outcomes groups with equal frequency.
Limitations:
Inaccuracy of call length measurement of less than 1 minute and more than 20 minutes was because of the limitations of the data extraction software. This system-led definition and measured length of a call limits both the analysis and conclusions that could be drawn about the content of NHS Direct nurse consultation.
Conclusions:
Registered Sick Children's Nurses take less time than Registered Nurses to triage calls about children presenting with 'rash' or 'fever'. Further investigation is required into the content and consultation process of the nurses, and also the safety and appropriateness of referral.
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