An audit of the appropriateness of teletriage nursing advice

This study assessed the appropriateness of advice given by teletriage nurses to patients in northern Ontario. Assessments used audiotapes and printed records of 73 calls, selected from approximately 350 calls based on sound quality, completeness, and consent of caller and teletriage nurse. Audits were conducted independently by one family physician, one nurse practitioner, and one registered nurse with teletriage experience. In 56% of the 73 calls, all three auditors judged the nurse's advice as "appropriate." In 92% of the 73 calls, at least two of the three auditors judged the teletriage nurse's advice as "appropriate." All calls were rated as "appropriate" by at least one auditor. If not "appropriate," then auditors were three times more likely to rate the advice as "overly-cautious" rather than "insufficient." The percentage of calls with the same rating varied from 62% to 86% with an outlier of 33%. Nurse practitioners tended to rate the appropriateness of the advice slightly, but significantly lower than the rating given by family physicians or registered nurses. Interestingly, nurse practitioners tended to rate aspects of the nurse-caller interaction advice as slightly and significantly better than the rating chosen by family physicians or registered nurses. The teletriage service was providing appropriate advice, but the generalizability of these results may be limited because of the selection of calls.