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Question design in nurse-led and GP-led telephone triage for same-day appointment requests: a comparative
Jamie Murdoch1, Rebecca Barnes, Jillian Pooler
1Faculty of Medicine and Health Sciences, School of Nursing Sciences, Edith Cavell Building, University of East Anglia, Norwich Research Park, Norwich, UK.
Objective:
To compare doctors' and nurses' communication with patients in primary care telephone triage consultations.
Design:
Qualitative comparative study of content and form of questions in 51 telephone triage encounters between practitioners (general practitioners (GPs)=29; nurses=22) and patients requesting a same-day appointment in primary care. Audio-recordings of nurse-led calls were synchronised with video recordings of nurse's use of computer decision support software (CDSS) during triage.
Setting:
2 GP practices in Devon and Warwickshire, UK.
Participants:
4 GPs and 29 patients; and 4 nurses and 22 patients requesting a same-day face-to-face appointment with a GP.
Main Outcome Measure:
Form and content of practitioner-initiated questions and patient responses during clinical assessment.
Results:
A total of 484 question-response sequences were coded (160 GP; 324 N). Despite average call lengths being similar (GP=4 min, 37 s, (SD=1 min, 26 s); N=4 min, 39 s, (SD=2 min, 22 s)), GPs and nurses differed in the average number (GP=5.51, (SD=4.66); N=14.72, (SD=6.42)), content and form of questions asked. A higher frequency of questioning in nurse-led triage was found to be due to nurses' use of CDSS to guide telephone triage. 89% of nurse questions were oriented to asking patients about their reported symptoms or to wider-information gathering, compared to 54% of GP questions. 43% of GP questions involved eliciting patient concerns or expectations, and obtaining details of medical history, compared to 11% of nurse questions. Nurses using CDSS frequently delivered questions designed as declarative statements requesting confirmation and which typically preferred a 'no problem' response. In contrast, GPs asked a higher proportion of interrogative questions designed to request information.
Conclusions:
Nurses and GPs emphasise different aspects of the clinical assessment process during telephone triage. These different styles of triage have implications for the type of information available following nurse-led or doctor-led triage, and for how patients experience triage.
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