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1. Displaying concerns within telephone triage conversations of callers with chest discomfort in out-of-hours primary care: a conversation analytic study

Author

Spek, Michelle, Charldorp, Tessa Cyrina, Vinck, Vera, Venekamp, R.P., Rutten, Frans, Zwart, Dorien, de Groot, Esther, Spek, Michelle, Charldorp, Tessa Cyrina, Vinck, Vera, Venekamp, R.P., Rutten, Frans, Zwart, Dorien, and de Groot, Esther

Abstract

Objectives: In primary care out of hours service (OHS-PC), triage nurses ask questions to assign urgency level for medical assessment. A semi-automatic decision tool (the Netherlands Triage Standard, NTS) facilitates triage nurses with key questions, but does not leave much room for paying attention to callers’ concerns. We wanted to understand how callers with chest pain formulate their concerns and are helped further during telephone triage. Methods: We conducted a conversation analytic study of 68 triage calls from callers with chest discomfort who contacted OHS-PC of which we selected 35 transcripts in which concerns were raised. We analyzed expressions of concerns and the corresponding triage nurse response. Results: Due to the task-oriented nature of the NTS, callers’ concerns were overlooked. For callers, however, discussing concerns was relevant, stressed by the finding that the majority of callers with chest discomfort expressed concerns. Conclusions: Interactional difficulties in concern-related discussions arised directly after expressed concerns if not handled adequately, or during the switch to the counseling phase. Practice implications: When callers display concerns during telephone triage, we recommend triage nurses to explore them briefly and then return to the sequence of tasks described in the NTS-assisted triage process.

Published
2023

2. Displaying concerns within telephone triage conversations of callers with chest discomfort in out-of-hours primary care: a conversation analytic study

Author

LS communicatie- en informatiewetenschap, ILS L&C, Spek, Michelle, Charldorp, Tessa Cyrina, Vinck, Vera, Venekamp, R.P., Rutten, Frans, Zwart, Dorien, de Groot, Esther, LS communicatie- en informatiewetenschap, ILS L&C, Spek, Michelle, Charldorp, Tessa Cyrina, Vinck, Vera, Venekamp, R.P., Rutten, Frans, Zwart, Dorien, and de Groot, Esther

Published
2023

3. Displaying concerns within telephone triage conversations of callers with chest discomfort in out-of-hours primary care: A conversation analytic study

Author

HAG Zorginnovatieonderzoek, HAG Onderzoek, Child Health, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, General Practice & Nursing Science, Huisartsopleiding, Spek, Michelle, van Charldorp, Tessa C, Vinck, Vera V, Venekamp, Roderick P, Rutten, Frans H, Zwart, Dorien LM, de Groot, Esther, HAG Zorginnovatieonderzoek, HAG Onderzoek, Child Health, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, General Practice & Nursing Science, Huisartsopleiding, Spek, Michelle, van Charldorp, Tessa C, Vinck, Vera V, Venekamp, Roderick P, Rutten, Frans H, Zwart, Dorien LM, and de Groot, Esther

Published
2023

4. Interactional implications of either/or-questions during telephone triage of callers with chest discomfort in out-of-hours primary care: A conversation analysis

Author

Erkelens, C.A.M., Charldorp, Tessa Cyrina, Vinck, Vera, Wouters, Loes, Damoiseaux, Roger, Rutten, Frans, Zwart, Dorien, de Groot, Esther, LS communicatie- en informatiewetenschap, and ILS L&C

Subjects
Acute coronary syndrome, Conversation analysis, Chest discomfort, media_common.quotation_subject, Telehealth, Out-of-hours primary care, 03 medical and health sciences, Presentation, 0302 clinical medicine, After-Hours Care, Telephone triage, medicine, Humans, 030212 general & internal medicine, Netherlands, media_common, Medicine(all), Primary Health Care, Communication, 030503 health policy & services, General Medicine, medicine.disease, Triage, Telephone, Multiple-choice either/or-questions, Feeling, Medical emergency, 0305 other medical science, Psychology, Qualitative research
Abstract

Objective To explore the interactional implications of either/or-questions on the interaction between people who call out-of-hours services in primary care (OHS-PC) and triage nurses who use a decision support tool called the ‘Netherlands Triage Standard’ (NTS) during telephone triage. Methods A qualitative study of 68 triage conversations at six Dutch OHS-PC. Patients called the OHS-PC with symptoms, e.g. chest discomfort, suggestive of acute coronary syndrome. Using conversation analysis, we identified two categories of multiple-choice either/or-questions that indicated interactional difficulties, shown in hesitation markers within callers’ responses. Results Our analysis shows that interactional difficulties mainly arise when (i) questions are poorly designed by the triage nurse; or (ii) when the caller’s complaints are ambiguously presented reflecting patient’s difficulties to verbalize them (e.g. “not feeling well”). Conclusion The way NTS displays key diagnostic options encourages triage nurses to use multiple-choice either/or-questions. More awareness among triage nurses is needed on undesirable implications of either/or-questions on the interaction. Practice implications We recommend changing the NTS display of diagnostic options and to use questions with fewer options in order to decrease the chance of formulating ambiguous questions soliciting unclear responses. Furthermore, asking content questions when complaints are ambiguously formulated may specify the presentation of complaints.

Published
2021
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5. Het effect van of-vragen tijdens telefonische triage

Author

AIOS SEH, General Practice & Nursing Science, Other research (not in main researchprogram), HAG Zorginnovatieonderzoek, HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Huisartsopleiding, Child Health, Infection & Immunity, JC Overig onderzoek, Erkelens, Carmen, van Charldorp, Tessa, Vinck, Vera, Wouters, Loes, Damoiseaux, Roger, Rutten, Frans, Zwart, D. L.M., de Groot, E., AIOS SEH, General Practice & Nursing Science, Other research (not in main researchprogram), HAG Zorginnovatieonderzoek, HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Huisartsopleiding, Child Health, Infection & Immunity, JC Overig onderzoek, Erkelens, Carmen, van Charldorp, Tessa, Vinck, Vera, Wouters, Loes, Damoiseaux, Roger, Rutten, Frans, Zwart, D. L.M., and de Groot, E.

Published
2022

6. Interactional implications of either/or-questions during telephone triage of callers with chest discomfort in out-of-hours primary care: A conversation analysis

Author

LS communicatie- en informatiewetenschap, UiL OTS L&C, Erkelens, C.A.M., Charldorp, Tessa Cyrina, Vinck, Vera, Wouters, Loes, Damoiseaux, Roger, Rutten, Frans, Zwart, Dorien, de Groot, Esther, LS communicatie- en informatiewetenschap, UiL OTS L&C, Erkelens, C.A.M., Charldorp, Tessa Cyrina, Vinck, Vera, Wouters, Loes, Damoiseaux, Roger, Rutten, Frans, Zwart, Dorien, and de Groot, Esther

Published
2021

7. Interactional implications of either/or-questions during telephone triage of callers with chest discomfort in out-of-hours primary care: A conversation analysis

Author

HAG Zorginnovatieonderzoek, Other research (not in main researchprogram), HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Huisartsopleiding, Child Health, Infection & Immunity, JC Overig onderzoek, General Practice & Nursing Science, Erkelens, Daphne C, van Charldorp, Tessa C, Vinck, Vera V, Wouters, Loes T, Damoiseaux, Roger A, Rutten, Frans H, Zwart, Dorien L, de Groot, Esther, HAG Zorginnovatieonderzoek, Other research (not in main researchprogram), HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Huisartsopleiding, Child Health, Infection & Immunity, JC Overig onderzoek, General Practice & Nursing Science, Erkelens, Daphne C, van Charldorp, Tessa C, Vinck, Vera V, Wouters, Loes T, Damoiseaux, Roger A, Rutten, Frans H, Zwart, Dorien L, and de Groot, Esther

Published
2021

8. Een conversatieanalyse van triagegesprekken

Author

Vinck, Vera, de Groot, Esther, Wouters, Loes, Rutten, Frans, Damoiseaux, Roger, Charldorp, Tessa Cyrina, Zwart, Dorien, Vinck, Vera, de Groot, Esther, Wouters, Loes, Rutten, Frans, Damoiseaux, Roger, Charldorp, Tessa Cyrina, and Zwart, Dorien

Abstract

Inleiding Triagisten op huisartsenposten voeren triagegesprekken met behulp van de Nederlandse Triage Standaard (NTS), die hen helpt vast te stellen wat de medische urgentie van de hulpvraag van de beller is. In de praktijk heerst het idee dat de NTS over- en ondertriage in de hand werkt. Afhankelijk van de manier waarop de gebruiker met de NTS omgaat kan de vraagstellingstructuur leiden tot een defensieve urgentiebepaling of tot het missen van relevante informatie. Methode Conversatieanalyse is een methode waarmee vanuit talig perspectief de effectiviteit van triagegesprekken kan worden onderzocht. Uit deze vorm van analyse blijkt dat de veiligheid en doelmatigheid van triage niet alleen worden bepaald door de vragen die triagisten stellen, maar ook door de manier waarop zij dit doen en hoe deze vraagstelling van invloed is op de reactie van de beller. De NTS spoort triagisten aan om de beller voortdurend te vragen een keuze te maken tussen opties, waarbij de ene optie leidt tot een hogere urgentie dan de andere. Triagisten formuleren deze opties door middel van een ‘of-vraag’: ‘Is de pijn drukkend, of stekend, of heel scherp?’ Resultaten Uit de analyse blijkt dat bepaalde ‘of-vragen’ effectiever zijn dan andere. Een conversatieanalyse van de effectiviteit van de communicatie tijdens triagegesprekken levert kennis op waarmee we de kwaliteit van de triagegesprekken kunnen vergroten. Conclusie Op grond van ons onderzoek bevelen we triagisten aan aanvullende communicatietrainingen te volgen.

Published
2018

9. Een conversatieanalyse van triagegesprekken

Author

LS communicatie- en informatiewetenschap, ILS L&C, Vinck, Vera, de Groot, Esther, Wouters, Loes, Rutten, Frans, Damoiseaux, Roger, Charldorp, Tessa Cyrina, Zwart, Dorien, LS communicatie- en informatiewetenschap, ILS L&C, Vinck, Vera, de Groot, Esther, Wouters, Loes, Rutten, Frans, Damoiseaux, Roger, Charldorp, Tessa Cyrina, and Zwart, Dorien

Published
2018

10. Een conversatieanalyse van triagegesprekken

Author

Huisartsopleiding, HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Child Health, Infection & Immunity, JC Overig onderzoek, Other research (not in main researchprogram), General Practice & Nursing Science, Curr. Onderwijs Huisartsgeneeskunde, Vinck, Vera, de Groot, Esther, Wouters, Loes, Rutten, Frans, Damoiseaux, Roger, van Charldorp, Tessa, Zwart, Dorien, Huisartsopleiding, HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Child Health, Infection & Immunity, JC Overig onderzoek, Other research (not in main researchprogram), General Practice & Nursing Science, Curr. Onderwijs Huisartsgeneeskunde, Vinck, Vera, de Groot, Esther, Wouters, Loes, Rutten, Frans, Damoiseaux, Roger, van Charldorp, Tessa, and Zwart, Dorien

Published
2018

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