Telephone triage of shortness of breath

Abstract

Shortness of breath is a common reason for contacting out-of-hours primary care. Triage nurses use the Netherlands Triage Standard (NTS) to determine the urgency and type of medical care required. Our research indicates that the current triage process for patients with shortness of breath is neither sufficiently safe nor efficient. Almost half of patients with a potentially life-threatening condition are assigned a too low urgency, while around 40% of patients without such condition are given a higher urgency than necessary. We therefore developed a new prediction model to improve the triage process. This model consists of two patient characteristics (age and gender), two call characteristics (calling at night and someone else calling on behalf of the patient), and four symptoms (coughing, fever, difficulty speaking in full sentences, and wheezing). When implemented in the NTS algorithm, the model has the potential to substantially improve the triage of patients with shortness of breath. We also investigated how expressing concerns affects triage conversations. Concern can hinder efficient communication between triage nurses and patients, especially when concerns are not adequately addressed. The best approach is to acknowledge the patient’s concerns and then clearly outline the next steps in the triage process. Finally, a literature review highlighted the key role of language in triage conversations. Language involves more than just the literal content; how and when questions are asked is as important as what is asked. Furthermore, automated decision-support systems, widely used by triage nurses, significantly shape the dynamics and flow of these conversations.