Safety of telephone triage in out-of-hours care: A systematic review
Safety of telephone triage in out-of-hours care: A systematic review
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DOI：
10.3109/02813432.2011.629150
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发表时间：
2011-12-01
影响因子：
2.1
通讯作者：
Wensing, Michel
中科院分区：
文献类型：
--
作者：
Huibers, Linda;Smits, Marleen;Wensing, Michel
Objective.电话分诊在病人请求帮助可能会危及病人的安全，特别是如果紧迫性被低估，病人没有看到医生。其目的是评估在非工作时间的初级保健电话分诊的安全性的研究证据。方法.对已发表的关于非工作时间护理中电话分诊的研究进行了系统综述，在PubMed和EMBASE中检索至2010年3月。如果研究涉及非工作时间的医疗护理，并侧重于第一次请求帮助的患者的电话分类，则纳入研究。研究纳入和数据提取由两名研究人员独立进行。区分了两种类型的事后研究：与真实的患者接触的观察性研究（紧急和高度紧急接触者），以及使用高风险模拟患者（具有高度紧急健康问题）的前瞻性观察性研究。结果13项观察性研究表明，平均97%（95% CI 96.5-97.4%）的所有接触非工作时间护理的患者和89%（95% CI 86.7-90.2%）的高度紧迫患者的分诊是安全的。10项使用高风险模拟患者的研究显示，平均46%（95% CI 42.7-49.8%）是安全的。研究中描述的不良事件包括死亡（n = 6项研究）、住院（n = 5）、急诊就诊（n = 1）和医疗差错（n = 6）。结论.对于出现高风险症状的患者，电话分诊的安全性仍有改进的余地。由于这些电话的发生率很低，因此识别这些电话对日常实践中的卫生保健提供者构成了挑战。
Objective. Telephone triage in patients requesting help may compromise patient safety, particularly if urgency is underestimated and the patient is not seen by a physician. The aim was to assess the research evidence on safety of telephone triage in out-of-hours primary care. Methods. A systematic review was performed of published research on telephone triage in out-of-hours care, searching in PubMed and EMBASE up to March 2010. Studies were included if they concerned out-of-hours medical care and focused on telephone triage in patients with a first request for help. Study inclusion and data extraction were performed by two researchers independently. Post-hoc two types of studies were distinguished: observational studies in contacts with real patients (unselected and highly urgent contacts), and prospective observational studies using high-risk simulated patients (with a highly urgent health problem). Results. Thirteen observational studies showed that on average triage was safe in 97% (95% CI 96.5-97.4%) of all patients contacting out-of-hours care and in 89% (95% CI 86.7-90.2%) of patients with high urgency. Ten studies that used high-risk simulated patients showed that on average 46% (95% CI 42.7-49.8%) were safe. Adverse events described in the studies included mortality (n = 6 studies), hospitalisations (n = 5), attendance at emergency department (n = 1), and medical errors (n = 6). Conclusions. There is room for improvement in safety of telephone triage in patients who present symptoms that are high risk. As these have a low incidence, recognition of these calls poses a challenge to health care providers in daily practice.