J Telemed Telecare - Incident reporting in nurse-led national telephone triage in Sweden: the reported errors reveal a pattern that needs to be broken.

Tópicos

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Resumo

We conducted a retrospective study of incident reports concerning the national, nurse-led telephone triage system in Sweden. The Swedish Health Care Direct organization (SHD) is staffed by registered nurses who act as telenurses and triage the callers' need for care, using a computerized decision support system. Data were collected during 2007 from all county councils that participated in the SHD and were analysed using content analysis. Incident reports were then compared concerning differences in reported categories and who reported the errors. The 426 incident reports included 452 errors. Of the analysed incident reports, 41% concerned accessibility problems, 25% incorrect assessment, 15% routines/guidelines, 13% technical problems and 6% information and communication. The most frequent outgoing incident reports (i.e. sent from SHD to other health-care providers) concerned accessibility problems and the most frequently incoming reports (i.e. sent to SHD from other health-care providers) concerned incorrect assessment. There was a significant difference (P < 0.001) between outgoing and incoming reports regarding the main category. Telenurses have limited possibilities for referring the caller to their primary health-care provider or specialist, which may cause them to over-triage or under-triage the callers' need for care. This over-triage or under-triage may in turn cause other health-care providers to report incorrect assessment to SHD. The implications for practice are that poor accessibility is a matter that should be addressed and that the reasons for incorrect assessment should be explored.

Resumo Limpo

conduct retrospect studi incid report concern nation nursel telephon triag system sweden swedish health care direct organ shd staf regist nurs act telenurs triag caller need care use computer decis support system data collect counti council particip shd analys use content analysi incid report compar concern differ report categori report error incid report includ error analys incid report concern access problem incorrect assess routinesguidelin technic problem inform communic frequent outgo incid report ie sent shd healthcar provid concern access problem frequent incom report ie sent shd healthcar provid concern incorrect assess signific differ p outgo incom report regard main categori telenurs limit possibl refer caller primari healthcar provid specialist may caus overtriag undertriag caller need care overtriag undertriag may turn caus healthcar provid report incorrect assess shd implic practic poor access matter address reason incorrect assess explor

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